USE OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

Ljiljana Lazić

2011-06-01

Full Text Available Cerebral palsy has an incidence of about 1-2 per 1000 live births, and in spite of the progress of neonatal medicine, it seems that the incidence will not subside in the near future. The most important characteristic of cerebral palsy is movement abnormality: spasticity, chorea, athetosis, ataxia, dystonia, as well as their different combinations. About 70% of children who suffer from cerebral palsy also suffer from some form of spasticity. Spasticity is a type of muscle hypertonicity characterized by rapid increase in resistance to passive stretching of muscles. The interest for botulinum toxin application in the treatment of spasticity has dramatically increased in the last 10 years. Botulinum toxin is the most powerful neurotoxin that is found in nature. It is produced by anaerobic bacteria – clostridium botulinum. It is produced in eight serotypes of which type A is the most commonly used. Botulinum toxin blocks neuromuscular transmission and causes irreversible weakness of the treated muscle. It has been used since 1993 in the treatment of cerebral palsy in children. The toxin effect is permanent and it results in irreversible denervation. Functional recovery is possible after 2-4 months, due to sprouting of nerve endings and the formation of new synaptic contacts. Treatment with botulinum toxin is safe. Adverse effects are rare, temporary and completely reversible. Application of botulinum toxin prevents or reduces contractures and deformities, and thus delays or avoids surgical treatment. Yet, physical therapy, which prolongs and improves the effects of botulinum toxin, remains an essential and most important form of therapy in the treatment of children with cerebral palsy.

A COMPARATIVE STUDY ON EFFECTIVENESS OF OPEN VERSUS CLOSED KINETIC CHAIN EXERCISES TO IMPROVE GAIT IN SPASTIC DIPLEGIC CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

Trishna Saikia Baruah

2016-04-01

Full Text Available Background: Cerebral Palsy (CP describes a non- progressive but not unchanging disorder of movement and posture due to an insult to or anomaly of the developing brain. People with spastic diplegia typically walk slowly and have difficulties in performing activities such as walking running or jumping. Children with spastic diplegic cerebral palsy are relied more on cadence to increase speed. Hence, the purpose of this study is to compare the effectiveness of open and closed kinetic chain (OKC and CKC exercises in improving gait in spastic diplegic cerebral palsy. Methods: 30 children with spastic diplegic cerebral palsy of both genders with age 4-12 years was taken. Cadence and distance covered in 1Minute Walk Test was calculated before and after the test. The intervention for group A was CKC exercises and group B was OKC exercises for 3 days a week for 6 weeks and each session lasted for 30-45 minutes was given for both the groups. Results: Paired t-test was performed to find effectiveness of CKC and OKC improving gait in spastic diplegic CP to see the difference of means of 1minute walk, t = 10.789 which is significant (p = 0.000 and for cadence, t = 3.37 which is highly significant (p = 0.00 implying that cadence and distance covered in1minute walk was more with CKC exercises. Conclusion: Based on the result it is concluded that CKC exercises are effective in improving gait than OKC exercises in spastic diplegic cerebral palsy.

Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments

NARCIS (Netherlands)

Scholtes, Vanessa A. B.; Becher, Jules G.; Beelen, Anita; Lankhorst, Gustaaf J.

2006-01-01

This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase,

Effects of a Nintendo Wii exercise program on spasticity and static standing balance in spastic cerebral palsy.

Science.gov (United States)

Gatica-Rojas, Valeska; Cartes-Velásquez, Ricardo; Méndez-Rebolledo, Guillermo; Guzman-Muñoz, Eduardo; Lizama, L Eduardo Cofré

2017-08-01

This study sought to evaluate the effects of a Nintendo Wii Balance Board (NWBB) intervention on ankle spasticity and static standing balance in young people with spastic cerebral palsy (SCP). Ten children and adolescents (aged 72-204 months) with SCP participated in an exercise program with NWBB. The intervention lasted 6 weeks, 3 sessions per week, 25 minutes for each session. Ankle spasticity was assessed using the Modified Modified Ashworth Scale (MMAS), and static standing balance was quantified using posturographic measures (center-of-pressure [CoP] measures). Pre- and post-intervention measures were compared. Significant decreases of spasticity in the ankle plantar flexor muscles (p balance in young people with SCP.

Classification of Topographical Pattern of Spasticity in Cerebral Palsy: A Registry Perspective

Science.gov (United States)

Reid, Susan M.; Carlin, John B.; Reddihough, Dinah S.

2011-01-01

This study used data from a population-based cerebral palsy (CP) registry and systematic review to assess the amount of heterogeneity between registries in topographical patterns when dichotomised into unilateral (USCP) and bilateral spastic CP (BSCP), and whether the terms diplegia and quadriplegia provide useful additional epidemiological…

The effect of hippotherapy on gait in patients with spastic cerebral palsy

Directory of Open Access Journals (Sweden)

Veronika Fízková

2013-12-01

Full Text Available BACKGROUND: Disorders of motor skills, especially regarding gait, are prevalent in nearly all forms of cerebral palsy. Through a horse’s back movement, the patient is exposed to proprioceptive stimulation, thus improvement in gait performance could be expected. OBJECTIVE: The aim of our study was to determine the effect of hippotherapy on gait in patients with spastic cerebral palsy. METHODS: Eleven subjects (age 14.3 ± 4.8 years, height 148.2 ± 17.6 cm, weight 43.3 ± 20.2 kg with spastic cerebral palsy participated in the study. Gait assessment was performed before and after a weeklong stay. The hippotherapy was conducted daily. Kinematic data from three trials for each child was obtained using the Vicon MX system (seven infrared cameras, frequency 200 Hz. Comparison of ankle, knee, hip and pelvis movement before and after hippotherapy intervention was performed in Statistica (version 10.0 using the Wilcoxon test. To determine the effect size, Cohen’s d was used. RESULTS: After completing the short-term hippotherapy intervention, we observed a decrease in the second plantar flexion during initial swing (p < .05, decrease in knee flexion during the stance phase (p < .05, decrease in the hip range of motion in sagittal plane (p < .05 and decrease in the pelvic obliquity (p < .05. The effect size for all statistically significant differences was low. CONCLUSIONS: Hippotherapy combined with individually defined physiotherapy can lead to some changes in bipedal locomotion in terms of improvement and thus contribute to greater self-sufficiency, self-reliance and independence of patients with cerebral palsy.

Spasticity and Its Contribution to Hypertonia in Cerebral Palsy

Directory of Open Access Journals (Sweden)

Lynn Bar-On

2015-01-01

Full Text Available Spasticity is considered an important neural contributor to muscle hypertonia in children with cerebral palsy (CP. It is most often treated with antispasticity medication, such as Botulinum Toxin-A. However, treatment response is highly variable. Part of this variability may be due to the inability of clinical tests to differentiate between the neural (e.g., spasticity and nonneural (e.g., soft tissue properties contributions to hypertonia, leading to the terms “spasticity” and “hypertonia” often being used interchangeably. Recent advancements in instrumented spasticity assessments offer objective measurement methods for distinction and quantification of hypertonia components. These methods can be applied in clinical settings and their results used to fine-tune and improve treatment. We reviewed current advancements and new insights with respect to quantifying spasticity and its contribution to muscle hypertonia in children with CP. First, we revisit what is known about spasticity in children with CP, including the various definitions and its pathophysiology. Second, we summarize the state of the art on instrumented spasticity assessment in CP and review the parameters developed to quantify the neural and nonneural components of hypertonia. Lastly, the impact these quantitative parameters have on clinical decision-making is considered and recommendations for future clinical and research investigations are discussed.

Classification of upper limb disability levels of children with spastic unilateral cerebral palsy using K-means algorithm.

Science.gov (United States)

Raouafi, Sana; Achiche, Sofiane; Begon, Mickael; Sarcher, Aurélie; Raison, Maxime

2018-01-01

Treatment for cerebral palsy depends upon the severity of the child's condition and requires knowledge about upper limb disability. The aim of this study was to develop a systematic quantitative classification method of the upper limb disability levels for children with spastic unilateral cerebral palsy based on upper limb movements and muscle activation. Thirteen children with spastic unilateral cerebral palsy and six typically developing children participated in this study. Patients were matched on age and manual ability classification system levels I to III. Twenty-three kinematic and electromyographic variables were collected from two tasks. Discriminative analysis and K-means clustering algorithm were applied using 23 kinematic and EMG variables of each participant. Among the 23 kinematic and electromyographic variables, only two variables containing the most relevant information for the prediction of the four levels of severity of spastic unilateral cerebral palsy, which are fixed by manual ability classification system, were identified by discriminant analysis: (1) the Falconer index (CAI E ) which represents the ratio of biceps to triceps brachii activity during extension and (2) the maximal angle extension (θ Extension,max ). A good correlation (Kendall Rank correlation coefficient = -0.53, p = 0.01) was found between levels fixed by manual ability classification system and the obtained classes. These findings suggest that the cost and effort needed to assess and characterize the disability level of a child can be further reduced.

CT findings in patients with cerebral palsy

International Nuclear Information System (INIS)

Konno, Kimiichi

1982-01-01

Clinical findings and CT findings in 73 cases of cerebral palsy were studied. The causes of cerebral palsy were presumed to be as follows: abnormal cerebral development (36%), asphyxial delivery (34%), and immature delivery (19%), etc. CT findings were abnormal in 58% of the 73 cases, 83% of the spastic tetraplegia patients and all of the spastic hemiplegia patients showed abnormal CT findings. All the patients with spastic monoplegia presented normal CT findings. In 75% of the spastic hemiplegia cases, the CT abnormalities were due to cerebral parenchymal abnormality such as porencephaly and regional low absorption. In cases of spastic tetraplegia, cerebral parenchymal abnormality was found only in 10%. Cortical atrophy was found only in 15 of the 73 cases, whereas central atrophy was found in 36 cases. (Ueda, J.)

Swedish Massage and Abnormal Reflexes of Children with Spastic Cerebral Palsy

Directory of Open Access Journals (Sweden)

Vida Alizad

2007-09-01

Full Text Available Objectives: Massage therapy is one of the most widely used complementary and alternative medicine therapies for children. This study was conducted to determine the effect of wedish massage on abnormal reflexes in children with spastic cerebral palsy (CP. Methods: This study was a single blind clinical trial conducted on forty children with spastic CP who were recruited from clinics of the University of Social Welfare & Rehabilitation Sciences. They were randomly assigned to intervention and control groups. The routine occupational therapy (OT techniques were performed during a 3 month-period in both groups. The intervention group also received Swedish massage for 30 minutes before every OT session. Primary, spinal, brain stem, midbrain, cortical and automatic reflexes were evaluated at the beginning of the study and 3 months later. The data analysis was done by parametric and nonparametric tests. Results: Finally, thirteen subjects in the intervention group and 14 subjects in the control group were remained and studied. The average ages in the intervention and control groups were 49.5 and 42.1 months respectively. There were no statistically significant differences in abnormal reflexes in the intervention group in comparison to the control (P>0.05. Discussion: Adding Swedish massage to traditional OT techniques had no significant effects on abnormal reflexes in children with spastic cerebral palsy. Evidently more research is required in order to completely reject the effects of Swedish massage on abnormal reflexes of children with CP.

Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review.

Science.gov (United States)

Moll, Irene; Vles, Johannes S H; Soudant, Dan L H M; Witlox, Adhiambo M A; Staal, Heleen M; Speth, Lucianne A W M; Janssen-Potten, Yvonne J M; Coenen, Marcel; Koudijs, Suzanne M; Vermeulen, R Jeroen

2017-12-01

To assess the effect of functional electrical stimulation (FES) of ankle dorsiflexors in children and adolescents with spastic cerebral palsy (CP) during walking. A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched for studies applying interventions to patients aged younger than 20 years. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). Seven hundred and eighty abstracts were found, 35 articles were fully screened, and 14 articles were used for analysis. Only five articles (three studies) were of level I to III evidence. At ICF participation and activity level, there is limited evidence for a decrease in self-reported frequency of toe-drag and falls. At ICF body structure and function level, there is clear evidence (I-III) that FES increased (active) ankle dorsiflexion angle, strength, and improved selective motor control, balance, and gait kinematics, but decreased walking speed. Adverse events include skin irritation, toleration, and acceptation issues. There are insufficient data supporting functional gain by FES on activity and participation level. However, evidence points towards a role for FES as an alternative to orthoses in children with spastic CP. Effects of functional electrical stimulation (FES) point towards a potential role as an alternative to orthoses for patients with spastic cerebral palsy (CP). Some evidence for a decrease in self-reported frequency of toe-drag and falls with the use of FES in spastic CP. Limited evidence for improvements in activity and participation in patients with spastic CP using FES. © 2017 Mac Keith Press.

Reproducibility and validity of video screen measurements of gait in children with spastic cerebral palsy.

NARCIS (Netherlands)

Grunt, S.; van Kampen, P.M.; van der Krogt, M.M.; Brehm, M.A.; Doorenbosch, C.A.M.; Becher, J.G.

2010-01-01

Purpose: To determine the reproducibility and validity of video screen measurement (VSM) of sagittal plane joint angles during gait. Methods: 17 children with spastic cerebral palsy walked on a 10. m walkway. Videos were recorded and 3d-instrumented gait analysis was performed. Two investigators

Reproducibility and validity of video screen measurements of gait in children with spastic cerebral palsy

NARCIS (Netherlands)

Grunt, Sebastian; van Kampen, Petra J.; van der Krogt, Marjolein M.; Brehm, Merel-Anne; Doorenbosch, Caroline A. M.; Becher, Jules G.

2010-01-01

PURPOSE: To determine the reproducibility and validity of video screen measurement (VSM) of sagittal plane joint angles during gait. METHODS: 17 children with spastic cerebral palsy walked on a 10m walkway. Videos were recorded and 3d-instrumented gait analysis was performed. Two investigators

Best seating condition in children with spastic cerebral palsy : One type does not fit all

NARCIS (Netherlands)

Angsupaisal, Mattana; Dijkstra, Linze-Jaap; la Bastide-van Gemert, Sacha; van Hoorn, Jessika F.; Burger, Karine; Maathuis, Carel G. B.; Hadders-Algra, Mijna

2017-01-01

Background: The effect of forward-tilting of the seat surface and foot-support in children with spastic cerebral palsy (CP) is debated. Aim: To assess the effect of forward-tilting of the seat surface and foot-support in children with CP on kinematic head stability and reaching. Methods: Nineteen

Clinical and neuroimaging profile of congenital brain malformations in children with spastic cerebral palsy

International Nuclear Information System (INIS)

Kulak, W.; Okurowska-Zawada, B.; Sobaniec, W.; Goscik, M.; Olenski, J.

2008-01-01

Purpose: Analysis of the incidence of congenital brain malformations in children with spastic cerebral palsy (CP) in a hospital based study. Material and Methods: The present study included 74 boys and 56 girls with spastic tetraplegia, diplegia, and hemiplegia CP. Magnetic resonance imaging MRI findings were analyzed in children with CP. Results: Significant abnormalities relevant to the CP were evident on MRI in 124 (95.3%) subjects. Periventicular leukomalacia (PVL) was detected more frequently in children with spastic diplegia than in patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 15 (10.7%) children with spastic CP. Brain malformations included: schizencephaly (5), agenesis corpus callosum (4), polymicrogyria (2), holoprosencephaly (2) and lissencephaly (2). Intractable epilepsy and mental retardation were observed more often in children with brain anomalies. Twelve patients with congenital brain malformations were born at term and three born at preterm. Conclusions: Neuroimaging results in children with CP may help determine the etiology and make better prognosis of CP. (authors)

Experience of using hippotherapy in complex effects on muscle spirals in children with spastic forms of cerebral palsy.

Science.gov (United States)

Strashko, Evhen Y; Kapustianska, Аnna A; Bobyreva, Lyudmyla E

Matters of physical and medical rehabilitation of children with organic lesions of the nervous system, in particular, with cerebral palsy, are actual in countries around the world. Hippotherapy is neurophysiologically oriented therapy using horses. Determine whether a combination of hippotherapy as a method of rehabilitation in the aftermath of outpatient comprehensive impact on MS on a stationary phase; Study of the effect of hippotherapy as securing and preparation method for learning new postures and movements in children with spastic cerebral palsy forms; The study of the possible optimization of psychophysical state, activation motivations of patients; Determination of the optimal timing of hippotherapy sessions, the number of procedures, the study of possible fatigue factor children. HT classes were conducted at the Ippotsentra "Wind of Change" in the period 2010-2013 the main group of children surveyed (36 people) with spastic forms of cerebral palsy. HT procedure took place twice a day - morning and evening - 30 minutes during 10-12 days. Thus, the proposed integration of the HT program of complex effects on muscle spirals children with spastic cerebral palsy forms is physiologically and anthropologically based on 4-5 day training children adequately transferred the full amount of lessons learned new postures and movements, HT does not cause complications in the somatic and psycho-emotional state of the children, HT enables sensorimotor and psychomotor effects, save and normalize muscle tone for a longer period (up to three months), compared with traditional methods of physiotherapy. HT can serve as a method of learning a new "postures and movements", the preparation of the locomotor apparatus to learn walking.

The effect of Sub-maximal exercise-rehabilitation program on cardio-respiratory endurance indexes and oxygen pulse in patients with spastic cerebral palsy

Directory of Open Access Journals (Sweden)

M Izadi

2006-05-01

Full Text Available Background: Physical or cardio-respiratory fitness are of the best important physiological variables in children with cerebral palsy (CP, but the researches on exercise response of individuals with CP are limited. Our aim was to determine the effect of sub-maximal rehabilitation program (aerobic exercise on maximal oxygen uptake, oxygen pulse and cardio- respiratory physiological variables of children with moderate to severe spastic cerebral palsy diplegia and compare with able-bodied children. Methods: In a controlled clinical trial study, 15 children with diplegia spastic cerebral palsy, were recruited on a voluntarily basis (experimental group and 18 subjects without neurological impairments selected as control group. In CP group, aerobic exercise program performed on the average of exercise intensity (144 beat per minute of heart rate, 3 times a week for 3 months. The time of each exercise session was 20-25 minutes. Dependent variables were measured in before (pretest and after (post test of rehabilitation program through Mac Master Protocol on Tantories cycle ergometer in CP group and compared with the control group. Results: The oxygen pulse (VO2/HR during ergometery protocol was significantly lower in CP group than normal group (P<0.05. No significant statistical difference in maximal oxygen uptake (VO2 max was found between groups. The rehabilitation program leads to little increase of this variable in CP group. After sub-maximal exercise in pretest and post test, the heart rate of patient group was greater than control group, and aerobic exercise leads to significant decrease in heart rate in CP patients(P<0.05. Conclusion: The patients with spastic cerebral palsy, because of high muscle tone, severe spasticity and involuntarily movements have higher energy cost and lower aerobic fitness than normal people. The rehabilitation exercise program can improve physiological function of muscle and cardio-respiratory endurance in these

Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study.

Science.gov (United States)

Schasfoort, Fabienne; Dallmeijer, Annet; Pangalila, Robert; Catsman, Coriene; Stam, Henk; Becher, Jules; Steyerberg, Ewout; Polinder, Suzanne; Bussmann, Johannes

2018-01-10

Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. Children with spastic cerebral palsy, age range 4-12 years, cerebral palsy-severity Gross Motor Function Classification System levels I-III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross

The Role of Exercise – Rehabilitation on Energy Cost and Metabolic Efficiency in Dipelegic Spastic Cerebral Palsy Children

Directory of Open Access Journals (Sweden)

M. Izadi

2005-07-01

Full Text Available Introduction & Objective: The aim of this study was to compare the resting energy expenditure and metabolic efficiency before and after of aerobic exercise in spastic cerebral palsy children (mean age of 11 years and also to compare with those of normal children. Materials & Methods : Fifteen dipelegia spastic cerebral palsy children (experimental group participated in exercise–rehabilitation program by voluntarily and the peers eighteen able body children(control group were selected randomly. The experimental group(cp performed rehabilitation program for 3 months,3 session in week with work intensity(%HRR=462.5equal to144bpm of heart rate. The values were measured on tantory cycle ergometer according to Macmaster protocol.Results: Rest and exercise heart rate and exercise intensity(%HRR in patients decreased after rehabilitation program(P<0.05. The resting energy expenditure was similar in cp and normal groups. The rate of oxygen cost of patients decreased in post test(P<0.05 that showed increasing in metabolic efficiency.Conclusion: cerebral palsy children have greater exercise energy cost and lower cardiovascular fitness than normal children and exercise–rehabilitation leads to enhance of metabolic efficiency in this patients that is remarkable from clinical perception.

Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia.

Science.gov (United States)

Çifter, Muhsin; Cura, Nil

2016-10-01

This report describes the clinical orthodontic management of a patient with spastic quadriplegia and cerebral palsy. Guidelines to overcome difficulties encountered during the treatment period are suggested. A 13-year-old boy with cerebral palsy and spastic quadriplegia complained of an undesirable oral appearance because of his malocclusion. He had a Class II molar relationship, with severe maxillary and moderate mandibular anterior crowding. Enamel hypoplasia was apparent on all teeth. He had losses of body function and upper extremity function of 70% and 39%, respectively. His physical limitations necessitated a treatment approach that did not rely on patient-dependent appliances. The treatment plan called for maxillary first premolar extractions, mandibular incisor protrusion, and air rotor stripping. The patient's oral function and esthetic appearance were significantly improved. Aligned dental arches with good occlusion were obtained. The patient's self-confidence improved during the treatment period. Physical appearance can influence personality and social acceptability. Corrective orthodontic treatment for patients with physical handicaps can improve not only oral function, but also self-confidence and self-esteem. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Research on the performance of the spastic calf muscle of young adults with cerebral palsy.

Science.gov (United States)

Lampe, Renee; Mitternacht, Jurgen

2011-02-12

The aim of this study was to find an objective graduation of pes equinus in infantile cerebral palsy, especially with regard to functional aspects, to allow a differentiated choice of the therapeutic options. Very often raises the question of whether a surgical lengthening of the Achilles tendon may let expect a functional improvement. For this documentation 17 patients with pes equinus and a diagnosis of spastic cerebral palsy, primarily of the lower limbs, and hemiplegia were examined first clinically and then by a procedure for calculating the functional kinetic parameters from an in-shoe plantar pressure distribution measurement (novel pedar-X system), which is used in many orthopedic practices and clinics as a standard measuring device. Using additional video motion analysis, the flexion in the ankle joint and the ankle joint torque were determined. From this the physical performance of the spastically shortened calf muscle was calculated. The course of the curves of torque and joint performance allows a functional classification of the pes equinus. Approximately three quarters of all pes equinus demonstrated functional activity of the most part of the normal push-off propulsion power. Even the rigid pes equinus was capable of performing push-off propulsion work, provided it converted energy that was absorbed during the heel-strike phase and released it again during the push-off phase. This suggests that the function of paretic ankle joint is better than its kinematics of motion. A heel strike with a pes equinus triggers via stretching stimuli in the muscle-ligament structure reflex motor functions, thereby causing the typical spastic gait pattern. This remarkable gait pattern is often evaluated as dysfunctional and as absolutely requiring correction. However, an aspect possibly neglected in this instance is the fact that this gait pattern may be efficient for the patient and may in fact be a suitable means allowing for economic locomotion despite the cerebral

Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy.

Science.gov (United States)

Rushton, Paul R P; Nasto, Luigi A; Aujla, Ranjit K; Ammar, Amr; Grevitt, Michael P; Vloeberghs, Michael H

2017-06-01

To compare scoliosis progression in quadriplegic spastic cerebral palsy with and without intrathecal baclofen (ITB) pumps. A retrospective matched cohort study was conducted. Patients with quadriplegic spastic cerebral palsy, GMFCS level 5, treated with ITB pumps with follow-up >1 year were matched to comparable cases by age and baseline Cobb angle without ITB pumps. Annual and peak coronal curve progression, pelvic obliquity progression and need for spinal fusion were compared. ITB group: 25 patients (9 female), mean age at pump insertion 9.4 and Risser 0.9. Initial Cobb angle 25.6° and pelvic tilt 3.2°. Follow-up 4.3 (1.0-7.8) years. Cobb angle at follow-up 76.1° and pelvic tilt 18.9°. Non-ITB group: 25 patients (14 female), mean age at baseline 9.2 and Risser 1.0. Initial Cobb angle 29.7° and pelvic tilt 7.1°. Follow-up 3.5 (1.0-7.5) years. Cobb angle at follow-up 69.1° and pelvic tilt 21.0°. The two groups were statistically similar for baseline age, Cobb angle and Risser grade. Mean curve progression was 13.6°/year for the ITB group vs 12.6°/year for the non-ITB group (p = 0.39). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable; ITB group 4.5°/year vs non-ITB 4.6°/year (p = 0.97). During follow-up 5 patients in the ITB group and 9 in the non-ITB group required spinal fusion surgery for curve progression (p = 0.35). Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population.

The Effect of Resistance Training on Performance of Gross Motor Skills and Balance in Children with Spastic Cerebral Palsy

OpenAIRE

Ebrahim Zarrinkalam; Majid Ebadi Fara

2016-01-01

Objective: Cerebral palsy is the most common chronic motor disability in children and can have negative effect on motor functions. The purpose of this study was to investigate the effect of eight weeks resistance training on gross motor ability, balance and walking speed in a group of such children. Methods: 21 cerebral palsy boys with spastic diplegia, aged between 12 and 16 years (mean, 13.66 years), participated in this study. A pre-test, involving walking, sitting, standing and walkin...

Effects of strength training program on hip extensors and knee extensors strength of lower limb in children with spastic diplegic cerebral palsy.

Science.gov (United States)

Aye, Thanda; Thein, Soe; Hlaing, Thaingi

2016-01-01

[Purpose] The purpose of this study was to determine whether strength training programs for hip extensors and knee extensors improve gross motor function of children with cerebral palsy in Myanmar. [Subjects and Methods] Forty children (25 boys and 15 girls, mean age: 6.07 ± 2.74 years) from National Rehabilitation Hospital, Yangon, Myanmar, who had been diagnosed with spastic diplegic cerebral palsy, Gross Motor Classification System I and II participated in a 6-week strength training program (45 minutes per day, 3 days per week) on hip and knee extensors. Assessment was made, before and after intervention, of the amount of training weight in pounds, as well as Gross Motor Function Measure (GMFM) dimensions D (standing) and E (walking, running, jumping). [Results] All scores had increased significantly after the strength-training program. [Conclusion] A simple method of strength-training program for hip and knee extensors might lead to improved muscle strength and gross motor function in children with spastic diplegic cerebral palsy.

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy

OpenAIRE

Park, Myoung-Ok

2017-01-01

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification S...

Cerebral Palsy: Still A Social Problem

Directory of Open Access Journals (Sweden)

Angom Bisharda

1997-08-01

Full Text Available Research Problem: What arc the social aspects of cerebral palsy?Objective: To determine the extent and severity of neuromuscular involvement in cases of cerebral palsy and to find out the associated defects among these children.Study Design: Cross sectional study.Setting: Tertiary care hospital, outdoor patients.Participants: Children in the age group of 0 - 12 years.Sample Size: 120 children suffering from cerebral palsy.Study Variables: Social factors, neuromuscular involvement.Statistical Analysis: By proportionsResult: Out of 120 cases, maximum number of cases (66.6% were in the age group of 1- 4 years. 83 cases ( 69.16% were males. Among the various types, spastic type was the commonest (87.5%. Of these spastic cases, 52 (49.52% had quadriplegia. No case of tremor and rigidity was seen. Delayed milestones was the commonest associated disorder, seen in 107 (89.16% cases, followed by speech defect in 58(48.3% cases, visual defect in 34(28.3% cases and convulsions in 24 (20.0% cases. Hearing defect was seen in 5 cases (4.16% only.Conclusion: More concerted efforts arc required to identify children with cerebral palsy and rehabilitate them for the betterment of society.

Cerebral Palsy: Still A Social Problem

Directory of Open Access Journals (Sweden)

Angom Bisharda

1997-08-01

Full Text Available Research Problem: What arc the social aspects of cerebral palsy? Objective: To determine the extent and severity of neuromuscular involvement in cases of cerebral palsy and to find out the associated defects among these children. Study Design: Cross sectional study. Setting: Tertiary care hospital, outdoor patients. Participants: Children in the age group of 0 - 12 years. Sample Size: 120 children suffering from cerebral palsy. Study Variables: Social factors, neuromuscular involvement. Statistical Analysis: By proportions Result: Out of 120 cases, maximum number of cases (66.6% were in the age group of 1- 4 years. 83 cases ( 69.16% were males. Among the various types, spastic type was the commonest (87.5%. Of these spastic cases, 52 (49.52% had quadriplegia. No case of tremor and rigidity was seen. Delayed milestones was the commonest associated disorder, seen in 107 (89.16% cases, followed by speech defect in 58(48.3% cases, visual defect in 34(28.3% cases and convulsions in 24 (20.0% cases. Hearing defect was seen in 5 cases (4.16% only. Conclusion: More concerted efforts arc required to identify children with cerebral palsy and rehabilitate them for the betterment of society.

NEYROPSYCHOLOGICAL CONSECUENCES OF CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

ANA MARÍA NAVARRO MELENDRO

2005-01-01

Full Text Available Cerebral Palsy is defined as a movement alteration result of a non progressive damage witch is permanent in anencephalon that has not acquired its final maturation. Patients that suffer cerebral palsy present learning disabilities,that varies between being completely normal to severe as a consequence of memory, gnosis, praxis, perceptive andlanguage impairments. Nevertheless the consequences of this disease are not always predictable. This paper pretendsto make a description of the cognitive and behavioral deficits that overcomes along with the manifestation of thecerebral palsy and its possible treatment. We used a complete neuropsychological battery to evaluate a 7 years oldpatient who was diagnosed of cerebral palsy and spastic diplegia finding some cognitive impairment in fields such asmnesic, gnosic and attention processes.

Teeth grinding, oral motor performance and maximal bite force in cerebral palsy children.

Science.gov (United States)

Botti Rodrigues Santos, Maria Teresa; Duarte Ferreira, Maria Cristina; de Oliveira Guaré, Renata; Guimarães, Antonio Sergio; Lira Ortega, Adriana

2015-01-01

Identify whether the degree of oral motor performance is related to the presence of teeth grinding and maximal bite force values in children with spastic cerebral palsy. Ninety-five spastic cerebral palsy children with and without teeth grinding, according to caregivers' reports, were submitted to a comprehensive oral motor performance evaluation during the feeding process using the Oral Motor Assessment Scale. Maximal bite force was measured using an electronic gnathodynamometer. The teeth grinding group (n = 42) was younger, used anticonvulsant drugs, and was more frequently classified within the subfunctional oral motor performance category. Teeth grinding subfunctional spastic cerebral palsy children presented lower values of maximal bite force. The functional groups showing the presence or absence of teeth grinding presented higher values of maximal bite force compared with the subfunctional groups. In spastic cerebral palsy children, teeth grinding is associated with the worse oral motor performance. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

[Effects of acupuncture on quality of life in children with spastic cerebral palsy].

Science.gov (United States)

Liu, Zhen-huan; Pan, Pei-guang; Ma, Mei-mei

2007-03-01

To investigate the effect of acupuncture in children with spastic cerebral palsy (SCP). One hundred SCP children, 2 to 7 years old, were randomly assigned to two groups equally. The control group was treated with rehabilitation training using Bobath and Vojta physical training methods and the acupuncture group treated also with the same training but with acupuncture conducted additionally. The therapeutic course was 3-12 months arranged according to the state of illness. The total effective rate, development quotient (DQ), improvement rate of brain hypogenesis and atrophy showed by skull CT, and recovery rate of cerebral emission computed tomography (ECT) were all higher in the acupuncture group than those in the control group (all P cerebral function and shows a favorable effect in improving quality of life of the children with SCP.

Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study

NARCIS (Netherlands)

F.C. Schasfoort (Fabiënne); A.J. Dallmeijer (Annet); R.F. Pangalila (Robert); C. Catsman (Coriene); H.J. Stam (Henk); J.G. Becher (Jules); E.W. Steyerberg (Ewout W.); S. Polinder (Suzanne); J.B.J. Bussmann (Hans); H.L.D. Horemans (Herwin); E.M. Sneekes (E.); Bolster, E. (Eline); Viola, I. (Irma); Beek, K. (Karlijn) van; J.M.A. Verheijden (Johannes)

2018-01-01

textabstractObjective: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. Design: A pragmatically designed, multi-centre trial, comparing the effectiveness of

Changes in Muscle Activation Following Ankle Strength Training in Children with Spastic Cerebral Palsy: An Electromyography Feasibility Case Report

Science.gov (United States)

Olsen, Jamie E.; Ross, Sandy A.; Foreman, Matthew H.; Engsberg, Jack R.

2013-01-01

Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No…

Botulinum toxin type A chemodenervation treatment in spastic forms of cerebral palsy

Directory of Open Access Journals (Sweden)

A. L. Kurenkov

2013-01-01

Full Text Available Cerebral palsy (CP is one of the most serious outcomes of the perinatal lesion of central nervous system and the most common reason for neurological disability in children. Being the key cause of pathological dynamic stereotypes that frequently result in pathological posture and contractures, spasticity is critically important for CP. The use of botulinum toxin type A (BTA in complex treatment 2-6 years old CP patients allows significantly to improve motor abilities, help to change the surgical procedure, delay or even avoid some types of surgery. For elder children the use of BTA allows to improve local motor impairment. The treatment of spasticity in CP with BTA is safe (evidence level A and highly effective (evidence level A. It leads to the positive change of pathological dynamic stereotype, significantly improves gait, decreases muscle tone with Ashworth and Tardeu scales and rises the gross motor function score. Our own experience of onabotulinumtoxinA treatment as a part of complex therapy in 68 patients with spastic forms of CP demonstrates the significant improvement of motor function, most noticeable in younger patients(early pre-school age with GMFS I-III.

Effect of Adding Swedish Massage to Occupational Therapy on Muscle Tone of Spastic Cerebral Palsied Children

Directory of Open Access Journals (Sweden)

Firouzeh Sajedi

2007-10-01

Full Text Available Objective: Cerebral palsy is a nonprogressive disorder in body posture and movement, due to different etiologies. Different medical and rehabilitation interventions include massage have been used in these children. This study has been done to determine the effect of adding massage to occupational therapy on muscle tone of children with spastic cerebral palsy. Materials & Methods: This study was a double blind clinical trial. The children were recruited from clinics of University of Welfare & Rehabilitation Sciences. The individuals were divided to intervention and control groups. The routine rehabilitation techniques were done in 3 months in both groups. The intervention group received massage for 30 minutes before rehabilitation. Muscle tonicity was evaluated at the beginning of the study and 3 months later by Ashworth test. The data analysis was done by parametric (t test, paired t test and nonparametric (Mann Whitney, Wilcoxon tests. Results: Thirteen subjects of case (intervention group and 14 subjects of control group were studied. The average age in case group and control group was 49.5, and 42.1 months respectively. There were no statistically significant differences in Tonicity of upper and lower limbs, trunk and neck between intervention group and control group (P>0/05. Conclusion: In general based on the results of this study, adding massage to occupational therapy had no effect on tonicity of spastic cerebral palsied children. Regarding to some effects of massage mentioned in different articles on physical abilities of children with C.P. as well as executive limitations in this research, it is not possible to reject the effects of homeopathy on physical abilities of children with C.P.

Phonologically based assessment and intervention in Spastic Cerebral Palsy: A case analysis

Directory of Open Access Journals (Sweden)

Michael A. Crary

1981-11-01

Full Text Available The articulation errors of one adult subject demonstrating a spastic variety of congenital cerebral palsy were evaluated via a phonological process analysis. This analysis indicated that a stopping process (replacement of fricatives with homorganic stops was the most detrimental to the subject's, intelligibility. Subsequent to this analysis a phonemic contrasting programme was initiated toward the goal of minimizing the influence of the stopping process. Results of  spontaneous speech sample analyses indicated that this approach was successful in increasing the percentage of correctly produced fricative patterns. Success in this case suggests the applicability of  a linguistically based intervention approach in structural/functional disturbances of speech articulation.

Ocular disorders in children with spastic subtype of cerebral palsy.

Science.gov (United States)

Ozturk, A Taylan; Berk, A Tulin; Yaman, Aylin

2013-01-01

To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP) and to find out whether any correlation exists between their occurance and etiologic factors. Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student's t tests were used in the statistical analysis. The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4%) and tetraplegia (36.1%) were found to be higher than the frequency of hemiplegia (16.5%) in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000). Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6%) had nystagmus and 107 children (55.2%) had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively). Abnormal morphology of the optic disc was present in 152 eyes (39.2%). Severe periventricular leukomalacia (PVL) was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000). Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.

Botulinum toxin treatment for limb spasticity in childhood cerebral palsy

Directory of Open Access Journals (Sweden)

Vito ePavone

2016-02-01

Full Text Available CP is the most common cause of chronic disability in childhood occurring in 2 to 2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects and possible resistance as well as specific use in the upper and lower limbs muscles

[Functional electric stimulation (FES) in cerebral palsy].

Science.gov (United States)

Miyazaki, M H; Lourenção, M I; Ribeiro Sobrinho, J B; Battistella, L R

1992-01-01

Our study concerns a patient with cerebral palsy, submitted to conventional occupational therapy and functional electrical stimulation. The results as to manual ability, spasticity, sensibility and synkinesis were satisfactory.

The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy

NARCIS (Netherlands)

Jelsma, Jennifer; Pronk, Marieke; Ferguson, Gillian; Jelsma-Smit, Dorothee

2013-01-01

Objective: To study the impact of training using the Nintendo Wii Fit in 14 children with spastic hemiplegic cerebral palsy. Methods: A single-subject single blinded design with multiple subjects and baselines was utilised. Interactive video gaming (IVG) in lieu of regular physiotherapy was given

Classification of topographical pattern of spasticity in cerebral palsy: a registry perspective.

Science.gov (United States)

Reid, Susan M; Carlin, John B; Reddihough, Dinah S

2011-01-01

This study used data from a population-based cerebral palsy (CP) registry and systematic review to assess the amount of heterogeneity between registries in topographical patterns when dichotomised into unilateral (USCP) and bilateral spastic CP (BSCP), and whether the terms diplegia and quadriplegia provide useful additional epidemiological information. From the Victorian CP Register, 2956 individuals (1658 males, 1298 females), born 1970-2003, with spastic CP were identified. The proportions with each topographical pattern were analysed overall and by gestational age. Binary logistic regression analysis was used to assess temporal trends. For the review, data were systematically collected on topographical patterns from 27 registries. Estimates of heterogeneity were obtained, overall and by region, reporting period and definition of quadriplegia. Among individuals born <32 weeks, 48% had diplegia, whereas the proportion for children born ≥ 32 weeks was 24% (p < 0.001). Evidence was weak for a temporal trend in the relative proportions of USCP and BSCP (p = 0.038), but much clearer for an increase in the proportion of spastic diplegia relative to quadriplegia (p < 0.001). The review revealed wide variations across studies in the proportion of diplegia (range 34-90%) and BSCP (range 51-86%). These findings argue against a topographical classification based solely on laterality. Copyright © 2011 Elsevier Ltd. All rights reserved.

Assessment of bone density in patients with scoliosis neuromuscular secondary to cerebral palsy

Directory of Open Access Journals (Sweden)

Charbel Jacob Júnior

2014-09-01

Full Text Available OBJECTIVE: To evaluate bone mineral density in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy. METHODS: A prospective descriptive study in which, in addition to bone densitometry, the anthropometric data of the patients were assessed. As inclusion criterion we adopted patients with spastic quadriplegic cerebral palsy, wheelchair users, aged between 10 and 20 years and with neuromuscular scoliosis. RESULTS: We evaluated 31 patients, 20 female, whose average age was 14.2 years. The mean bone density was -3.2 standard deviation (Z-score, with mean biceps circumference of 19.4 cm, calf circumference 18.6 cm and BMI of 13.6 kg/m². CONCLUSION: There is a high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy.

Ocular disorders in children with spastic subtype of cerebral palsy

Directory of Open Access Journals (Sweden)

Aylin Yaman

2013-04-01

Full Text Available AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP and to find out whether any correlation exists between their occurance and etiologic factors. METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student’s t tests were used in the statistical analysis. RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4% and tetraplegia (36.1% were found to be higher than the frequency of hemiplegia (16.5% in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000. Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6% had nystagmus and 107 children (55.2% had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively. Abnormal morphology of the optic disc was present in 152 eyes (39.2%. Severe periventricular leukomalacia (PVL was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000. CONCLUSION: Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.

Comparison of Tc-99m ECD brain SPECT between patients with delayed development and cerebral palsy

International Nuclear Information System (INIS)

Cho, I.; Chun, K.; Won, K.; Lee, H.; Jang, S.; Lee, J.

2002-01-01

Purpose: In previous study, thalamic or cerebellar hypoperfusion were reported in patients with cerebral palsy. This study was performed to evaluate cerebral perfusion abnormalities using Tc-99m ECD brain SPECT in patients with delayed motor development. Methods: Nineteen patients (9 boys, 10 girls, mean age 25.5 months) with delayed development underwent brain SPECT after injection of 185∼370 MBq of Tc-99m ECD. The imaging was obtained between 30 minutes and 1hr after injection. The patients were divided clinically as follows, patients with delayed development (n=5) and patients with cerebral palsy (n=14) who has delayed development and abnormal movement. The clinical subtypes of cerebral palsy were spastic quadriplegia (n=5), spastic diplegia (n=6) and spastic hemiplegia (n=3). In each group, decrease of cerebral perfusion was evaluated visually as mild, moderate and severe and quantitation of cerebral perfusion after Lassen's correction was also obtained. Results: SPECT findings showed normal or mildly decreased thalamic perfusion in patients with delayed development and severe decrease of thalamic or cerebellar perfusion in patients with spastic quadriplegia. In patients with spastic diplegia, mild decrease of perfusion was observed in thalamus. In quantified data, thalamic perfusion was lowest in patients with spastic quadriplegia and highest in patients with delayed development, but there were no statistically significant differences. Conclusion: Brain SPECT with Tc-99m ECD has a role in the detection of perfusion abnormalities in patients with delayed development and cerebral palsy

Brain State Before Error Making in Young Patients With Mild Spastic Cerebral Palsy.

Science.gov (United States)

Hakkarainen, Elina; Pirilä, Silja; Kaartinen, Jukka; van der Meere, Jaap J

2015-10-01

In the present experiment, children with mild spastic cerebral palsy and a control group carried out a memory recognition task. The key question was if errors of the patient group are foreshadowed by attention lapses, by weak motor preparation, or by both. Reaction times together with event-related potentials associated with motor preparation (frontal late contingent negative variation), attention (parietal P300), and response evaluation (parietal error-preceding positivity) were investigated in instances where 3 subsequent correct trials preceded an error. The findings indicated that error responses of the patient group are foreshadowed by weak motor preparation in correct trials directly preceding an error. © The Author(s) 2015.

Maternal thyroid disorder in pregnancy and risk of cerebral palsy in the child: a population-based cohort study.

Science.gov (United States)

Petersen, Tanja Gram; Andersen, Anne-Marie Nybo; Uldall, Peter; Paneth, Nigel; Feldt-Rasmussen, Ulla; Tollånes, Mette Christophersen; Strandberg-Larsen, Katrine

2018-05-31

Cerebral palsy is the most frequent motor disability in childhood, but little is known about its etiology. It has been suggested that cerebral palsy risk may be increased by prenatal thyroid hormone disturbances. The objective of this study was to investigate whether maternal thyroid disorder is associated with increased risk of cerebral palsy. A population-based cohort study using two study populations. 1) 1,270,079 children born in Denmark 1979-2007 identified in nationwide registers, and 2) 192,918 children born 1996-2009 recruited into the Danish National Birth Cohort and The Norwegian Mother and Child Cohort study, combined in the MOthers and BAbies in Norway and Denmark (MOBAND) collaboration cohort. Register-based and self-reported information on maternal thyroid disorder was studied in relation to risk of cerebral palsy and its unilateral and bilateral spastic subtypes using multiple logistic regression. Children were followed from the age of 1 year to the age of 6 years, and cerebral palsy was identified in nationwide registers with verified diagnoses. In register data, hypothyroidism was recognized in 12,929 (1.0%), hyperthyroidism in 9943 (0.8%), and unclassifiable thyroid disorder in 753 (cerebral palsy was 1.0 (95% CI: 0.7-1.5). Maternal thyroid disorder identified during pregnancy was associated with elevated risk of unilateral spastic cerebral palsy (odds ratio 3.1 (95% CI: 1.2-8.4)). In MOBAND, 3042 (1.6%) of the mothers reported a thyroid disorder in pregnancy, which was not associated with cerebral palsy overall (odds ratio 1.2 (95% CI: 0.6-2.4)). Maternal thyroid disorder overall was not related to bilateral spastic cerebral palsy, but maternal thyroid disorder identified in pregnancy was associated with increased risk of unilateral spastic cerebral palsy. These findings should be replicated in studies making use of maternal blood samples.

Physical activity as a prescription for the children with cerebral palsy

Directory of Open Access Journals (Sweden)

Arghavan Shariat

2014-03-01

Full Text Available After so many years devoted to practicing medicine as children physiotherapists, the therapists finally found the importance of balance training exercises in children who suffer from cerebral palsy. It is only through controlling balance that we can achieve improvement in body movement and position that will culminate into performance independence in a child. Formerly, working over controlling balance in cerebral palsy children has been very difficult, because contracture and spasticity did not let us to have an effective balance training exercise. In this respect, we have summarized the results of previous authors that specify the level of effectiveness of exercise therapy. The results of different studies showed that level of effectiveness of exercise therapy on alleviating the symptoms of spastic cerebral palsy is average in accordance with Cohen's effect size Interpretation table.

Stimulus Evaluation, Event Preparation, and Motor Action Planning in Young Patients With Mild Spastic Cerebral Palsy : An Event-Related Brain Potential Study

NARCIS (Netherlands)

Hakkarainen, Elina; Pirila, Silja; Kaartinen, Jukka; van der Meere, Jaap J.

The study investigated stimulus evaluation time, event preparation, and motor action planning of patients with mild spastic cerebral palsy and a peer control group in the age range of 9 to 18 years. To this end, participants were carrying out a stimulus recognition task. Findings indicated an

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

Directory of Open Access Journals (Sweden)

D.C. Garção

2011-01-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy

Directory of Open Access Journals (Sweden)

Diogo Costa Garção

2011-09-01

Full Text Available The aim of this study was to investigate the influence of dance therapy on the functional mobility of children with spastic hemiparetic cerebral palsy. Ten female children (mean age 7.2 ± 1.2 years diagnosed with cerebral palsy were included. In order to evaluate their functional mobility, standing (D and walking, running and jumping (E dimensions from GMFM were applied, and measurements were carried out in two phases: 1 control, six weeks without any motor intervention, and 2 activity, 18 sessions of dancing. Children were assessed three times: first, before the control phase, second, after the control phase, and third, at the end of the dancing phase. Kruskal-Wallis (p < .05 and Dunn tests (p < .05 were used. There were no changes in performance between the two first phases of evaluation (p = 1.00, however, at the end of the dancing phase a significant increase was measured in relation to D (p < .01 and E dimensions (p < .01. Results showed that dance therapy influences children's functional mobility.

Our Approach to the Spastic Hip Subluxation and Dislocation in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Pavel Šponer

2006-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1–3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.

Stability and Harmony of Gait in Children with Cerebral Palsy

Science.gov (United States)

Iosa, Marco; Marro, Tiziana; Paolucci, Stefano; Morelli, Daniela

2012-01-01

The aim of this study was to quantitatively assess the stability and harmony of gait in children with cerebral palsy. Seventeen children with spastic hemiplegia due to cerebral palsy (5.0 [plus or minus] 2.3 years old) who were able to walk autonomously and seventeen age-matched children with typical development (5.7 [plus or minus] 2.5 years old,…

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study

Directory of Open Access Journals (Sweden)

Marise Bueno Zonta

2013-07-01

Full Text Available Objective To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP. Only the study group (SG received early treatment of spasticity with botulinum neurotoxin type A (BXT-A. Methods Gross Motor Function Measure (GMFM, functional performance (Pediatric Evaluation of Disability Inventory - PEDI, range of movement, gait pattern (Physician Rating Scale - PRS and the speed of hand movements were considered. Results The SG, composed of 11 HCP (45.64±6.3 months, was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months. SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. Conclusion Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.

Comprehensive visual impairment evaluation for cerebral palsy children

Directory of Open Access Journals (Sweden)

Ping Wang

2015-01-01

Full Text Available AIM: To evaluate the visual impairment in cerebral palsy children with series objective indicators, and conclude their clinical features of visual function.METHODS: Objective tests including following pursuing test, optokinetic nystagmus(OKNdrum test, refractive error examination, fundus examination, ocular deviation examination, pattern visual evoked potential(P-VEPtests and brain magnetic resonance imaging(MRIwere carried out in 43 cerebral palsy children(86 eyeswith ocular visual dysfunction; The visual impairment data of the cerebral palsy children were collected, and the clinical features and possible mechanism were analyzed.RESULTS: 1. Of the 43 cerebral palsy children(86 eyeswith the visual impairment presented diversified, 25(50 eyes, 58.1%of refractive error, 24(48 eyes, 55.8%of strabismus, 12(24 eyes, 27.9%with nystagmus, 19(38 eyes, 44.2%of optical nerve atrophy or hyperplasia, 35(70 eyes, 81.4%of VEP abnormality. Among children with spastic cerebral palsy, the incidence of visual impairment was statistically significant difference compared with other groups(PP>0.05, no nystagmus in patients with severe occipital cortex damage.CONCLUSION: Cerebral palsy children were usually with visual impairment, and presented with special clinical features; Comprehensive objective visual tests are accurate and reliable for evaluation of the visual function in cerebral palsy children.

Cerebral Palsy: General Information. Fact Sheet Number 2 = La Paralisis Cerebral: Informacion General. Fact Sheet Number 18.

Science.gov (United States)

Interstate Research Associates, McLean, VA.

This fact sheet on cerebral palsy is offered in both English and Spanish. First, it provides a definition and considers various causes (e.g., an insufficient amount of oxygen reaching the fetal or newborn brain). The fact sheet then offers incidence figures and explains characteristics of the three main types of cerebral palsy: spastic, athetoid,…

The positive effect of mirror visual feedback on arm control in children with Spastic hemiparetic cerebral palsy is dependent on which arm is viewed

NARCIS (Netherlands)

Smorenburg, A; Ledebt, A.; Feltham, M.; Deconinck, F.; Savelsbergh, G.J.P.

2011-01-01

Mirror visual feedback has previously been found to reduce disproportionate interlimb variability and neuromuscular activity in the arm muscles in children with Spastic Hemiparetic Cerebral Palsy (SHCP). The aim of the current study was to determine whether these positive effects are generated by

Clinical significance of the corpus callosum in cerebral palsy

International Nuclear Information System (INIS)

Lee, Eun Ja; Kim, Ji Chang; Kim, Jong Chul; And Others

2000-01-01

To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. Fifty-two children (30 boys and 22 girls aged between six and 96 (median, 19) months) in whom cerebral palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebral palsy were classified as hemiplegia (n=14), spastic diplegia (n=22), or spastic quadriplegia (n=16), and according to the severity of motor palsy, the condition was also classified as mild (n=26), moderate (n=13), or severe (n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p less than 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p less than 0.05). There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury

Clinical significance of the corpus callosum in cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

Lee, Eun Ja; Kim, Ji Chang [The Catholic University of Korea, Seoul (Korea, Republic of); Kim, Jong Chul [School of Medicine, Chungnam National University, Taejon (Korea, Republic of); And Others

2000-10-01

To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. Fifty-two children (30 boys and 22 girls aged between six and 96 (median, 19) months) in whom cerebral palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebral palsy were classified as hemiplegia (n=14), spastic diplegia (n=22), or spastic quadriplegia (n=16), and according to the severity of motor palsy, the condition was also classified as mild (n=26), moderate (n=13), or severe (n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p less than 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p less than 0.05). There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

The effect of reflexology upon spasticity and function among children with cerebral palsy who received physiotherapy: Three group randomised trial.

Science.gov (United States)

Özkan, Filiz; Zincir, Handan

2017-08-01

To assess the effectiveness of reflexology method upon spasticity and function among children with cerebral palsy who received physiotherapy. A three group, randomised trial with blinded evaluator. Randomization was made sealed and opaque envelopes. 45 children with cerebral palsy who were trained at a Special Education and Rehabilitation Centre. In the reflexology and placebo group; a 20min reflexology was performed twice a week in a total 24 sessions. In the control group; no intervention was done. Before and after the implementation; measurements of the participants were obtained. The data were collected using Gross Motor Function Measure, Modified Ashworth Scale (MAS), Modified Tardieu Scale, Pediatric Functional Independence Scale, Pediatric Quality of Life Scale (PedsQL) and demographic data. A total of 45 children completed the study. The groups were homogeneous at baseline. Between right MAS Gastrocnemius muscle was a difference and right and left Soleus muscles was significant among the groups (p0.05). Reflexology with physiotherapy reduced spasticity in legs, improved gross motor functions, decreased dependency but led to no change in quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Public health issues related to infection in pregnancy and cerebral palsy

DEFF Research Database (Denmark)

Schendel, Diana E.; Schuchat, Anne; Thorsen, Poul

2002-01-01

Cerebral palsy is the most common neuromotor developmental disability of childhood, affecting as many as 8,000 to 12,000 children born in the U.S. each year (corresponding to a prevalence rate of between 2 and 3 per 1000 children). Recent improvements in neonatal care have not resulted in a decline...... in the overall prevalence of cerebral palsy and, in fact, greater numbers of very preterm/very low birth weight infants are surviving with cerebral palsy and other developmental problems. Infection in pregnancy may be an important cause of the disorder. In preterm infants, there appears to be about a 2-fold...... increased risk for cerebral palsy from chorioamnionitis, and in term infants the estimated increased risk is about 4-fold. Provisionally, chorioamnionitis might account for 12% of spastic cerebral palsy in term infants and 28% of cerebral palsy in preterm infants. Studies of biochemical markers of fetal...

Cerebral palsy

International Nuclear Information System (INIS)

Truwit, C.L.; Barkovich, A.J.; Koch, T.; Ferreiro, D.

1990-01-01

This paper reviews cranial MR findings in patients with cerebral palsy (CP) to clarify and categorize this disorder. The MR images of 40 patients with clinical CP were retrospectively reviewed. All patients suffered either varying spastic plegias, hypotonicity, or choreoathetosis. Concomitantly, the patients suffered from static encephalopathy, developmental delay, and/or microcephaly. Twenty-four patients were born at or near term, 10 were premature, and incomplete birth histories were available in six. The MR images revealed mild to severe degrees of white matter damage in 24 patients (12 term, nine premature, three unknown)

Survey on Types and Associated disorders of Cerebral Palsy in Eastern and Northern Districts of Tehran

Directory of Open Access Journals (Sweden)

Farin Soleimani

2011-10-01

Conclusion: In this study, unilateral - spastic cerebral palsy was found as the most common type. Therefore, more evaluation to determine the about etiology of this type of cerebral palsy in our population is necessary.

The Effect of Resistance Training on Performance of Gross Motor Skills and Balance in Children with Spastic Cerebral Palsy

Directory of Open Access Journals (Sweden)

Ebrahim Zarrinkalam

2016-03-01

Full Text Available Objective: Cerebral palsy is the most common chronic motor disability in children and can have negative effect on motor functions. The purpose of this study was to investigate the effect of eight weeks resistance training on gross motor ability, balance and walking speed in a group of such children. Methods: 21 cerebral palsy boys with spastic diplegia, aged between 12 and 16 years (mean, 13.66 years, participated in this study. A pre-test, involving walking, sitting, standing and walking up stairs. They were randomly divided into an experimental and control groups. Then, the experimental group participated in 8 weeks of resistance training.  The data was attained from a 10 meter walk test, Berg Balance Test, gross motor ability Section E, D and GMFCS tests.  Kolmogorov-Smirnov test, sample t-test were used for analyzing the data. Results: The results showed a significant improvement in the performance of experimental group in gross motor abilities section  E and D, balance and walking speed after 8 weeks of resistance training (P <0.05(. However, significant differences were not observed in the control group before and after the study (P <0.05.  Conclusion: The results showed that resistance training improves gross motor ability, balance and gait in children with cerebral palsy hence, it is recommended that resistance exercise be used as a therapeutic modality for children with cerebral palsy.

The Distribution of Body Weight Force on Toe and Heel before and after Exercise Therapy in Children with Spastic Diplegia Cerebral Palsy

Directory of Open Access Journals (Sweden)

Keyvan Sharif-Moradi

2005-07-01

Full Text Available Objective: The purpose of this study was to assess the distribution of body weight force on toe and heel before and after exercise therapy and its effects on relaxation of children with spastic diplegia cerebral palsy. Materials & Methods: Ten children with spastic diplegia cerebral palsy between 8 to15 years of age participated in this study. Their mean weight and height were (30.8kg ± 5.7kg and (1.35m±0.09m respectively. Subjects underwent a 12 weeks of exercise therapy. A dynamic stability platform system (BIODEX was used to measure the mean percentage of body weight pressure on toe and heal. The balance tests were repeated on stable, almost stable and unstable base of support as well as with and without shoes. Results: Showed that the mean percentage of body weight pressure on toe and heal after exercise therapy was not significant (p>0.05. The mean percentage of body weight pressure on toe and heal was significantly decrease after exercise therapy in both with and without shoes (p<0.05. The greatest improvement achieved on almost stable and unstable conditions. Wearing shoes resulted in a balance percentage of body weight pressure on toe and heal on stable situation of stability platform the percentage of body weight pressure on toe and heal has no difference before and after exercise therapy. After exercise therapy strengthening the muscle of the ankle joint balance the percentage of body weight pressure on toe and heal. Wearing shoes decrease the muscle stretch and therefore balance the percentage of body weight pressure on toe and heal. Conclusion: The flexibility of spastic muscle and strengthening of the relax muscle must be perform. This result provides good information for physician in recognizing and therapy impacts on cerebral palsy children.

X-Ray Hip Examination in Patients with Cerebral Palsy

OpenAIRE

Holiuk, Ye.L.

2017-01-01

Background. X-ray indicators of the hip are important diagnostic factors of spastic hip dislocation in cerebral palsy. Correct X-ray examination has a decisive influence on the treatment strategy. Correct positioning parameters are well known, but their importance is often underestimated. This could be a trigger factor for further diagnostic and treatment errors. Materials and me-thods. The material was radiographs of the hip joints of 126 patients with cerebral palsy aged 2 to 18 years. Retr...

A DESCRIPTIVE STUDY ON THE ASSESSMENT OF FUNCTIONAL MOTOR DISABILITY IN CHILDREN WITH CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

Wadugodapitiya .S .I

2015-08-01

Full Text Available Background: Cerebral palsy (CP is one of the most common conditions in childhood causing severe physical disability. Spastic paresis is the most common form of CP. According to the topographic classification, CP is divided into spastic hemiplegia, diplegia and quadriplegia. Distribution of functional motor disability is varied in each type of CP. Aims: To describe functional motor disability in children with cerebral palsy using standard scales. Method: This cross-sectional descriptive study included 93 children with cerebral palsy (CP. Functional motor disability of each type of spastic CP was assessed using standard scales. Results: The dominant sub-type of cerebral palsy in the present study was spastic diplegia. Most affected muscle with spasticity was gastrocnemius-soleus group of muscles. Active range of motion of foot eversion and dorsiflexion were the most affected movements in all the types of CP. In the overall sample, only 35% were able to walk independently. Majority of subjects with quadriplegia were in levels III and IV of Gross Motor Functional Classification Scale representing severe disability. There was a significant relationship observed between the muscle tone and range of motion of their corresponding joints as well as between the muscle tone of gastrocnemius-soleus group of muscles and the ankle components of Observational Gait Analysis. Conclusions: Results of the present study confirms the clinical impression of disability levels in each type of CP and showed that the assessment of functional motor disability in children with different types of spastic CP is useful in planning and evaluation of treatment options.

Attentional and executive impairments in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Bottcher, Louise; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function.......Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function....

Analysis of structure-function network decoupling in the brain systems of spastic diplegic cerebral palsy.

Science.gov (United States)

Lee, Dongha; Pae, Chongwon; Lee, Jong Doo; Park, Eun Sook; Cho, Sung-Rae; Um, Min-Hee; Lee, Seung-Koo; Oh, Maeng-Keun; Park, Hae-Jeong

2017-10-01

Manifestation of the functionalities from the structural brain network is becoming increasingly important to understand a brain disease. With the aim of investigating the differential structure-function couplings according to network systems, we investigated the structural and functional brain networks of patients with spastic diplegic cerebral palsy with periventricular leukomalacia compared to healthy controls. The structural and functional networks of the whole brain and motor system, constructed using deterministic and probabilistic tractography of diffusion tensor magnetic resonance images and Pearson and partial correlation analyses of resting-state functional magnetic resonance images, showed differential embedding of functional networks in the structural networks in patients. In the whole-brain network of patients, significantly reduced global network efficiency compared to healthy controls were found in the structural networks but not in the functional networks, resulting in reduced structural-functional coupling. On the contrary, the motor network of patients had a significantly lower functional network efficiency over the intact structural network and a lower structure-function coupling than the control group. This reduced coupling but reverse directionality in the whole-brain and motor networks of patients was prominent particularly between the probabilistic structural and partial correlation-based functional networks. Intact (or less deficient) functional network over impaired structural networks of the whole brain and highly impaired functional network topology over the intact structural motor network might subserve relatively preserved cognitions and impaired motor functions in cerebral palsy. This study suggests that the structure-function relationship, evaluated specifically using sparse functional connectivity, may reveal important clues to functional reorganization in cerebral palsy. Hum Brain Mapp 38:5292-5306, 2017. © 2017 Wiley Periodicals

Why is joint range of motion limited in patients with cerebral palsy?

NARCIS (Netherlands)

de Bruin, M.; Smeulders, M. J. C.; Kreulen, M.

2013-01-01

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand

Bone mineral density and insulin-like growth factor-1 in children with spastic cerebral palsy.

Science.gov (United States)

Nazif, H; Shatla, R; Elsayed, R; Tawfik, E; Osman, N; Korra, S; Ibrahim, A

2017-04-01

Children with cerebral palsy (CP) have significant decrease linear growth rate and low bone mineral density (BMD). This study is to evaluate BMD in children with CP and its relation to the levels of insulin-like growth factor-1 (IGF-1). This cross-sectional study was carried out on 58 children suffering from spastic CP with the age range 4-12 years compared to 19 controls. All assessed by dual energy x-ray absorptiometry (DXA) to measure BMD, serum level of IGF-1, and serum vitamin D. The patients were classified according to their GMFCS. Fractures were reported in seven (12.1%) of cases. Our study demonstrated that, IGF-1 level and BMD decrease in correlation with the severity of CP. IGF-1correlates positively with serum vitamin D, BMI, and BMD. CP children with severe GMFCS level or who use anticonvulsive drugs are at a high risk for low BMD and low levels of IGF-1. Both BMD and IGF-1 were significantly in low children with spastic CP; IGF-1 negatively correlates with the severity of osteopenia in children with spastic. Children with CP who are not independently ambulant or with severe GMFCS level or who use anticonvulsive drugs are at a high risk for developing low BMD.

Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy).

Science.gov (United States)

Benda, William; McGibbon, Nancy H; Grant, Kathryn L

2003-12-01

To evaluate the effect of hippotherapy (physical therapy utilizing the movement of a horse) on muscle activity in children with spastic cerebral palsy. Pretest/post-test control group. Therapeutic Riding of Tucson (TROT), Tucson, AZ. Fifteen (15) children ranging from 4 to 12 years of age diagnosed with spastic cerebral palsy. Children meeting inclusion criteria were randomized to either 8 minutes of hippotherapy or 8 minutes astride a stationary barrel. Remote surface electromyography (EMG) was used to measure muscle activity of the trunk and upper legs during sitting, standing, and walking tasks before and after each intervention. After hippotherapy, significant improvement in symmetry of muscle activity was noted in those muscle groups displaying the highest asymmetry prior to hippotherapy. No significant change was noted after sitting astride a barrel. Eight minutes of hippotherapy, but not stationary sitting astride a barrel, resulted in improved symmetry in muscle activity in children with spastic cerebral palsy. These results suggest that the movement of the horse rather than passive stretching accounts for the measured improvements.

Computed tomographic (CT) scans in cerebral palsy (CP)

International Nuclear Information System (INIS)

Kolawole, T.M.; Patel, P.J.; Mahdi, A.H.

1989-01-01

The CT findings in 120 cerebral palsied children are analysed. The 72.5% positive findings are correlated with the clinical types, as well as the aetiological basis for the cerebral palsy. The spastic type, 83.3% of the total number of children, had the highest positive findings. The yield was increased in children with seizures (91.3%) and those in the postnatal group (90%), as well as those with birth trauma and neonatal asphyxia (94%). The findings were those of atrophy in 30.8%, hydrocephalus, in 10%, infarct in 11.6%, porencephaly in 8.3% and others. The atropic changes and their patterns are explained. Treatable lesions, such as tumour, hydrocephalus, subdural haematoma, porencephaly and hygroma were identified in 22.5% of cases. It is concluded that CT scan is definitely efficacious in the management of cerebral palsied children. (orig.)

Neuro-musculoskeletal simulation of instrumented contracture and spasticity assessment in children with cerebral palsy.

Science.gov (United States)

van der Krogt, Marjolein Margaretha; Bar-On, Lynn; Kindt, Thalia; Desloovere, Kaat; Harlaar, Jaap

2016-07-16

Increased resistance in muscles and joints is an important phenomenon in patients with cerebral palsy (CP), and is caused by a combination of neural (e.g. spasticity) and non-neural (e.g. contracture) components. The aim of this study was to simulate instrumented, clinical assessment of the hamstring muscles in CP using a conceptual model of contracture and spasticity, and to determine to what extent contracture can be explained by altered passive muscle stiffness, and spasticity by (purely) velocity-dependent stretch reflex. Instrumented hamstrings spasticity assessment was performed on 11 children with CP and 9 typically developing children. In this test, the knee was passively stretched at slow and fast speed, and knee angle, applied forces and EMG were measured. A dedicated OpenSim model was created with motion and muscles around the knee only. Contracture was modeled by optimizing the passive muscle stiffness parameters of vasti and hamstrings, based on slow stretch data. Spasticity was modeled using a velocity-dependent feedback controller, with threshold values derived from experimental data and gain values optimized for individual subjects. Forward dynamic simulations were performed to predict muscle behavior during slow and fast passive stretches. Both slow and fast stretch data could be successfully simulated by including subject-specific levels of contracture and, for CP fast stretches, spasticity. The RMS errors of predicted knee motion in CP were 1.1 ± 0.9° for slow and 5.9 ± 2.1° for fast stretches. CP hamstrings were found to be stiffer compared with TD, and both hamstrings and vasti were more compliant than the original generic model, except for the CP hamstrings. The purely velocity-dependent spasticity model could predict response during fast passive stretch in terms of predicted knee angle, muscle activity, and fiber length and velocity. Only sustained muscle activity, independent of velocity, was not predicted by our model. The

Influence of Botulinum Toxin Therapy on Postural Control and Lower Limb Intersegmental Coordination in Children with Spastic Cerebral Palsy

Directory of Open Access Journals (Sweden)

Bernard Dan

2013-01-01

Full Text Available Botulinum toxin injections may significantly improve lower limb kinematics in gait of children with spastic forms of cerebral palsy. Here we aimed to analyze the effect of lower limb botulinum toxin injections on trunk postural control and lower limb intralimb (intersegmental coordination in children with spastic diplegia or spastic hemiplegia (GMFCS I or II. We recorded tridimensional trunk kinematics and thigh, shank and foot elevation angles in fourteen 3–12 year-old children with spastic diplegia and 14 with spastic hemiplegia while walking either barefoot or with ankle-foot orthoses (AFO before and after botulinum toxin infiltration according to a management protocol. We found significantly greater trunk excursions in the transverse plane (barefoot condition and in the frontal plane (AFO condition. Intralimb coordination showed significant differences only in the barefoot condition, suggesting that reducing the degrees of freedom may limit the emergence of selective coordination. Minimal relative phase analysis showed differences between the groups (diplegia and hemiplegia but there were no significant alterations unless the children wore AFO. We conclude that botulinum toxin injection in lower limb spastic muscles leads to changes in motor planning, including through interference with trunk stability, but a combination of therapies (orthoses and physical therapy is needed in order to learn new motor strategies.

Executive Functions in Youth With Spastic Cerebral Palsy

NARCIS (Netherlands)

Pirila, Silja; van der Meere, Jaap J.; Rantanen, Kati; Jokiluoma, Maria; Eriksson, Kai

Dependent on criteria used, between 35% and 53% of the participants with cerebral palsy fulfilled the criteria of clinically relevant executive function problems as defined by Conners' (1994) Continuous Performance Test. Executive function problems were noticed mainly in participants with bilateral

Selective dorsal rhizotomy opportunities with foot deformitiesin children with cerebral palsy

Directory of Open Access Journals (Sweden)

Vladimir Markovich Kenis

2015-03-01

Full Text Available Foot deformities are the most common orthopedic condition in children with cerebral palsy. The aim of the study was to evaluate the influence of selective dorsal rhizotomy (SDR on foot deformities in children with cerebral palsy. The results were assessed clinically by measurement of changes in muscle spaticity and foot posture. Percentage of resection of dorsal rootlets was from 40 to 90 % of total thickness. The degree of tone reduction had a tendency to be more pronounced in the more proximal muscles and was minimal in calf muscles. Nevertheless, foot posture improved more significantly. That can be explained by generalimprovement of pathological posture at the level of more proximal joints. Thus, SDR has insignificant direct effect on spastic foot deformity and can not be recommended as a basic method of treatment even in pure spasticity. However, SDR should be considered as a part of multidisciplinary management protocol if foot deformity reflects more complex postural disturbance due to generalized spasticity.

Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics?

Science.gov (United States)

Remijn, L; Groen, B E; Speyer, R; van Limbeek, J; Vermaire, J A; van den Engel-Hoek, L; Nijhuis-van der Sanden, M W G

2017-02-01

The aim of this study was to explore the feasibility of the Mastication Observation and Evaluation (MOE) instrument, dynamic ultrasound and 3D kinematic measurements to describe mastication in children with spastic cerebral palsy and typically developing children. Masticatory movements during five trials of eating a biscuit were assessed in 8 children with cerebral palsy, spastic type (mean age 9.08years) and 14 typically developing children (mean age 9.01years). Differences between trials were tested (t-test) and the mastication of individual children with cerebral palsy was analyzed. MOE scores ranged from 17 to 31 (median 24) for the children with cerebral palsy and from 28 to 32 (median 31) for the typically developing children. There was an increased chewing cycle duration, a smaller left-right and up-down tongue displacement and larger anterior mandible movements for the trials (n=40) of cerebral palsy children (pmastication between individual children with cerebral palsy. The MOE items 'jaw movement' and 'fluency and coordination' showed the most similarity with the objective measurements. Objective measurements of dynamic ultrasound and 3D kinematics complemented data from the MOE instrument. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy

Science.gov (United States)

Santos, Maria Teresa Botti Rodrigues; Diniz, Michele Baffi; Gouw-Soares, Sheila Cynthia; Lopes-Martins, Rodrigo Alvaro Brandão; Frigo, Lucio; Baeder, Fernando Martins

2016-02-01

Spasticity is a motor disorder frequently present in individuals with cerebral palsy (CP). This study aimed to evaluate the effect of low-level laser therapy (LLLT) on the spasticity of the masseter and anterior temporal muscle fibers in children with CP over three weeks of intermittent laser exposures. The bite force (BF) of the masticatory muscles and the amplitude of mouth opening were evaluated before and after laser irradiation in 30 children with CP. Both sides of the masseter and temporalis muscles were irradiated with low-intensity diode laser pulses of 808-nm wavelength six times over three consecutive weeks. During the subsequent three weeks of postlaser exposures, although no laser treatment was applied, the evaluation parameters were measured and recorded. A significant improvement in the amplitude of mouth opening and a decrease in the BF were observed in the weeks following LLLT (Peffective short-term therapeutic tool. This method increased the amplitude of mouth opening and decreased the muscle tonus of children with spastic CP over a time course of three weeks of intermittent laser applications.

Modified Constraint-Induced Movement Therapy combined with Bimanual Training (mCIMT-BiT) in children with unilateral spastic cerebral palsy: how are improvements in arm-hand use established?

NARCIS (Netherlands)

Aarts, P.B.M.; Jongerius, P.H.; Geerdink-van Nistelrooij, Y.A. van; Limbeek, J. van; Geurts, A.C.H.

2011-01-01

A recent randomized controlled trial indicated that modified Constraint-Induced Movement Therapy followed by Bimanual Training (mCIMT-BiT) is an effective intervention to improve spontaneous use of the affected upper limb in children with unilateral spastic cerebral palsy (CP). The present study

SPASTIC FORM OF CEREBRAL PALSY, EPILEPSY WITH BENIGN EPILEPTIFORM DISCHARGE OF CHILDHOOD ON ELECTROENCEPHALOGRAM, AND IATROGENIC STEVENS–JOHNSON SYNDROME (CASE DESCRIPTION

Directory of Open Access Journals (Sweden)

A. S. Kotov

2016-01-01

Full Text Available The article describes the phenomenon of dual pathology – a combination of structural changes in the brain and benign epileptiform discharge of childhood on electroencephalogram. The uniqueness lies in the observation that the child, since birth suffering from spastic form of cerebral palsy and severe epilepsy, demonstrated the development of Stevens–Johnson syndrome due to intolerance of one of the antiepileptic drugs. Therapeutic approaches to overcome a whole range of violations are discussed in the article.

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy.

Science.gov (United States)

Park, Myoung-Ok

2017-02-01

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification Systems, and manual function was measured using the Manual Ability Classification System. [Results] Motor skills in daily activities were significantly different on Gross Motor Function Classification System level and Manual Ability Classification System level. According to the results of multiple regression analysis, children categorized as Gross Motor Function Classification System level III scored lower in terms of performance based motor skills than Gross Motor Function Classification System level I children. Also, when analyzed with respect to Manual Ability Classification System level, level II was lower than level I, and level III was lower than level II in terms of performance based motor skills. [Conclusion] The results of this study indicate that performance-based motor skills differ among children categorized based on Gross Motor Function Classification System and Manual Ability Classification System levels of cerebral palsy.

Spasticity Measurement Based on Tonic Stretch Reflex Threshold in Children with Cerebral Palsy Using the PediAnklebot

Directory of Open Access Journals (Sweden)

Marco Germanotta

2017-05-01

Full Text Available Nowadays, objective measures are becoming prominent in spasticity assessment, to overcome limitations of clinical scales. Among others, Tonic Stretch Reflex Threshold (TSRT showed promising results. Previous studies demonstrated the validity and reliability of TSRT in spasticity assessment at elbow and ankle joints in adults. Purposes of the present study were to assess: (i the feasibility of measuring TSRT to evaluate spasticity at the ankle joint in children with Cerebral Palsy (CP, and (ii the correlation between objective measures and clinical scores. A mechatronic device, the pediAnklebot, was used to impose 50 passive stretches to the ankle of 10 children with CP and 3 healthy children, to elicit muscles response at 5 different velocities. Surface electromyography, angles, and angular velocities were recorded to compute dynamic stretch reflex threshold; TSRT was computed with a linear regression through angles and angular velocities. TSRTs for the most affected side of children with CP resulted into the biomechanical range (95.7 ± 12.9° and 86.7 ± 17.4° for Medial and Lateral Gastrocnemius, and 75.9 ± 12.5° for Tibialis Anterior. In three patients, the stretch reflex was not elicited in the less affected side. TSRTs were outside the biomechanical range in healthy children. However, no correlation was found between clinical scores and TSRT values. Here, we demonstrated the capability of TSRT to discriminate between spastic and non-spastic muscles, while no significant outcomes were found for the dorsiflexor muscle.

Analysis of cranial CT-scan findings in cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

Wada, F.; Andoh, T.; Une, K.; Takamatsu, T. (Kitakyushu Municipal Sogo-Ryoiku Center (Japan))

1981-06-01

CT-scan findings of 87 cerebral palsied children were studied. They consist of 23 cases of spastic quadriplegia, 9 cases of diplegia, 12 cases of paraplegia, 24 cases of athetosis and mixed type, and 19 cases of hemiplegia. In the former four types, ventricular dilatation and cortical atrophy were measured and abnormal changes in cerebral substance and cerebellar atrophy were observed. Spastic quadriplegia showed most intense changes in every aspect of the abnormalities, while paraplegia had almost normal appearance. Athetosis and mixed type had moderate changes. Hemiplegia always showed asymmetrical view on CT-scan, dilatation of lateral ventricle or atrophy of hemisphere in contralateral side being observed.

Analysis of cranial CT-scan findings in cerebral palsy

International Nuclear Information System (INIS)

Wada, Fumio; Andoh, Tadashi; Une, Koji; Takamatsu, Tsurukichi

1981-01-01

CT-scan findings of 87 cerebral palsied children were studied. They consist of 23 cases of spastic quadriplegia, 9 cases of diplegia, 12 cases of paraplegia, 24 cases of athetosis and mixed type, and 19 cases of hemiplegia. In the former four types, ventricular dilatation and cortical atrophy were measured and abnormal changes in cerebral substance and cerebellar atrophy were observed. Spastic quadriplegia showed most intense changes in every aspect of the abnormalities, while paraplegia had almost normal appearance. Athetosis and mixed type had moderate changes. Hemiplegia always showed asymmetrical view on CT-scan, dilatation of lateral ventricle or atrophy of hemisphere in contralateral side being observed. (author)

Computerized tomographic studies in cerebral palsy

International Nuclear Information System (INIS)

Sugie, Yoko

1981-01-01

Computed tomographic (CT) findings in 200 children with cerebral palsy (CP) were analysed from the viewpoint of clinical manifestations, disease complications and etiological factors. CT scans of 135 cases (67.5%) were found to be abnormal and there were 14 (7%) borderline cases. The major abnormality found on CT scans was cerebral atrophy. Other important changes included focal or diffuse low density area in the brain tissue, congenital malformation, and cerebellar atrophy. From the clinical point of view, a large number of patients with spastic tetraplegia and spastic diplegia showed highly abnormal CT scans. On the other hand, in patients with spastic monoplegia, spastic paraplegia, and athetotic type, CT findings were normal or revealed only minor cerebral atrophy. Most children showing asymmetric clinical symptoms had corresponding asymmetric CT abnormalities which included ventricular enlargement, low density area in the brain tissue, and hemispherical volume. There was a significant correlation between the severity of physical impairment and the extent of CT abnormalities. Severely affected children had grossly abnormal CT scans such as hydranencephaly, polycystic change, and extensive cerebral atrophy. In the patients complicated with epilepsy, the incidence and severity of abnormal CT were higher than those of non-epileptic patients. Mentally retarded patients had variable enlargement of the subarachnoidal space depending on the severity of their mental retardation. Patients with suspected postnatal etiology also had high incidence of severe CT abnormality. CT scan is a valuable tool for evaluating patients with CP and in some cases, possible etiology of the disease may be discovered. (author)

Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy.

Science.gov (United States)

Kwak, Eunmi Emily

2007-01-01

The purpose of this study was to use Rhythmic Auditory Stimulation (RAS) for children with spastic cerebral palsy (CP) in a clinical setting in order to determine its effectiveness in gait training for ambulation. RAS has been shown to improve gait performance in patients with significant gait deficits. All 25 participants (6 to 20 years old) had spastic CP and were ambulatory, but needed to stabilize and gain more coordinated movement. Participants were placed in three groups: the control group, the therapist-guided training (TGT) group, and the self-guided training (SGT) group. The TGT group showed a statistically significant difference in stride length, velocity, and symmetry. The analysis of the results in SGT group suggests that the self-guided training might not be as effective as therapist-guided depending on motivation level. The results of this study support three conclusions: (a) RAS does influence gait performance of people with CP; (b) individual characteristics, such as cognitive functioning, support of parents, and physical ability play an important role in designing a training application, the effectiveness of RAS, and expected benefits from the training; and (c) velocity and stride length can be improved by enhancing balance, trajectory, and kinematic stability without increasing cadence.

Percutaneous Adductor Release in Nonambulant Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Ramji Lal Sahu

2014-03-01

Full Text Available Introduction: Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anesthesia. Methods: From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children. Results: Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (p = 0.01.The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%. Conclusions: Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis. Keywords: Adductor contracture, Percutaneous, Cerebral palsy, Minimal invasive procedure.

MRI in spastic cerebral palsy - correlations with motor development and mental retardation

International Nuclear Information System (INIS)

Kulal, W.; Sobaniec, W.; Kubas, B.

2004-01-01

The introduction of magnetic resonance (MR) has improved our understanding of the pathophysiology and early diagnosis of cerebral palsy (CP). The aim of this study was to evaluate types of lesions on MR in children with CP in correlations with motor development, cognitive impairment and risk factors. Twenty-two children aged 4-17 years (boys 12, girls 10) with CP diplegia - 16 and tetraplegia - 6 were studied. Routine MR images were performed in all children. Results: All patients had periventricular leukomalacia (PVL) in MR findings. In addition three different degrees of MRI lesion patterns were defined: a mild pattern (nucleus lentiformis and thalamus) moderate (nucleus lentiformis, thalamus and pericentral region)and a severe pattern (nucleus lentiformis , thalamus, pericentral region and hippocampus). Significant correlations of the MR findings with the motor development and mental retardation were found. No significant relationships between the MR findings and the etiological factors (prematurity, low birthweight, Apgar score, sepsis, seizures, pre-eclamsia , and gestational age) were noted. MR imaging is useful in the evaluation structural abnormalities in the brains in the children with spastic diplegia and tetraplegia. (author)

TO STUDY THE EFFECT OF PLAY THERAPY AND CHILD FRIENDLY CONSTRAINT INDUCED MOMEMENT THERAPY TO IMPROVE HAND FUNCTION IN SPASTIC HEMIPLEGIC CEREBRAL PALSY CHILDREN: A COMPARATIVE STUDY

Directory of Open Access Journals (Sweden)

Anjuman Nahar

2015-12-01

Full Text Available Background: Cerebral Palsy (CP is a neurodevelopmental disorder caused by nonprogressive lesion in the developing brain. The early central nervous system (CNS damage results in chronic physical disabilities and often includes sensory impairments. In addition CP is often associated with epilepsy and abnormalities of speech, vision, and intellect; it is the selective vulnerability of the brains motor systems that defines the disorder. Child friendly CIMT involves intensive targeted practice with the involved extremity coordination above and beyond their unilateral impairments. Ply Therapy is designed for active involvement of child in performing various tasks. The aim of the study is to evaluate the effectiveness of constraint induced movement therapy and play therapy to improve hand function in spastic hemiplegic cerebral palsy children. Methods: A sample of 30 patients was divided in two groups, each group having 15 children. Convenient sampling was done on the basis of base line assessment and diagnosis of their condition. Duration of the study was 3 months and data collection started at day 0 and at the end of 90 days. Children in group A wore a bivalve plaster cast on the non-involved upper extremity from shoulder to finger tips for the entire time during the session lasting for 2 hours and the plaster cast was removed at the end of the session. B group consists of 15 subjects who received play therapy. The treatment program was conducted individually and adjusted to current needs and abilities of each of the patients. Outcomes: Box and Block test, QOM scale and AOU scale. Results: It was found that there is an improvement in the hand function on application of child friendly CIMT in the patients with spastic hemiplegic cerebral palsy which was found significant using the Mann-Whitney U test (p≤0.005. Conclusion: In this study it has been found that the use of Child friendly CIMT and PLAY THERAPY produces significant improvement in hand

Spasticity

Science.gov (United States)

... Easter Seals March of Dimes National Multiple Sclerosis Society United Cerebral Palsy (UCP) See all related organizations Publications Order NINDS Publications Definition Spasticity is a condition in which there is ...

Cerebral Palsy Symptoms in Children Decreased Following Massage Therapy

Science.gov (United States)

Hernandez-Reif, Maria; Field, Tiffany; Largie, Shay; Diego, Miguel; Manigat, Natasha; Seoanes, Jacqueline; Bornstein, Joan

2005-01-01

Twenty young children (mean age = 32 months) with cerebral palsy (CP) recruited from early intervention programs received 30 minutes of massage or reading twice weekly for 12 weeks. The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms, and improved fine…

Use of Botulinum toxin in 55 children with cerebral palsy

Directory of Open Access Journals (Sweden)

Mohammadi M

2000-10-01

Full Text Available Botulinum toxin A (BTA inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders.To evaluate the effect of botulinum toxin on cerebral palsied children with spastic or mixed type of the disease, especially those patiens having spasticity as a cardinal symptom without joint contracture, we designed the following study. Ninety-one cases (55 of referred patients to pediatic Neurology outpatient clinics of children’s Medical Center were given BTA injections in affected muscles of the lower limb. They were reevaluating 3 to 5 weeks and 3 months later for type of walking and range of affected joints’ movement. The study showed a clinically significant gait improvement in 71.2% of patients (P<0.0005 and also an overall increased range of motion in affected limbs after BTA injection (P<0.04. Side effects occurred only in two cases as transient generalized weakness, gent recurvatum and ptosis. Drug effectiveness was time-limited, lasting abot 3 months in all patients ( a golden time for rehabilitation therapists to improve the patients’ condition. Overall, BTA has improved both the type of walking as well as the range of joints motion in our patients. So its’ administration is suggested in cerebral palsied children if the spasticity is a major and disabling sign

SPASTICITY PATTERNS OF HAND MUSCLES AND BOTULINUM TOXIN THERAPY APPLICATION IN PATIENTS WITH CEREBRAL PALSY WITH UPPER LIMB INVOLVEMENT

Directory of Open Access Journals (Sweden)

O. A. Klochkova

2013-01-01

Full Text Available Botulinum toxin therapy is an effective and safe method of treatment of local spasticity in patients with cerebral palsy (CP. Calculation of botulinum toxin A (BTA dosage based on the spasticity patterns and functional capabilities of the patient proved effective for the hypertonic lower limb muscle spasm treatment and is being applied to BTA injections in hand muscles more often. The article presents contemporary scientific data and results of the original study of BTA injections efficacy for pathologic tension reduction in hand muscles of 52 patients with CP. The authors give detailed description of the upper limb spasticity patterns, their frequency and role in the pathological movement pattern formation. The authors propose BTA dosage calculation for the functional segments of upper limbs, which allows minimizing the total amount of the administered drug and avoiding excessive weakness. The authors have also conducted a follow-up analysis of changes in hand muscle tone for the period of 6 months after the first BTA injection, compared results of botulinum toxin therapy at various clinical forms of CP and given recommendations on the optimum duration of the follow-up period.

Effectiveness of Functional Power Training on Walking Ability in Young Children With Cerebral Palsy : Study Protocol of a Double-Baseline Trial

NARCIS (Netherlands)

van Vulpen, Liesbeth F.; de Groot, Sonja; Rameckers, Eugene A. A.; Becher, Jules G.; Dallmeijer, Annet J.

Purpose: To evaluate the effect of functional high-velocity resistance (power) training to improve walking ability of young children with cerebral palsy. Methods: Twenty-two children with bi-or unilateral spastic cerebral palsy, Gross Motor Function Classification System levels I and II, aged 4 to

Developmental Profiles of Preschool Children With Spastic Diplegic and Quadriplegic Cerebral Palsy

Directory of Open Access Journals (Sweden)

Ya-Chen Lee

2010-07-01

Full Text Available Cerebral palsy (CP is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD CP and spastic quadriplegic (SQ CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 ± 2.1 years, and we classified them into two groups: SD (n = 59 and SQ (n = 78. The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01. There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to

Passive muscle properties are altered in children with cerebral palsy before the age of 3 years and are difficult to distinguish clinically from spasticity

DEFF Research Database (Denmark)

Willerslev-Olsen, Maria; Lorentzen, Jakob; Sinkjær, Thomas

2013-01-01

AIM: Clinical determination of spasticity is confounded by the difficulty in distinguishing reflex from passive contributions to muscle stiffness. There is, therefore, a risk that children with cerebral palsy (CP) receive antispasticity treatment unnecessarily. To investigate this, we aimed...... to determine the contribution of reflex mechanisms to changes in the passive elastic properties of muscles and tendons in children with CP. METHOD: Biomechanical and electrophysiological measures were used to determine the relative contribution of reflex and passive mechanisms to ankle muscle stiffness in 35...... tetraplegia. According to the Gross Motor Function Classification System, 31 children were classified in level I, two in level II, and two in level III. RESULTS: Only seven children with spastic CP showed reflex stiffness outside the range of the control children. In contrast, 20 children with spastic CP...

Influence of Hippotherapy on Body Balance in the Sitting Position Among Children with Cerebral Palsy.

Science.gov (United States)

Matusiak-Wieczorek, Ewelina; Małachowska-Sobieska, Monika; Synder, Marek

2016-03-23

Cerebrally palsied children demonstrated limited independence while performing various activities of daily living, which is due to disorders of postural control. The best solution to improve postural control is the use of therapies that simultaneously focus on the sense of balance and motor skills. Such possibilities for patients with cerebral palsy are offered, for example, by hippotherapy. To assess the influence of hippotherapy on body balance in the sitting position among children with cerebral palsy. The study enrolled thirty-nine children aged 6-12 years with GMFCS level 1 or 2 spastic diplegia or spastic hemiplegia. The participants were divided into an intervention group (n=19) and a control group (n=20). Children from the intervention group attended 30 minutes of hippotherapy once weekly for 12 consecutive weeks. The Sitting Assessment Scale (SAS) was used to assess the patients' posture and balance. Some children improved their posture and balance during the study. Generally, control of trunk and head position and function of arms were getting better, while footwork was the weakest. Hippotherapy has positive effects on the position and function of individual parts of the body, thus making it possible for cerebrally palsied children to improve posture and the ability to maintain balance in the sitting position.

Clinical Observation on Treatment of Spastic Cerebral Palsy with Tuina plus Music Therapy

Institute of Scientific and Technical Information of China (English)

马美美; 刘振寰; 赵勇; 罗冠君; 李诺; 招文健; 万瑞平; 韩丑萍

2009-01-01

目的:观察小儿推拿结合音乐疗法对改善痉挛型小儿脑性瘫痪患者踝关节活动度及下肢肌肉痉挛的作用.方法:对符合小儿脑性瘫痪诊断标准的286例痉挛型患儿,在背景音乐下进行通督循经点穴推拿、益肾健脾推拿、捏脊疗法、足底推拿、节段性推拿、促肌力恢复推拿及关节活动度推拿7种推拿治疗,每次25～30min,每日1～2次.30天为1个疗程.于治疗前后进行股内收肌角、足背屈角和综合痉挛量表(CompositeSpastic@Scale,CSS)评分,以评价疗效.结果:治疗前后足背屈角、股内收肌角、CSS评分统计学处理,差异有统计学意义(P<0.01).总体疗效为显效106例,有效172例,无效8例.结论:推拿结合音乐疗法治疗痉挛型小儿脑瘫,有滑利关节,松解肌腱挛缩,缓解肌肉痉挛作用,能改善剪刀步态和尖足步态.对患儿坐、跪、站、行大运动功能恢复有极积治疗作用.%Objective: To observe the effect oftuina plus music therapy on range of motion of ankle joints and muscle spasm of lower limbs in children with spastic cerebral palsy. Method:All of 286 cases that conformed to the diagnostic criteria of infantile cerebral palsy were treated with 7 types of tuina manipulations respectively to unblock the Governor Vessel, reinforce the kidney and strengthen the spleen, pinch along the spine, stimulate specific foot-reflex area and different spinal segments, accelerate recovery of muscle strength and increase joint range of motion, 25-30 rain each treatment, once or twice a day, 30 d constitute a course of treatment.After this, the efficacy on femoral medial adduction and dorsiflexion angle and composite spasticity score (CSS) was evaluated. Result: The statistical analysis showed significant differences in dorsiflexion and femoral medial adduction angle and CCS scores (P<0.01) after the treatments. Conclusion: Tuina plus music therapy can lubricate the joints, relax contraction of tendons, alleviate

Spatial patterns of whole brain grey and white matter injury in patients with occult spastic diplegic cerebral palsy.

Science.gov (United States)

Mu, Xuetao; Nie, Binbin; Wang, Hong; Duan, Shaofeng; Zhang, Zan; Dai, Guanghui; Ma, Qiaozhi; Shan, Baoci; Ma, Lin

2014-01-01

Spastic diplegic cerebral palsy (SDCP) is a common type of cerebral palsy (CP), which presents as a group of motor-impairment syndromes. Previous conventional MRI studies have reported abnormal structural changes in SDCP, such as periventricular leucomalacia. However, there are roughly 27.8% SDCP patients presenting normal appearance in conventional MRI, which were considered as occult SDCP. In this study, sixteen patients with occult SDCP and 16 age- and sex-matched healthy control subjects were collected and the data were acquired on a 3T MR system. We applied voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analysis to investigate whole brain grey and white matter injury in occult SDCP. By using VBM method, the grey matter volume reduction was revealed in the bilateral basal ganglia regions, thalamus, insula, and left cerebral peduncle, whereas the white matter atrophy was found to be located in the posterior part of corpus callosum and right posterior corona radiata in the occult SDCP patients. By using TBSS, reduced fractional anisotropy (FA) values were detected in multiple white matter regions, including bilateral white matter tracts in prefrontal lobe, temporal lobe, internal and external capsule, corpus callosum, cingulum, thalamus, brainstem and cerebellum. Additionally, several regions of white matter tracts injury were found to be significantly correlated with motor dysfunction. These results collectively revealed the spatial patterns of whole brain grey and white matter injury in occult SDCP.

Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by means of electrical stimulation

NARCIS (Netherlands)

Warnink-Kavelaars, Jessica; Vermeulen, Roland Jeroen; Becher, Jules Guilhelmus

2013-01-01

Background: Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is

Disruption of basal lamina components in neuromotor synapses of children with spastic quadriplegic cerebral palsy.

Directory of Open Access Journals (Sweden)

Karyn G Robinson

Full Text Available Cerebral palsy (CP is a static encephalopathy occurring when a lesion to the developing brain results in disordered movement and posture. Patients present with sometimes overlapping spastic, athetoid/dyskinetic, and ataxic symptoms. Spastic CP, which is characterized by stiff muscles, weakness, and poor motor control, accounts for ∼80% of cases. The detailed mechanisms leading to disordered movement in spastic CP are not completely understood, but clinical experience and recent studies suggest involvement of peripheral motor synapses. For example, it is recognized that CP patients have altered sensitivities to drugs that target neuromuscular junctions (NMJs, and protein localization studies suggest that NMJ microanatomy is disrupted in CP. Since CP originates during maturation, we hypothesized that NMJ disruption in spastic CP is associated with retention of an immature neuromotor phenotype later in life. Scoliosis patients with spastic CP or idiopathic disease were enrolled in a prospective, partially-blinded study to evaluate NMJ organization and neuromotor maturation. The localization of synaptic acetylcholine esterase (AChE relative to postsynaptic acetylcholine receptor (AChR, synaptic laminin β2, and presynaptic vesicle protein 2 (SV2 appeared mismatched in the CP samples; whereas, no significant disruption was found between AChR and SV2. These data suggest that pre- and postsynaptic NMJ components in CP children were appropriately distributed even though AChE and laminin β2 within the synaptic basal lamina appeared disrupted. Follow up electron microscopy indicated that NMJs from CP patients appeared generally mature and similar to controls with some differences present, including deeper postsynaptic folds and reduced presynaptic mitochondria. Analysis of maturational markers, including myosin, syntrophin, myogenin, and AChR subunit expression, and telomere lengths, all indicated similar levels of motor maturation in the two groups

United Cerebral Palsy

Science.gov (United States)

... your local affiliate Find your local affiliate United Cerebral Palsy United Cerebral Palsy (UCP) is a trusted resource for individuals with Cerebral Palsy and other disabilities and their networks. Individuals with ...

Energy expenditure in adults with cerebral palsy playing Wii Sports.

Science.gov (United States)

Hurkmans, Henri L; van den Berg-Emons, Rita J; Stam, Henk J

2010-10-01

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. Cross-sectional study. University medical center. Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study

Science.gov (United States)

Grøholt, Else-Karin; Eskild, Anne

2010-01-01

Objectives To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. Design Population based cohort study. Setting The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data were linked to the Norwegian Registry of Cerebral Palsy in Children born 1986-95, which was established on the basis of discharge diagnoses at all paediatric departments in Norway. Population All singletons without malformations born in Norway during 1986-95 and who survived the first year of life (n=543 064). Main outcome measure Cerebral palsy diagnosed before the age of 5 years. Results 988 children (1.8 in 1000) were diagnosed with cerebral palsy before the age of 5 years. In total, 11% (39/369) of the children with Apgar score of less than 3 at birth were diagnosed with cerebral palsy, compared with only 0.1% (162/179 515) of the children with Apgar score of 10 (odds ratio (OR) 53, 95% CI 35 to 80 after adjustment for birth weight). In children with a birth weight of 2500 g or more, those with an Apgar score of less than 4 were much more likely to have cerebral palsy than those who had an Apgar score of more than 8 (OR 125, 95% confidence interval 91 to 170). The corresponding OR in children weighing less than 1500 g was 5 (95% CI 2 to 9). Among children with Apgar score of less than 4, 10-17% in all birthweight groups developed cerebral palsy. Low Apgar score was strongly associated with each of the three subgroups of spastic cerebral palsy, although the association was strongest for quadriplegia (adjusted OR 137 for Apgar score 8, 95% CI 77 to 244). Conclusions Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the

Creative Dance Practice Improves Postural Control in a Child With Cerebral Palsy.

Science.gov (United States)

Stribling, Kate; Christy, Jennifer

2017-10-01

To investigate the effect of creative dance instruction on postural control and balance in an 11-year-old with spastic triplegic cerebral palsy, Gross Motor Function Classification Scale level II. We conducted 1-hour dance interventions twice weekly for 8 weeks, with a focus on somatosensory awareness and movement in all planes of motion. Computerized dynamic posturography using the SMART Balance Master/EquiTest (NeuroCom) was used to assess postural control and balance reactions before the first class and following the final class. Gains in standing stability, balance recovery, directional control, and endpoint excursion of movement were found. Participation in creative dance lessons appears to improve somatosensory effectiveness and postural control in a child with cerebral palsy. Dance is a fun way to improve balance and coordination. These interventions could be easily implemented into programs for children with cerebral palsy.

Lung vital capacity and oxygen saturation in adults with cerebral palsy

Directory of Open Access Journals (Sweden)

Lampe R

2014-12-01

Full Text Available Renée Lampe,1,2 Tobias Blumenstein,2 Varvara Turova,2 Ana Alves-Pinto2 1Markus Würth Stiftungsprofessur, Technical University of Munich, Munich, Germany; 2Research Unit for Cerebral Palsy and Children Neuroorthopaedics of the Buhl-Strohmaier Foundation, Orthopedic Department of the Clinic “rechts der Isar” of the Technical University of Munich, Munich, Germany Background: Individuals with infantile cerebral palsy have multiple disabilities. The most conspicuous syndrome being investigated from many aspects is motor movement disorder with a spastic gait pattern. The lung function of adults with spasticity attracts less attention in the literature. This is surprising because decreased thoracic mobility and longstanding scoliosis should have an impact on lung function. With increasing age and the level of disability, individuals become susceptible to lung infections and reflux illness, and these are accompanied by increased aspiration risk. This study examined, with different methods, to what extent adults with congenital cerebral palsy and acquired spastic paresis – following traumatic brain injury – showed restriction of lung function. It also assessed the contribution of disability level on this restriction.Methods: The oxygen saturation of 46 adults with a diagnosis of cerebral palsy was measured with an oximeter. Lung vital capacity was measured with a mobile spirometer and excursion of the thorax was clinically registered. The gross motor function levels and the presence or absence of scoliosis were determined.Results: A significantly positive correlation between lung vital capacity and chest expansion was established. Both the lung vital capacity and the thorax excursion decreased with increases in gross motor function level. Oxygen saturation remained within the normal range in all persons, in spite of reduced values of the measured lung parameters. No statistically significant dependency between lung vital capacity and oxygen

Cerebral Palsy (For Teens)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Cerebral Palsy KidsHealth / For Teens / Cerebral Palsy What's in this ... do just what everyone else does. What Is Cerebral Palsy? Cerebral palsy (CP) is a disorder of the ...

[Oral motor dysfunction, feeding problems and nutritional status in children with cerebral palsy].

Science.gov (United States)

Hou, Mei; Fu, Ping; Zhao, Jian-hui; Lan, Kun; Zhang, Hong

2004-10-01

This study was undertaken to investigate the clinical features of oral motor dysfunction and feeding problems as well as the nutritional status of children with cerebral palsy (CP). Fifty-nine CP children, 39 boys and 20 girls, mean age 31 months (20 to 72 months), were recruited. Their parents were interviewed for high risk factors and feeding history. Each case was assessed for oral motor and feeding problems based on oral motor and feeding skill score; for nutritional status by measurement of weight, height; neurologically for type of cerebral palsy and for developmental age by Gesell's developmental scale. Equal number of age and sex matched controls were included for comparison of nutritional status, oral motor and feeding skill score. Among 59 patients, 51 cases had oral motor dysfunction and 55 cases had feeding problems including all athtosis, spastic tetraplegia, and 16 had spastic diplegia. The scores of both the mean oral motor function and feeding skill of CP children were significantly lower than those of the controls (P children with cerebral palsy consisted of liquid and semisolid diet. Body weight and height below the 25th percentile were found in 13 cases and 19 cases, respectively. The majority of the children with cerebral palsy had oral motor dysfunction and feeding problems which appeared in early age and disturbed the growth and nutritional status. Thorough assessment for oral motor function, feeding problems and nutritional status of CP children is indicated in order to start timely rehabilitation and nutritional interventions which can significantly improve their nutritional status and quality of life.

Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking

DEFF Research Database (Denmark)

Streja, Elani; Miller, Jessica; Bech, Bodil H

2013-01-01

OBJECTIVE: The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP). STUDY DESIGN: We included the 81,066 mothers of singletons born between 1996...... and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: Self-reported vaginal...

Muscle growth is reduced in 15-month-old children with cerebral palsy

DEFF Research Database (Denmark)

Herskind, Anna; Ritterband-Rosenbaum, Anina; Willerslev-Olsen, Maria

2016-01-01

AimLack of muscle growth relative to bone growth may be responsible for development of contractures in children with cerebral palsy (CP). Here, we used ultrasonography to compare growth of the medial gastrocnemius muscle in children with and without CP.MethodTwenty-six children with spastic CP (15...

Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial.

Science.gov (United States)

Unger, Marianne; Jelsma, Jennifer; Stark, Christina

2013-01-01

This study aimed to determine whether strengthening trunk muscles using vibration can improve posture and gait in children with spastic-type cerebral palsy (STCP). A total of 27 children (6-13 years) participated in a single-blinded pre-post crossover experimental trial. The 1-Minute Walk Test, 2D-posturography, ultrasound imaging and sit-ups in one minute were used to assess effect on gait, posture, resting abdominal muscle thickness and functional strength. Significant increase in distance walked (p posture, an increase in sit-ups executed (p posture were maintained at 4-weeks post-intervention. A trunk-targeted intervention using vibration can improve posture and gait in children with STCP without any known side effects. It is recommended that vibration and specific trunk strengthening is included in training or rehabilitation programmes. Effects of vibration on force generation and spasticity need further investigation.

Cerebral Palsy

Science.gov (United States)

Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...

MRI of patients with cerebral palsy and normal CT scan

International Nuclear Information System (INIS)

Bogaert, P. van; Szliwowski, H.B.

1992-01-01

Three children with clinical evidence of cerebral palsy (CP) and normal cerebral computed tomography (CT) scans were evaluated by magnetic resonance imaging (MRI) to identify CT-undetectable white matter lesions in the watershed zones of arterial territories. The two patients with spastic diplegia showed bilateral lesions either in the subcortical regions or in the occipital periventricular regions. The patient with congenital hemiplegia exhibited unilateral lesions in the periventricular region. We conclude that MRI is more informative than CT for the evaluation of patients with CP. (orig.)

MRI of patients with cerebral palsy and normal CT scan

Energy Technology Data Exchange (ETDEWEB)

Bogaert, P. van; Szliwowski, H.B. (Hopital Erasme, Brussels (Belgium). Dept. of Neurology); Baleriaux, D.; Christophe, C. (Hopital Erasme, Brussels (Belgium). Dept. of Radiology (Neuroradiology))

1992-02-01

Three children with clinical evidence of cerebral palsy (CP) and normal cerebral computed tomography (CT) scans were evaluated by magnetic resonance imaging (MRI) to identify CT-undetectable white matter lesions in the watershed zones of arterial territories. The two patients with spastic diplegia showed bilateral lesions either in the subcortical regions or in the occipital periventricular regions. The patient with congenital hemiplegia exhibited unilateral lesions in the periventricular region. We conclude that MRI is more informative than CT for the evaluation of patients with CP. (orig.).

Birth Defects: Cerebral Palsy

Science.gov (United States)

... Loss > Birth defects & other health conditions > Cerebral palsy Cerebral palsy E-mail to a friend Please fill in ... this page It's been added to your dashboard . Cerebral palsy (also called CP) is a group of conditions ...

Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy

NARCIS (Netherlands)

De Gooijer-van de Groep, K.L.; De Vlugt, E.; De Groot, J.H.; Van der Heijden-Maessen, H.C.M.; Wielheesen, D.H.M.; Van Wijlen-Hempel, R.M.S.; Arendzen, J.H.; Meskers, C.G.M.

2013-01-01

Background Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: “spasticity” vs. “contracture”).

Neurorehabilitation with versus without resistance training after botulinum toxin treatment in children with cerebral palsy

DEFF Research Database (Denmark)

Bandholm, Thomas Quaade; Jensen, Bente Rona; Nielsen, Lone M

2012-01-01

Objective: To compare the effects of physical rehabilitation with (PRT) and without (CON) progressive resistance training following treatment of spastic plantarflexors with botulinum toxin type A (BoNT) in children with cerebral palsy (CP). Methods: Fourteen children with CP performed supervised...

Employees with Cerebral Palsy

Science.gov (United States)

... Resources Home | Accommodation and Compliance Series: Employees with Cerebral Palsy (CP) By Eddie Whidden, MA Preface Introduction Information ... SOAR) at http://AskJAN.org/soar. Information about Cerebral Palsy (CP) What is CP? Cerebral palsy is a ...

Efficacy of Repeated Botulinum Toxin Type A Injections for Spastic Equinus in Children with Cerebral Palsy-A Secondary Analysis of the Randomized Clinical Trial.

Science.gov (United States)

Hong, Bo Young; Chang, Hyun Jung; Lee, Sang-Jee; Lee, Soyoung; Park, Joo Hyun; Kwon, Jeong-Yi

2017-08-21

Botulinum toxin A is considered an important tool to control spasticity in children with cerebral palsy. Several factors are known to affect the efficacy of botulinum toxin, such as dosage, appropriate muscle selection and application, age, and accompanying therapy. A multicenter, double-blind, randomized, prospective phase III clinical trial of botulinum toxin A for the treatment of dynamic equinus in 144 children with cerebral palsy was performed to compare the efficacies of letibotulinumtoxin A and onabotulinumtoxin A. Secondary analyses were performed to evaluate factors that affected the outcome, focusing on the number of times injections were repeated. Effectiveness was defined as a change of 2 or more in the physician's rating scale. Multivariate regression analyses were performed with multiple variables. The first injection of botulinum toxin A significantly improved D subscale of Gross Motor Function Measure-88 scores at 3 months compared to repeated injections ( p < 0.05). After 6 months, patients who had one injection or none before the study showed significantly better outcomes than those who had more than one injection in terms of observational gait scores.

Effects of a Supported Speed Treadmill Training Exercise Program on Impairment and Function for Children with Cerebral Palsy

Science.gov (United States)

Johnston, Therese E.; Watson, Kyle E.; Ross, Sandy A.; Gates, Philip E.; Gaughan, John P.; Lauer, Richard T.; Tucker, Carole A.; Engsberg, Jack R.

2011-01-01

Aim: To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function. Method: Twenty-six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n =…

Interception of moving objects while walking in children with spastic hemiparetic cerebral palsy.

Science.gov (United States)

Ricken, Annieck X C; Savelsbergh, G J P; Bennett, S J

2007-01-15

The purpose of the study was to examine the coordination of reaching and walking behaviour when children with Spastic Hemiparetic Cerebral Palsy (SHCP) intercept an approaching and hence externally-timed object. Using either the impaired or non-impaired arm, children intercepted a ball approaching from a fixed distance with one of three velocities. Each participant's initial starting position was scaled to their maximum walking velocity determined prior to testing; for the medium ball velocity, participants would arrive at the point of interception at the correct time if they walked with their maximum velocity. Children with SHCP adapted their reaching and walking behaviour to the different ball approach velocities. These adaptations were exhibited when using the impaired and non-impaired arm, and resulted in similar outcome performance irrespective of which arm was used. Still, children with SHCP found it necessary to increase trunk movement to compensate for the decreased elbow excursion and a decreased peak velocity of the impaired arm. Children with SHCP exhibited specific adaptations to their altered movement capabilities when performing a behaviourally-realistic task. The provision of an external timing constraint appeared to facilitate both reaching and walking movements and hence could represent a useful technique in rehabilitation.

A pilot single-blind multicentre randomized controlled trial to evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on the arm function of children with spastic cerebral palsy.

Science.gov (United States)

Preston, Nick; Weightman, Andrew; Gallagher, Justin; Levesley, Martin; Mon-Williams, Mark; Clarke, Mike; O'Connor, Rory J

2016-10-01

To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy. A single-blind randomized controlled trial design. Power calculations indicated that 58 children would be required to demonstrate a clinically important difference. Intervention was home-based; recruitment took place in regional spasticity clinics. A total of 15 children with cerebral palsy aged five to 12 years were recruited; eight to the device group. Both study groups received 'usual follow-up treatment' following spasticity treatment with botulinum toxin; the intervention group also received a rehabilitation gaming device. ABILHAND-kids and Canadian Occupational Performance Measure were performed by blinded assessors at baseline, six and 12 weeks. An analysis of covariance showed no group differences in mean ABILHAND-kids scores between time points. A non-parametric analysis of variance on Canadian Occupational Performance Measure scores showed a statistically significant improvement across time points (χ 2 (2,15) = 6.778, p = 0.031), but this improvement did not reach minimal clinically important difference. Mean daily device use was seven minutes. Recruitment did not reach target owing to unanticipated staff shortages in clinical services. Feedback from children and their families indicated that the games were not sufficiently engaging to promote sufficient use that was likely to result in functional benefits. This study suggests that computer-assisted arm rehabilitation gaming does not benefit arm function, but a Type II error cannot be ruled out. © The Author(s) 2015.

THE INFLUENCE OF COMBINATION NON-MEDICAL TREATMENT INCLUDING FUNCTIONAL PROGRAMMED ELECTRICAL STIMULATION ON THE CLINICAL AND INSTRUMENTAL PARAMETERS IN PATIENTS WITH CEREBRAL PALSY WITH SPASTIC DIPLEGIA

Directory of Open Access Journals (Sweden)

V. V. Eliseev

2015-01-01

Full Text Available Background: Cerebral palsy is the leading cause of physical disability in pediatric  age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part  of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had  been  randomized  into two groups  depending on the type of treatment. In  the  first group,  the  patients  (n = 38 received a course of functional programmed electric stim- ulation  in combination with  other  non-medical treatment  methods.  The  second   group   (n = 33 underwent a usual  course  of electrical  stimula- tion in combination with non-medical  treatment, similar to that  in the first group. The third group (control   included   41   children   without    cere- bral palsy. Clinical and  instrumental parameters were  assessed  in all study  participants. Results: After the course of combination treatment in the group  1, the  tonus  of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group  of femur muscles by 43%, adductor group of femur muscles by 36%. In the group  2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power  endurance was  increased  signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps  by 19.8 and 7.2 sec, of m. anterior  tibialis by 12.1 and 4.6 sec, respec- tively. After the  treatment, the  active movement volume in the large joints of lower extremities  in the group 1 patients  improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by

Threshold values of ankle dorsiflexion and gross motor function in 60 children with cerebral palsy

DEFF Research Database (Denmark)

Rasmussen, Helle M; Svensson, Joachim; Thorning, Maria

2018-01-01

Background and purpose - Threshold values defining 3 categories of passive range of motion are used in the Cerebral Palsy follow-Up Program to guide clinical decisions. The aim of this study was to investigate the threshold values by testing the hypothesis that passive range of motion in ankle...... dorsiflexion is associated with gross motor function and that function differs between the groups of participants in each category. Patients and methods - We analyzed data from 60 ambulatory children (aged 5-9 years) with spastic cerebral palsy. Outcomes were passive range of motion in ankle dorsiflexion...... with flexed and extended knee and gross motor function (Gait Deviation Index, Gait Variable Score of the ankle, peak dorsiflexion during gait, 1-minute walk, Gross Motor Function Measure, the Pediatric Quality of Life Inventory Cerebral Palsy Module, and Pediatric Outcomes Data Collection Instrument). Results...

Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy

OpenAIRE

Shin, Ji-won; Song, Gui-bin; Hwangbo, Gak

2015-01-01

[Purpose] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy. [Subjects] Sixteen children (9 males, 7 females) with spastic diplegic cerebral palsy were recruited and randomly assigned to the conventional neurological physical therapy group (CG) and virtual reality training group (VRG). [Methods] Eight children in the control group performed 45 minutes of th...

Neuroimpairment, activity limitation, and participation restriction among children with cerebral palsy in Hong Kong.

Science.gov (United States)

Chan, H S S; Lau, P H B; Fong, K H; Poon, D; Lam, C C C

2005-10-01

To study children with cerebral palsy in Hong Kong, their neuroimpairment, activity limitation, and participation restriction in society. Parents' opinion on current medical and rehabilitation services was also sought. Systematic survey using questionnaires. Four associations in Hong Kong: Child Assessment Service, Hong Kong Association for Parents of Children with Physical Disabilities, Association of Parents of the Severely Mentally Handicapped, and Hong Kong Physically Handicapped and Able-Bodied Association. Parents of children with cerebral palsy. Neuroimpairment, activity limitation, and participation restriction. Information from 181 children with cerebral palsy was analysed. Among them, 56% were boys. The mean age was 7 years 6 months (standard deviation, 3 years 11 months). The most common diagnostic type was spastic cerebral palsy. Co-morbidities in children with cerebral palsy were common. Limitation in daily activities including mobility and self-care tasks was considerable and this posed great stress to parents when taking care of their children. Children's participation in both social and leisure activities was regarded as a low priority. A high percentage (70%) of parents reported difficulty in travelling. The reasons involved problems in transportation, building access (entry and exit), and attitudes of the general public. These environmental factors restricted the social participation of the children and their families. Over 75% of parents were satisfied with the current medical and rehabilitation services. Children with cerebral palsy have multiple and complex needs. The findings of this study may serve as a reference for parents, service providers, and policy makers to work in partnership to achieve a more comprehensive health-care service for children with cerebral palsy and to facilitate better integration into the community.

Stair-shaped Achilles tendon lengthening in continuity - A new method to treat equinus deformity in patients with spastic cerebral palsy.

Science.gov (United States)

Li, Zhengxun; Zhang, Ning; Wang, Yang; Cao, Songhua; Huang, Zheng; Hu, Yong

2017-10-27

Equinus of the ankle is a common deformity in spastic cerebral palsy. Achilles tendon lengthening is one of the effective options for the treatment of equinus deformity. In the study, a new stair-shaped Achilles tendon lengthening (ATL) procedure that preserves of the tendon continuity was performed in 28 tendons with equinus deformity (20 patients, mean age=10.5±2.6 years). The results were compared with a group of patients treated with the Z-lengthening procedure. During the latest follow-up visit, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale score was much higher in the stair-shaped ATL group than in the Z-lengthening group (pantigravity stability and quicker recovery in patients. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Nanomedicine in cerebral palsy

Science.gov (United States)

Balakrishnan, Bindu; Nance, Elizabeth; Johnston, Michael V; Kannan, Rangaramanujam; Kannan, Sujatha

2013-01-01

Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the developing brain that occurs either in utero or soon after birth can result in the motor, sensory, and cognitive deficits seen in cerebral palsy. Although the etiologies for cerebral palsy are variable, neuroinflammation plays a key role in the pathophysiology of the brain injury irrespective of the etiology. Currently, there is no effective cure for cerebral palsy. Nanomedicine offers a new frontier in the development of therapies for prevention and treatment of brain injury resulting in cerebral palsy. Nanomaterials such as dendrimers provide opportunities for the targeted delivery of multiple drugs that can mitigate several pathways involved in injury and can be delivered specifically to the cells that are responsible for neuroinflammation and injury. These materials also offer the opportunity to deliver agents that would promote repair and regeneration in the brain, resulting not only in attenuation of injury, but also enabling normal growth. In this review, the current advances in nanotechnology for treatment of brain injury are discussed with specific relevance to cerebral palsy. Future directions that would facilitate clinical translation in neonates and children are also addressed. PMID:24204146

Dental trauma in individuals with severe cerebral palsy: prevalence and associated factors

Directory of Open Access Journals (Sweden)

Cristina Batista Miamoto

2011-08-01

Full Text Available The aim of the present study was to determine the prevalence of dental trauma and associated factors among a sample of patients with severe cerebral palsy. The sample was made up of 120 individuals equally divided into two groups. The group with cerebral palsy was made up of 60 patients diagnosed with the spastic form of the disease. The control group was made up of 60 individuals with no mental impairment. Questionnaires were used to collect information on individual, socioeconomic and behavioral characteristics. Dental trauma was assessed based on the clinical chart of each participant, on a questionnaire and on a clinical evaluation to determine past injuries. Mouth mirrors and millimeter periodontal probes (Community Periodontal Index probe were used to measure overjet. Lip seal and breathing type were determined during the clinical exams and interviews. Statistical analysis involved the chi-square test (p < 0.05 and multivariate logistic regression (forward stepwise procedure. The prevalence of dental trauma was greater among individuals with cerebral palsy (18% than in the control group (5%, with the difference achieving statistical significance (p = 0.023. Individuals with lip incompetence had a greater chance of exhibiting dental trauma (OR [CI 95%] = 3.81 [1.19-12.24]. The prevalence of dental trauma among individuals with cerebral palsy was high. A lack of lip seal was identified as a factor directly associated to this prevalence.

The Influence of Age at Single-Event Multilevel Surgery on Outcome in Children with Cerebral Palsy Who Walk with Flexed Knee Gait

Science.gov (United States)

Svehlik, Martin; Steinwender, Gerhard; Kraus, Tanja; Saraph, Vinay; Lehmann, Thomas; Linhart, Wolfgang E.; Zwick, Ernst B.

2011-01-01

Aim: Information on the timing and long-term outcome of single-event multilevel surgery in children with bilateral spastic cerebral palsy (CP) walking with flexed knee gait is limited. Based on our clinical experience, we hypothesized that older children with bilateral spastic CP would benefit more from single-event multilevel surgery than younger…

OPTIMIZATION OF EARLY PHYSICAL REHABILITATION OF PATIENTS WITH SPASTIC INFANTILE CEREBRAL PALSIES

Directory of Open Access Journals (Sweden)

G. S. Lupandina-Bolotova

2014-01-01

Full Text Available Infantile cerebral palsy is an urgent issue of pediatric neurology all over the world. Adequate choice of the term and methods of rehabilitation helps children with this pathology to adapt to the society and improves prognosis of motor and mental development thereof. The article presents the optimal methods of physical rehabilitation at early stages of a child’s development based on the current understanding of neuroplasticity, reserve capabilities of a developing brain, as well as of pathophysiological aspects of recovery and compensation of the damaged structures of the central nervous system. The authors demonstrate crucial differences between approaches to rehabilitation of children under and over 2 years of age. Despite the selected methods of rehabilitation of children with infantile cerebral palsy, successful results of the therapy require a multidisciplinary approach characterized by early onset, balanced combination of methods of physical rehabilitation and drug therapy, physiotherapy and psychological-pedagogic support. 

Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study.

Science.gov (United States)

Bleyenheuft, Yannick; Dricot, Laurence; Gilis, Nathalie; Kuo, Hsing-Ching; Grandin, Cécile; Bleyenheuft, Corinne; Gordon, Andrew M; Friel, Kathleen M

2015-01-01

Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP. Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The effect of botulinum toxin A (Botox) injections used to treat limb spasticity on speech patterns in children with dysarthria and cerebral palsy: A report of two cases.

Science.gov (United States)

Workinger, Marilyn Seif; Kent, Raymond D; Meilahn, Jill R

2017-05-19

Botulinum toxin A (Btx-A) injections are used to treat limb spasticity in children with cerebral palsy (CP) resulting in improved gross and fine motor control. This treatment has also been reported to have additional functional effects, but the effect of treatment on speech has not been reported. This report presents results of longitudinal speech evaluation of two children with CP given injections of Btx-A for treatment of limb spasticity. Speech evaluations were accomplished at baseline (date of injections) and 4- and 10-weeks post-injections. Improvements in production of consonants, loudness control, and syllables produced per breath were found. Parental survey also suggested improvements in subjects' speech production and willingness to speak outside the testing situation. Future larger studies are warranted to assess the nature of the changes observed related to Btx-A.

Three Case Reports of Successful Vibration Therapy of the Plantar Fascia for Spasticity Due to Cerebral Palsy-Like Syndrome, Fetal-Type Minamata Disease.

Science.gov (United States)

Usuki, Fusako; Tohyama, Satsuki

2016-04-01

Fetal-type Minamata disease is caused by the exposure to high concentrations of methylmercury in the fetal period and shows cerebral palsy-like clinical features. Relief of spasticity is a major task of rehabilitation to improve their activities of daily living. Here we report the effect of long-term vibration therapy on bilateral lower-limb spasticity in 3 patients with fetal-type Minamata disease. We used a simple, inexpensive, and noninvasive approach with hand-held vibration massagers, which were applied to the plantar fascia at 90 Hz for 15 minutes. The effect was observed soon after the first treatment and resulted in better performance of the repetitive facilitation. Vibration therapy for 1 year improved Modified Ashworth Scale for the ankle flexors in 2 cases. The labored gait improved and gait speed increased in another case. Continued vibration therapy for another 1 year further improved Modified Ashworth Scale score and range of motion of ankle dorsiflexion in 1 case. This case showed the decreased amplitude of soleus H-reflex after the 15-minute vibration therapy, suggesting that α-motor neuron excitability was suppressed. Vibration therapy using a hand-held vibration massager may offer safe and effective treatment for lower-limb spasticity in patients with chronic neurological disorders.

Therapeutic interventions in cerebral palsy.

Science.gov (United States)

Patel, Dilip R

2005-11-01

Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy.

Changes in Trunk and Head Stability in Children with Cerebral Palsy after Hippotherapy: A Pilot Study

Science.gov (United States)

Shurtleff, Tim L.; Engsberg, Jack R.

2010-01-01

Hippotherapy (HPOT) is a therapy that uses horse movement. This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a…

Nanomedicine in cerebral palsy

Directory of Open Access Journals (Sweden)

Balakrishnan B

2013-11-01

Full Text Available Bindu Balakrishnan,1 Elizabeth Nance,1 Michael V Johnston,2 Rangaramanujam Kannan,3 Sujatha Kannan1 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; Baltimore, MD, USA; 2Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA; 3Department of Ophthalmology, Center for Nanomedicine, Johns Hopkins University, Baltimore, MD, USA Abstract: Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the developing brain that occurs either in utero or soon after birth can result in the motor, sensory, and cognitive deficits seen in cerebral palsy. Although the etiologies for cerebral palsy are variable, neuroinflammation plays a key role in the pathophysiology of the brain injury irrespective of the etiology. Currently, there is no effective cure for cerebral palsy. Nanomedicine offers a new frontier in the development of therapies for prevention and treatment of brain injury resulting in cerebral palsy. Nanomaterials such as dendrimers provide opportunities for the targeted delivery of multiple drugs that can mitigate several pathways involved in injury and can be delivered specifically to the cells that are responsible for neuroinflammation and injury. These materials also offer the opportunity to deliver agents that would promote repair and regeneration in the brain, resulting not only in attenuation of injury, but also enabling normal growth. In this review, the current advances in nanotechnology for treatment of brain injury are discussed with specific relevance to cerebral palsy. Future directions that would facilitate clinical translation in neonates and children are also addressed. Keywords: dendrimer, cerebral palsy, neuroinflammation, nanoparticle, neonatal brain injury, G4OH-PAMAM

Use of Hybrid Assistive Limb (HAL®) for a postoperative patient with cerebral palsy: a case report.

Science.gov (United States)

Mataki, Yuki; Kamada, Hiroshi; Mutsuzaki, Hirotaka; Shimizu, Yukiyo; Takeuchi, Ryoko; Mizukami, Masafumi; Yoshikawa, Kenichi; Takahashi, Kazushi; Matsuda, Mayumi; Iwasaki, Nobuaki; Kawamoto, Hiroaki; Wadano, Yasuyoshi; Sankai, Yoshiyuki; Yamazaki, Masashi

2018-03-27

The Hybrid Assistive Limb (HAL ® ) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery. We report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased. Hybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting.

The validity and reliability of modelled neural and tissue properties of the ankle muscles in children with cerebral palsy

NARCIS (Netherlands)

Sloot, L.H.; van der Krogt, M.M.; de Gooijer-van Groep, K.; van Eesbeek, S.; de Groot, J.; Buizer, A.I.; Meskers, C.; Becher, J.G.; de Vlugt, E.; Harlaar, J.

2015-01-01

Spastic cerebral palsy (CP) is characterized by increased joint resistance, caused by a mix of increased tissue stiffness, as well as involuntary reflex and background muscle activity. These properties can be quantified using a neuromechanical model of the musculoskeletal complex and instrumented

Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy.

Science.gov (United States)

Shin, Yoon Kyum; Lee, Dong Ryul; Kim, Do Hyun; Lee, Jae Jin; You, Sung Joshua Hyun; Yi, Chung Hwi; Jeon, Hye Seon

2014-01-01

Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP.

Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy

NARCIS (Netherlands)

Dallmeijer, A.J.; Baker, R.; Dodd, K.; Taylor, N.

2011-01-01

The purpose of this study was to determine the association between isometric muscle strength of the lower limbs and gait joint kinetics in adolescents and young adults with cerebral palsy (CP). Twenty-five participants (11 males) with bilateral spastic CP, aged 14-22 years (mean: 18.9, sd: 2.0. yr)

What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR).

Science.gov (United States)

Jahan, Israt; Muhit, Mohammad; Karim, Tasneem; Smithers-Sheedy, Hayley; Novak, Iona; Jones, Cheryl; Badawi, Nadia; Khandaker, Gulam

2018-04-16

To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. 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. 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. 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

[Advances in genetic research of cerebral palsy].

Science.gov (United States)

Wang, Fang-Fang; Luo, Rong; Qu, Yi; Mu, De-Zhi

2017-09-01

Cerebral palsy is a group of syndromes caused by non-progressive brain injury in the fetus or infant and can cause disabilities in childhood. Etiology of cerebral palsy has always been a hot topic for clinical scientists. More and more studies have shown that genetic factors are closely associated with the development of cerebral palsy. With the development and application of various molecular and biological techniques such as chromosome microarray analysis, genome-wide association study, and whole exome sequencing, new achievements have been made in the genetic research of cerebral palsy. Chromosome abnormalities, copy number variations, susceptibility genes, and single gene mutation associated with the development of cerebral palsy have been identified, which provides new opportunities for the research on the pathogenesis of cerebral palsy. This article reviews the advances in the genetic research on cerebral palsy in recent years.

Effectiveness of functional progressive resistance exercise training on walking ability in children with cerebral palsy: A randomized controlled trial

NARCIS (Netherlands)

Scholtes, V.A.; Becher, J.G.; Janssen-Potten, Y.J.; Dekkers, H.; Smallenbroek, L.; Dallmeijer, A.J.

2012-01-01

The objective of the study was to evaluate the effectiveness of functional progressive resistance exercise (PRE) training on walking ability in children with cerebral palsy (CP).Fifty-one ambulant children with spastic CP (mean age 10 years 5 months, 29 boys) were randomized to an intervention (n=

The Effect of Hydrotherapy on Health of Cerebral Palsy Patients: An Integrative Review

Directory of Open Access Journals (Sweden)

Masoud Khalaji

2017-06-01

Discussion: The results of the review showed that hydrotherapy when applied along with other conventional methods of rehabilitation, exerts positive effects on all areas of ICF. Hydrotherapy can be used in children and adolescents with spastic diplegia cerebral palsy, but the exercises chosen must be in accordance with the physical and cognitive conditions of the patients. However, studies in some areas of ICF are limited and further studies in this field are felt.

Planning of surgical treatment of upper extremity in patients with cerebral palsy

Directory of Open Access Journals (Sweden)

V. V. Umnov

2013-01-01

Full Text Available The purpose - to devise the algorithm of patient examination with spastic hand to determine what the variant of surgical treatment is indicated. The variant of surgical treatment and it's results are depend on the cause of upper extremity deformation. Materials and methods. This study is based on a survey of children with cerebral palsy with lesions of the upper extremity. The main criterion for the selection of patients was the presence of the combined lesion of the upper extremity, where the cause of dysfunction hands are not only fixed contractures, but primary tonic. Was to survey 47 patients with spastic forms of cerebral palsy with the defeat of the upper limb, but the study group included only 26 of them in the ages of 7 to 18 years (average 12,1, as having the clinical picture both types of contractures. We have developed and applied a system of examinations, modeling expected outcome of selective neurotomy motor nerves of the upper limb, which allows to estimate the possible result of such treatment, and clearly differentiate tonic and fixed contracture. Results and conclusions. Based on the results of study we supposed that, using diagnostic blockade motor nerve at the period of planning surgical treatment help us to create temporary reversible model of selective neurotomy motor nerve branches and identify the type of contracture, degree of manifestation and functional perspective.

Feasibility and reliability of measuring strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy

NARCIS (Netherlands)

De Groot, Sonja; Janssen, Thomas W. J.; Evers, Marijn; Van der Luijt, Pieter; Nienhuys, Kirsten N. G.; Dallmeijer, Annet J.

Aim The aim of this study was to analyse the feasibility and reliability of the tests used to determine muscle strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy (CP). Methods Twenty individuals with spastic CP (four females, 16 males; age range 1849y;

The Impact of Cranios acral Therapy on Inhibition of Hypertonicity of the Lower Limb in Children with Dipelgia Spastic Cerebral Palsy of 3-8 Years Old

Directory of Open Access Journals (Sweden)

Ebrahim Pishyareh

2001-01-01

Full Text Available Objective: The purpose of this study was to assess the facilitating impact of craniosacral therapy on inhibition of hypertonicity of the lower limb in children with spastic dipelgic cerebral palsy. Materials & Methods: 100 children with cerebral palsy were studied and 36 children selected, aged 3 to 8 years, were randomly assigned to a control and an experimental group. Muscle tone was assessed using modified Ashworth scale, passive range of motion by goniometer, neurodevelopment level by Bobath scale. All children were Pre-Post-tested with in an interval of three months. Results: A further finding of the analyses revealed that significant reduction was observed in hypertonicity of the hip adductors and the ankle plantar flexors. Significant increase was observed in passive range of motion of the hip abduction and the ankle dorsiflexion. There was found no significant difference of reduction in hypertonicity of the knee flexors, of increase in passive range of motion of the knee extensor, of improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip adductors and improvement of the neurodevelopmental level. Conclusion: It should be mentioned that in all above cases the was set at 5%. Implications for clinical O.T. are mentioned.

Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy.

Science.gov (United States)

El-Shamy, Shamekh Mohamed; Abd El Kafy, Ehab Mohamed

2014-01-01

The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Thirty spastic diplegic cerebral palsied children (10-12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30 min/d, 3 d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p control group (p postural balance control in children with diplegic cerebral palsy.

Splint: The efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

NARCIS (Netherlands)

Maas, J.C.; Dallmeijer, A.J.; Huijing, P.A.; Brunstrom-Hernandez, J.E; van Kampen, P.J.; Jaspers, R.T.; Becher, J.G.

2012-01-01

Background: Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP). Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range

Flexed-knee gait in children with cerebral palsy.

Science.gov (United States)

Church, C; Ge, J; Hager, S; Haumont, T; Lennon, N; Niiler, T; Hulbert, R; Miller, F

2018-04-01

Aims The purpose of this study was to evaluate the long-term outcome of adolescents with cerebral palsy who have undergone single-event multilevel surgery for a flexed-knee gait, followed into young adulthood using 3D motion analysis. Patients and Methods A total of 59 young adults with spastic cerebral palsy, with a mean age of 26 years (sd 3), were enrolled into the study in which their gait was compared with an evaluation that had taken place a mean of 12 years (sd 2) previously. At their visits during adolescence, the children walked with excessive flexion of the knee at initial contact and surgical or therapeutic interventions were not controlled between visits. Results Based on the change in flexed-knee gait over approximately ten years, improvements were seen in increased Gait Deviation Index (p gait (p = 0.007) suggested a mild decline in function. Quality-of-life measures showed that these patients fell within normal limits compared with typical young adults in areas other than physical function. Conclusion While some small significant changes were noted, little clinically significant change was seen in function and gait, with gross motor function maintained between adolescence and young adulthood. Cite this article: Bone Joint J 2018;100-B:549-56.

Feasibility and reliability of measuring strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy

NARCIS (Netherlands)

de Groot, S.; Janssen, T.W.J.; Evers, M.; Van der Luijt, P.; Nienhuys, K.N.G.; Dallmeijer, A.J.

2012-01-01

Aim The aim of this study was to analyse the feasibility and reliability of the tests used to determine muscle strength, sprint power, and aerobic capacity in athletes and non-athletes with cerebral palsy (CP). Methods Twenty individuals with spastic CP (four females, 16 males; age range 18-49y;

Muscle activation patterns when passively stretching spastic lower limb muscles of children with cerebral palsy.

Directory of Open Access Journals (Sweden)

Lynn Bar-On

Full Text Available The definition of spasticity as a velocity-dependent activation of the tonic stretch reflex during a stretch to a passive muscle is the most widely accepted. However, other mechanisms are also thought to contribute to pathological muscle activity and, in patients post-stroke and spinal cord injury can result in different activation patterns. In the lower-limbs of children with spastic cerebral palsy (CP these distinct activation patterns have not yet been thoroughly explored. The aim of the study was to apply an instrumented assessment to quantify different muscle activation patterns in four lower-limb muscles of children with CP. Fifty-four children with CP were included (males/females n = 35/19; 10.8 ± 3.8 yrs; bilateral/unilateral involvement n =  32/22; Gross Motor Functional Classification Score I-IV of whom ten were retested to evaluate intra-rater reliability. With the subject relaxed, single-joint, sagittal-plane movements of the hip, knee, and ankle were performed to stretch the lower-limb muscles at three increasing velocities. Muscle activity and joint motion were synchronously recorded using inertial sensors and electromyography (EMG from the adductors, medial hamstrings, rectus femoris, and gastrocnemius. Muscles were visually categorised into activation patterns using average, normalized root mean square EMG (RMS-EMG compared across increasing position zones and velocities. Based on the visual categorisation, quantitative parameters were defined using stretch-reflex thresholds and normalized RMS-EMG. These parameters were compared between muscles with different activation patterns. All patterns were dominated by high velocity-dependent muscle activation, but in more than half, low velocity-dependent activation was also observed. Muscle activation patterns were found to be both muscle- and subject-specific (p<0.01. The intra-rater reliability of all quantitative parameters was moderate to good. Comparing RMS-EMG between

The Effects of a Music and Movement Program on Gait, Balance and Psychological Parametres of Adults with Cerebral Palsy

Science.gov (United States)

Efraimidou, Vasiliki; Sidiropoulou, Maria; Giagazoglou, Paraskevi; Proios, Miltiadis; Tsimaras, Vasileios; Orologas, Anastasios

2016-01-01

The purpose of this investigation was to examine the effect of a music and movement intervention program on gait, balance and psychological parameters of 10 male athletes in throwing events (ball and disc) with Cerebral Palsy (CP) (spastic hemiplegia), all coming from a sport club in Thessaloniki. Participants were divided randomly by methodical…

Overview of Four Functional Classification Systems Commonly Used in Cerebral Palsy

Directory of Open Access Journals (Sweden)

Andrea Paulson

2017-04-01

Full Text Available Cerebral palsy (CP is the most common physical disability in childhood. CP comprises a heterogeneous group of disorders that can result in spasticity, dystonia, muscle contractures, weakness and coordination difficulty that ultimately affects the ability to control movements. Traditionally, CP has been classified using a combination of the motor type and the topographical distribution, as well as subjective severity level. Imprecise terms such as these tell very little about what a person is able to do functionally and can impair clear communication between providers. More recently, classification systems have been created employing a simple ordinal grading system of functional performance. These systems allow a more precise discussion between providers, as well as better subject stratification for research. The goal of this review is to describe four common functional classification systems for cerebral palsy: the Gross Motor Function Classification System (GMFCS, the Manual Ability Classification System (MACS, the Communication Function Classification System (CFCS, and the Eating and Drinking Ability Classification System (EDACS. These measures are all standardized, reliable, and complementary to one another.

Sit-to-Stand Movement in Children with Hemiplegic Cerebral Palsy: Relationship with Knee Extensor Torque and Social Participation

Science.gov (United States)

dos Santos, Adriana Neves; Pavao, Silvia Leticia; Santiago, Paulo Roberto Pereira; Salvini, Tania de Fatima; Rocha, Nelci Adriana Cicuto Ferreira

2013-01-01

This study aimed to investigate the relationship between sit-to-stand (STS) movement, knee extensor torque and social participation in children with cerebral palsy (CP). Seven spastic hemiplegic CP patients (8.0 plus or minus 2.2 years), classified by the Gross Motor Function Classification System as I and II, and 18 typical children (8.4 plus or…

Auditory Selective Attention in Cerebral-Palsied Individuals.

Science.gov (United States)

Laraway, Lee Ann

1985-01-01

To examine differences between auditory selective attention abilities of normal and cerebral-palsied individuals, 23 cerebral-palsied and 23 normal subjects (5-21) were asked to repeat a series of 30 items in presence of intermittent white noise. Results indicated that cerebral-palsied individuals perform significantly more poorly when the…

Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI)

NARCIS (Netherlands)

Salavati, M.; Rameckers, E.A.A.; Steenbergen, B.; Schans, C.P. van der

2014-01-01

Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method: Data

Gross motor function, functional skills and caregiver assistance in children with spastic cerebral palsy (CP) with and without cerebral visual impairment (CVI)

NARCIS (Netherlands)

Salavati, Masoud; Rameckers, E.A.A.; Steenbergen, B.; van der Schans, Cees

2014-01-01

Abstract Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method:

Early results of surgical intervention for elbow deformity in cerebral palsy based on degree of contracture.

Science.gov (United States)

Carlson, Michelle G; Hearns, Krystle A; Inkellis, Elizabeth; Leach, Michelle E

2012-08-01

Elbow flexion posture, caused by spasticity of the muscles on the anterior surface of the elbow, is the most common elbow deformity seen in patients with cerebral palsy. This study retrospectively evaluated early results of 2 surgical interventions for elbow flexion deformities based on degree of contracture. We hypothesized that by guiding surgical treatment to degree of preoperative contracture, elbow extension and flexion posture angle at ambulation could be improved while preserving maximum flexion. Eighty-six patients (90 elbows) were treated for elbow spasticity due to cerebral palsy. Seventy-one patients (74 elbows) were available for follow-up. Fifty-seven patients with fixed elbow contractures less than 45° were surgically treated with a partial elbow muscle lengthening, which included partial lengthening of the biceps and brachialis and proximal release of the brachioradialis. Fourteen patients (17 elbows) with fixed elbow contractures ≥ 45° had a more extensive full elbow release, with biceps z-lengthening, partial brachialis myotomy, and brachioradialis proximal release. Age at surgery averaged 10 years (range, 3-20 y) for partial lengthening and 14 years (range, 5-20 y) for full elbow release. Follow-up averaged 22 months (range, 7-144 mo) for partial lengthening and 18 months (range, 6-51 mo) for full elbow release. Both groups achieved meaningful improvement in flexion posture angle at ambulation, active and passive extension, and total range of motion. Elbow flexion posture angle at ambulation improved by 57° and active extension increased 17° in the partial lengthening group, with a 4° loss of active flexion. In the full elbow release group, elbow flexion posture angle at ambulation improved 51° and active extension improved 38°, with a loss of 19° of active flexion. Surgical treatment of spastic elbow flexion in cerebral palsy can improve deformity. We obtained excellent results by guiding the surgical intervention by the amount of

Neuroevolutional Approach to Cerebral Palsy and Speech.

Science.gov (United States)

Mysak, Edward D.

Intended for cerebral palsy specialists, the book emphasizes the contribution that a neuroevolutional approach to therapy can make to habilitation goals of the child with cerebral palsy and applies the basic principles of the Bobath approach to therapy. The first section discusses cerebral palsy as a reflection of disturbed neuro-ontogenisis and…

Cerebral Palsy. Fact Sheet = La Paralisis Cerebral. Hojas Informativas Sobre Discapacidades.

Science.gov (United States)

National Information Center for Children and Youth with Disabilities, Washington, DC.

This fact sheet on cerebral palsy is written in both English and Spanish. First, it provides a definition of cerebral palsy and considers various causes (e.g., an insufficient amount of oxygen reaching the fetal or newborn brain). The fact sheet then offers incidence figures and explains characteristics of the three main types of cerebral palsy:…

Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy

Science.gov (United States)

Hong, Wei-Hsien; Chen, Hseih-Ching; Shen, I-Hsuan; Chen, Chung-Yao; Chen, Chia-Ling; Chung, Chia-Ying

2012-01-01

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n =…

Motor-independent Visual Perception Skill Indexes are Related with Reading Skills in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Vahid Reza Khodabandeh

2015-10-01

Full Text Available Objective: Cerebral palsy is one of the most common causes of physical disability in childhood that lead to various difficulties for children. These children may have abnormalities in visual perception. Visual perception plays an important role in learning of basic childhood’s skills. This research was designed to study the relation between each of subtests of visual perception with accuracy and speed components of reading skills in school-aged cerebral palsy children. Materials & Methods: In this cross-sectional study, 24 spastic cerebral palsy students in second grade (10 girls and 14 boy were selected be available as from Tehran’s rehabilitation clinics. Visual perception and Reading skills were evaluated with the Test of Visual Perceptual Skill-revised (TVPS-R and Diagnostic Reading Test. Results: The results showed that between standard score of visual perception with accuracy and speed components of reading skills of cerebral palsy student were significantly correlated. Visual Discrimination with accuracy (P<0.001 and with speed (P<0.001, Visual Memory with accuracy  (P=0.002 and with speed (P=0.004, Visual-Spatial with accuracy (P<0.001 and with speed (P<0.001, Form Constancy with accuracy (P=0.003 and with speed (p<0.001, Visual Sequential Memory with accuracy (P=0.023 and with speed (P<0.028, Figure Ground Discrimination with accuracy (P=0.010 and with speed (P<0.011, Visual Closure with accuracy (p=0.009 and with speed (P<0.009 Conclusion: In general we can say that the relationship between visual perception skills with reading skills in first and second grade students with cerebral palsy is evident.

Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

Directory of Open Access Journals (Sweden)

van Rhijn Lodewijk W

2010-06-01

Full Text Available Abstract Background Cerebral palsy (CP may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis. Methods We performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS, Gross Motor Function Measure (GMFM and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS for spasticity, pain and ease of care. Results A total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options. Conclusion RF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial.

Videofluoroscopic assessment in children with severe cerebral palsy presenting with dysphagia

International Nuclear Information System (INIS)

Wright, R.E.R.; Wright, F.R.; Carson, C.A.

1996-01-01

In this study 16 patients with severe spastic cerebral palsy with an age range between 6 months and 16 years were examined using videofluoroscopy and a modified barium meal. All patients were slow, inefficient eaters. Silent aspiration was demonstrated in five cases. The latter five patients demonstrated a delayed swallow reflex but there was little correlation between aspiration and the oral phase of deglutition. Our data confirms the impression that early diagnostic workup including videofluoroscopy is helpful in managing the feeding difficulties in these children, and may prevent chronic aspiration and malnutrition. (orig.). With 2 tabs

Videofluoroscopic assessment in children with severe cerebral palsy presenting with dysphagia

Energy Technology Data Exchange (ETDEWEB)

Wright, R.E.R. [Ulster Hospital, Belfast (United Kingdom); Wright, F.R. [Ulster Hospital, Belfast (United Kingdom); Carson, C.A. [Ulster Hospital, Belfast (United Kingdom)

1996-10-01

In this study 16 patients with severe spastic cerebral palsy with an age range between 6 months and 16 years were examined using videofluoroscopy and a modified barium meal. All patients were slow, inefficient eaters. Silent aspiration was demonstrated in five cases. The latter five patients demonstrated a delayed swallow reflex but there was little correlation between aspiration and the oral phase of deglutition. Our data confirms the impression that early diagnostic workup including videofluoroscopy is helpful in managing the feeding difficulties in these children, and may prevent chronic aspiration and malnutrition. (orig.). With 2 tabs.

COMPARISON BETWEEN PHYSIOLOGICAL COST INDEX IN HEALTHY NORMAL CHILDREN AS AGAINST AMBULATORY SPASTIC DIPLEGIC CEREBRAL PALSY (WITH AND WITHOUT ORTHOSIS IN THE AGE GROUP 6 TO 18 YEARS

Directory of Open Access Journals (Sweden)

Swatia Bhise

2016-08-01

Full Text Available Background: Efficacy of rehabilitation program for subjects with orthosis with objective measurement. The study aiming to objectively compare the PCI and walking speed of normal children with ambulatory spastic diaplegic. Also we aimed to analyze whether BMIhad impact on energy cost. Methods: 41 normal children and 41 community walking spastic diaplegic aged between 6 to 18 yrs. were assessed to compare the PCI. Speed of walking and heart rate were checked constantlyboth barefoot and in shoes in normal children and with and without conventional AFO in children with spastic diaplegic at their chosen velocities over four consecutive lengths of a 12.5m walkway i.e. total 50m.,Pre and Post readings are taken. Heart rate is affected by speed; PCI with speed of walking and heart rate was calculated for each child. Results: The mean PCI in shoes and barefoot was same in normal children i.e. 0.05 ±0.039beats/meter. The PCI for children with pathological gait i.e. spastic diaplegic without orthosis and with orthosis is 0.199 ±0.176 and 0.104± 0.093beats/meter appreciably greater than that for normal children(p less than 0.05. Conclusion: This study showed that walking with orthosis in spastic diplegic CP children showed higher costs of energy and slower walking speed compared normal children with age matched. The PCI of walking, with orthosis in children with spastic Diplegic cerebral palsy is less as compared to without orthosis i.e. gait is more energy efficient with orthosis. BMI doesn’t show any correlation with PCI further study may require.

Cerebral palsy and congenital malformations

DEFF Research Database (Denmark)

Garne, Ester; Dolk, Helen; Krägeloh-Mann, Inge

2007-01-01

AIM: To determine the proportion of children with cerebral palsy (CP) who have cerebral and non-cerebral congenital malformations. METHODS: Data from 11 CP registries contributing to the European Cerebral Palsy Database (SCPE), for children born in the period 1976-1996. The malformations were...... classified as recognized syndromes, chromosomal anomalies, cerebral malformations or non-cerebral malformations. Prevalence of malformations was compared to published data on livebirths from a European database of congenital malformations (EUROCAT). RESULTS: Overall 547 out of 4584 children (11.9%) with CP...... were reported to have a congenital malformation. The majority (8.6% of all children) were diagnosed with a cerebral malformation. The most frequent types of cerebral malformations were microcephaly and hydrocephaly. Non-cerebral malformations were present in 97 CP children and in further 14 CP children...

Twenty weeks of computer-training improves sense of agency in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Ritterband-Rosenbaum, Anina; Christensen, Mark Schram; Nielsen, Jens Bo

2012-01-01

Children with cerebral palsy (CP) show alteration of perceptual and cognitive abilities in addition to motor and sensory deficits, which may include altered sense of agency. The aim of this study was to evaluate whether 20 weeks of internet-based motor, perceptual and cognitive training enhances...

Different horse's paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study.

Science.gov (United States)

Antunes, Fabiane Nunes; Pinho, Alexandre Severo do; Kleiner, Ana Francisca Rozin; Salazar, Ana Paula; Eltz, Giovana Duarte; de Oliveira Junior, Alcyr Alves; Cechetti, Fernanda; Galli, Manuela; Pagnussat, Aline Souza

2016-12-01

Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separate days: Protocol 1: the horse's pace was a walking pace; and Protocol 2: the horse's pace was a walk-trot pace. Children from the reference group were not subjected to treatment. A wireless inertial measurement unit measured gait spatio-temporal parameters before and after each session. The Modified Ashworth Scale was applied for muscle tone measurement of hip adductors. The participants underwent the gait assessment on a path with surface irregularities (ecological context). The comparisons between BS-CP and the reference group found differences in all spatio-temporal parameters, except for gait velocity. Within-group analysis of children with BS-CP showed that the swing phase did not change after the walk pace and after the walk-trot pace. The percentage of rolling phase and double support improved after the walk-trot. The spasticity of the hip adductors was significantly reduced as an immediate result of both protocols, but this decrease was more evident after the walk-trot. The walk-trot protocol is feasible and is able to induce an immediate effect that improves the gait spatio-temporal parameters and the hip adductors spasticity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cortical somatosensory reorganization in children with spastic cerebral palsy: a multimodal neuroimaging study

Directory of Open Access Journals (Sweden)

CHRISTOS ePAPADELIS

2014-09-01

Full Text Available Although cerebral palsy (CP is among the most common causes of physical disability in early childhood, we know little about the functional and structural changes of this disorder in the developing brain. Here, we investigated with three different neuroimaging modalities (magnetoencephalography (MEG, diffusion tension imaging (DTI, and resting state fMRI whether spastic CP is associated with functional and anatomical abnormalities in the sensorimotor network. Ten children participated in the study: four with diplegic CP (DCP, three with hemiplegic CP (HCP, and three typically-developing (TD children. Somatosensory evoked fields (SEFs were recorded in response to pneumatic stimuli applied to digits D1, D3, and D5 of both hands. Several parameters of water diffusion were calculated from DTI between the thalamus and the precentral and postcentral gyri in both hemispheres. The sensorimotor resting state networks (RSNs were examined by using an independent component analysis method. Tactile stimulation of the fingers elicited the first prominent cortical response at ~50 ms, in all except one child, localized over the primary somatosensory cortex (S1. In five CP children, abnormal somatotopic organization was observed in the affected (or more affected hemisphere. Euclidean distances were markedly different between the two hemispheres in the HCP children, and between DCP and TD children for both hemispheres. DTI analysis revealed decreased fractional anisotropy and increased apparent diffusion coefficient for the thalamocortical pathways in the more affected compared to less affected hemisphere in CP children. Rs-fMRI results indicated absent and/or abnormal sensorimotor RSNs for children with HCP and DCP consistent with the severity and location of their lesions. Our findings suggest an abnormal somatosensory processing mechanism in the sensorimotor network of children with CP possibly as a result of diminished thalamocortical projections.

Sport-specific fitness testing and intervention for an adolescent with cerebral palsy: a case report.

Science.gov (United States)

Kenyon, Lisa K; Sleeper, Mark D; Tovin, Melissa M

2010-01-01

This case report describes the development, implementation, and outcomes of a fitness-related intervention program that addressed the sport-specific goals of an adolescent with cerebral palsy. The participant in this case was a 16-year-old African American male with spastic diplegia. The participant joined his high school wrestling team and asked to focus his physical therapy on interventions that would improve his wrestling performance. An examination was performed using the muscle power sprint test, the 10 x 5-m sprint test, strength tests, the 10-m shuttle run test, and the Gross Motor Function Measure. The intervention consisted of interval training, which focused on the demands of wrestling. Scores on all tests and measures were higher after the intervention. The outcomes of this case report seem to support the use of a fitness-related intervention program for addressing the sport-specific goals of an adolescent with cerebral palsy.

Validation of a Cerebral Palsy Register

DEFF Research Database (Denmark)

Topp, Monica; Langhoff-Roos, Jens; Uldall, P.

1997-01-01

OBJECTIVES: To analyse completeness and validity of data in the Cerebral Palsy Register in Denmark, 1979-1982. METHODS: Completeness has been assessed by comparing data from The Danish National Patient Register (DNPR) with the cases included in the Cerebral Palsy Register (CPR). Agreement between......, but gestational age was subject to a systematic error, and urinary infections in pregnancy (kappa = 0.43) and placental abruption (kappa = 0.52) were seriously under-reported in the CPR. CONCLUSIONS: Completeness of the Cerebral Palsy Register in Denmark, 1979-1982, has been assessed to maximal 85%, emphasizing...

Effect of Knee Orthoses on Hamstring Contracture in Children With Cerebral Palsy: Multiple Single-Subject Study.

Science.gov (United States)

Laessker-Alkema, Kristina; Eek, Meta Nyström

2016-01-01

To examine the effect of knee orthoses on extensibility of the hamstrings in children with spastic cerebral palsy (CP). The short-term effects of knee orthoses on passive range of motion (ROM), spasticity, and gross motor function of the hamstrings. Ten children with spastic CP, aged 5 to 14 years, at Gross Motor Function Classification System levels I to V, were followed. The orthoses were worn for a minimum of 30 minutes day, 5 days per week, during the intervention period of 8 weeks. Visual analysis using the Two Standard Deviation Band Method supported improvements in passive ROM for all 20 hamstring muscles and in 12 of 14 knee extension measurements. Analyses with the Wilcoxon signed rank test confirm the individual results and support a significant increase in hamstring muscles (P = .005) and knee extension (right: P =.028; left: P =.018) compared with baseline. In children with spastic CP, 8 weeks of treatment with knee orthoses can improve extensibility of the hamstrings.

Cerebral palsy in preterm infants

Directory of Open Access Journals (Sweden)

Demeši-Drljan Čila

2016-01-01

Full Text Available Background/Aim. Cerebral palsy (CP is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS. Results. More than half of the children with CP were born prematurely (54.4%. Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001. In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049, children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0% affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032. Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy. [Projekat Ministarstva nauke Republike

Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.

Science.gov (United States)

Lidman, Git; Nachemson, Ann; Peny-Dahlstrand, Marie; Himmelmann, Kate

2015-08-01

To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains. This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months. AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (poccupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups. © 2015 Mac Keith Press.

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Ghai S

2017-12-01

enhance gait performance in people with cerebral palsy. Keywords: entrainment, spastic diplegia, hemiplegia, ataxia, rehabilitation, balance 

Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy.

Science.gov (United States)

Kassee, Caroline; Hunt, Carolyn; Holmes, Michael W R; Lloyd, Meghann

2017-05-17

This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.

Cerebral palsy: Influence of TheraTogs ® on gait, posture and in functional performance

Directory of Open Access Journals (Sweden)

Raquel Ehlert

Full Text Available Abstract Introduction: For children with cerebral palsy, orthoses take an important role in improving posture, gait, functional performance and preventing secondary musculoskeletal disorders. Objective: To evaluate the influence of TheraTogs® on the posture, distribution of plantar pressure during gait and functional performance of a child with spastic diplegia cerebral palsy. Methods: A quantitative evaluation was carried out on a case study in which an 11-year-old child diagnosed with diplegic cerebral palsy underwent postural assessment through the Postural Assessment Software (PAS, plantar pressure distribution assessment during barefoot gait through the Emed-X system, before and after the intervention period of 8 weeks and functional assessment (Pediatric Evaluation of Disability Inventory - PEDI, with and without TheraTogs®. Results: In posture, TheraTogs® had greater influence on hip extension and this change was greater during its use. In the plantar pressure distribution assessment, an increase in posteriorization of plantar pressure occurred in the initial contact, the performance of the push-off phase and initial swing phase improved. In functionality, the child showed improvements in mobility, however, their self-care ability with TheraTogs® was reduced. Conclusion: Although improvements in posture, gait and functionality were verified with the use of TheraTogs®, the excessive heat, difficulties in toileting and self-care were disadvantages in wearing TheraTogs®.

Aquatic exercise in the treatment of children with cerebral palsy

Directory of Open Access Journals (Sweden)

Dimitrijević Lidija

2012-01-01

Full Text Available Introduction. Aquatic exercise is one of the most popular supplementary treatments for children with neuro-motor impairment, especially for cerebral palsy (CP. As water reduces gravity force which increases postural stability, a child with CP exercises more easily in water than on land. Objective. The aim of the study was to examine aquatic exercise effects on gross motor functioning, muscle tone and cardiorespiratory endurance in children with spastic CP. Methods. The study included 19 children of both sexes, aged 6 to 12 years, with spastic CP. They were included in a 12-week aquatic exercise program, twice a week. Measurements of GMFM (Gross Motor Function Measurement, spasticity (MAS – Modified Ashworth Scale, heart rate (HR and maximal oxygen consumption (VO2max were carried out before and after treatment. The measurement results were compared before and after treatment. Results. GMFM mean value before therapy was 80.2% and statistically it was significantly lower in comparison to the same value after therapy, which was 86.2% (p<0.05. The level of spasticity was considerably decreased after therapy; the mean value before treatment was 3.21 according to MAS, and after treatment it was 1.95 (p<0.001. After treatment there was a statistically significant improvement of cardiorespiratory indurance, i.e., there was a significant decrease in the mean value of HR and a significant increase of VO2max (p<0.001. Conclusion. Aquatic exercise program can be useful in improving gross motor functioning, reducing spasticity and increasing cardiorespiratory endurance in children with spastic CP. [Projekat Ministarstva nauke Republike Srbije, br. 175092

Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial

NARCIS (Netherlands)

Geerdink-van Nistelrooij, Y.A. van; Aarts, P.; Geurts, A.C.H.

2013-01-01

The goal of this study was to determine the progression of manual dexterity during 6 weeks (54h) (modified) constraint-induced movement therapy ((m)CIMT) followed by 2 weeks (18h) bimanual training (BiT) in children with unilateral spastic cerebral palsy (CP), to establish whether and when a maximal

11 Things to Know about Cerebral Palsy

Science.gov (United States)

... Button Past Emails 11 Things to Know about Cerebral Palsy Language: English (US) Español (Spanish) Recommend on Facebook Tweet Share Compartir Cerebral palsy (CP) is the most common motor disability in ...

Outcomes in spasticity after repetitive transcranial magnetic and transcranial direct current stimulations

OpenAIRE

Gunduz, Aysegul; Kumru, Hatice; Pascual-Leone, Alvaro

2014-01-01

Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhibits satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in improving ...

[Spasticity and dynamic plantar pressure distribution measurements in hemiplegic spastic children].

Science.gov (United States)

Femery, V; Moretto, P; Renaut, H; Thévenon, A

2001-02-01

The aim of this study was to analyse the plantar pressure distribution in nine hemiplegic spastic children to illustrate the dynamic alteration during stance phase linked spasticity grade. The graduation of the lower limbs muscle tone related to the Aschworth spasticity scale enabled us to identify two groups of hemiplegics subjects. The groups Asch 1 and Asch 3 have respectively presented a low and a strong spasticity. The peak pressures during consecutive gait cycles were determined under the feet of 30 healthy subjects and two cerebral palsy groups using a wearable footprint analysis system. A statistical study showed a similarity between the two disabled groups. Peak pressures under the midfoot were significantly higher compared to the control group. While the plantar pressure distribution profile was specific for each group under all other anatomical structures. The significant alterations were observed under the forefoot and hallux. Spasticity modifies the foot contact to ground and leads to a specific plantar pressure distribution profile linked to the spasticity grade. The equinovarus with clawed toes deformity due to higher spasticity seems to be an important factor in terminal stance phase perturbations. However spastic hemiplegic subjects seem to adopt a gait pattern in agreement with stability optimization criteria.

Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy.

Science.gov (United States)

Shin, Ji-Won; Song, Gui-Bin; Hwangbo, Gak

2015-07-01

[Purpose] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy. [Subjects] Sixteen children (9 males, 7 females) with spastic diplegic cerebral palsy were recruited and randomly assigned to the conventional neurological physical therapy group (CG) and virtual reality training group (VRG). [Methods] Eight children in the control group performed 45 minutes of therapeutic exercise twice a week for eight weeks. In the experimental group, the other eight children performed 30 minutes of therapeutic exercise and 15 minutes of a training program using virtual reality twice a week during the experimental period. [Results] After eight weeks of the training program, there were significant differences in eye-hand coordination and visual motor speed in the comparison of the virtual reality training group with the conventional neurological physical therapy group. [Conclusion] We conclude that a well-designed training program using virtual reality can improve eye-hand coordination in children with cerebral palsy.

Are we there yet? Evaluating commercial grade brain-computer interface for control of computer applications by individuals with cerebral palsy.

Science.gov (United States)

Taherian, Sarvnaz; Selitskiy, Dmitry; Pau, James; Claire Davies, T

2017-02-01

Using a commercial electroencephalography (EEG)-based brain-computer interface (BCI), the training and testing protocol for six individuals with spastic quadriplegic cerebral palsy (GMFCS and MACS IV and V) was evaluated. A customised, gamified training paradigm was employed. Over three weeks, the participants spent two sessions exploring the system, and up to six sessions playing the game which focussed on EEG feedback of left and right arm motor imagery. The participants showed variable inconclusive results in the ability to produce two distinct EEG patterns. Participant performance was influenced by physical illness, motivation, fatigue and concentration. The results from this case study highlight the infancy of BCIs as a form of assistive technology for people with cerebral palsy. Existing commercial BCIs are not designed according to the needs of end-users. Implications for Rehabilitation Mood, fatigue, physical illness and motivation influence the usability of a brain-computer interface. Commercial brain-computer interfaces are not designed for practical assistive technology use for people with cerebral palsy. Practical brain-computer interface assistive technologies may need to be flexible to suit individual needs.

Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy.

Science.gov (United States)

Stark, C; Nikopoulou-Smyrni, P; Stabrey, A; Semler, O; Schoenau, E

2010-06-01

The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children. In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training. Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training. The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

Cerebral Palsy: Comprehensive Review and Update

International Nuclear Information System (INIS)

Jan, Mohammed M.S.

2006-01-01

Cerebral palsy (CP) is a common pediatric disorder occurring in about 2 to 2.5 per 1000 live births. It is a chronic motor disorder resulting from a nonprogressive (static) insult to the developing brain. CP is the clinical presentation of a wide variety of cerebral cortical or sub-cortical insults occurring during the first year of life. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the commonest risk factor. Children with CP suffer multiple problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Screening for those conditions should be part of the initial assessment. The child with CP is best cared for with an individualized treatment plan that provides a combination of interventions. This requires the provision of a number of family-centered services that make a difference in the lives of these children and their families. Management of spasticity can be challenging with a wide variety of possible therapeutic interventions. The treatment must be goal oriented, such as to assist with mobility, reduce or prevent contractures, improve positioning and hygiene, and provide comfort. Each member of the child's multidisciplinary team, including the child and both parents, should participate in the serial evaluations and treatment planning. (author)

Association of Lead Levels and Cerebral Palsy

Directory of Open Access Journals (Sweden)

Neha Bansal MD

2017-03-01

Full Text Available Background: Cerebral palsy is a common motor disability in childhood. Raised lead levels affect cognition. Children with cerebral palsy may have raised lead levels, further impairing their residual cognitive motor and behavioral abilities. Environmental exposure and abnormal eating habits may lead to increased lead levels. Aims and Objectives: To measure blood lead levels in children with cerebral palsy and compare them with healthy neurologically normal children. To correlate blood lead levels with environmental factors. Material and Methods: Design: Prospective case-control study. Setting: Tertiary care hospital. Participants: Cases comprised 34 children with cerebral palsy, and controls comprised 34 neurologically normal, age- and sex-matched children. Methods: Clinical and demographic details were recorded as per proforma. Detailed environmental history was recorded to know the source of exposure to lead. These children were investigated and treated as per protocol. Venous blood was collected in ethylenediaminetetraacetic acid vials for analysis of blood lead levels. Lead levels were estimated by Schimadzu Flame AA-6800 (atomic absorption spectrophotometer. Data were analyzed using SPSS version 17. P < .05 was taken as significant. Results: Mean blood lead levels were 9.20 ± 8.31 µg/dL in cerebral palsy cases and 2.89 ± 3.04 µg/dL in their controls (P < .001. Among children with cerebral palsy, 19 (55.88% children had blood lead levels ≥5 µg/dL. Lead levels in children with pica were 12.33 ± 10.02 µg/dL in comparison to children with no history of pica, 6.70 ± 4.60 µg/dL (P = .029. No correlation was found between hemoglobin and blood lead levels in cases and controls. Conclusion: In our study, blood lead levels are raised in children with cerebral palsy. However, further studies are required to show effects of raised levels in these children.

Effect of body-weight suspension training versus treadmill training on gross motor abilities of children with spastic diplegic cerebral palsy.

Science.gov (United States)

Emara, Hatem A; El-Gohary, Tarek M; Al-Johany, Ahmed A

2016-06-01

Suspension training and treadmill training are commonly used for promoting functional gross motor skills in children with cerebral palsy. The aim of this study was to compare the effect of body-weight suspension training versus treadmill training on gross motor functional skills. Assessor-blinded, randomized, controlled intervention study. Outpatient rehabilitation facility. Twenty children with spastic diplegia (7 boys and 13 girls) in the age ranged from 6 to 8 years old were randomly allocated into two equal groups. All children were assessed at baseline, after 18-session and after 36-session. During the twelve-week outpatient rehabilitation program, both groups received traditional therapeutic exercises. Additionally, one group received locomotor training using the treadmill while the other group received locomotor training using body-weight suspension through the dynamic spider cage. Assessment included dimensions "D" standing and "E" walking of the gross motor function measure, in addition to the 10-m Walking Test and the five times sit to stand test. Training was applied three times per week for twelve consecutive weeks. No significant difference was found in standing or walking ability for measurements taken at baseline or after 18-session of therapy. Measurements taken at 36-session showed that suspension training achieved significantly (Ptraining for dimension D as well as for dimension E. No significant difference was found between suspension training and treadmill training regarding walking speed or sit to stand transitional skills. Body-weight suspension training is effective in improving walking and locomotor capabilities in children with spastic diplegia. After three month suspension training was superior to treadmill training. Body-weight suspension training promotes adequate postural stability, good balance control, and less exertion which facilitates efficient and safe gait.

The Danish Cerebral Palsy Follow-up Program

DEFF Research Database (Denmark)

Rasmussen, Helle Mätzke; Nordbye-Nielsen, Kirsten; Møller-Madsen, Bjarne

2016-01-01

AIM OF DATABASE: The Danish Cerebral Palsy Follow-up Program is a combined follow-up program and national clinical quality database that aims to monitor and improve the quality of health care for children with cerebral palsy (CP). STUDY POPULATION: The database includes children with CP aged 0...... indicators in three of five regions in Denmark comprising 432 children with CP, corresponding to a coverage of 82% of the expected population. CONCLUSION: The Danish Cerebral Palsy Follow-up Program is currently under development as a national clinical quality database in Denmark. The database holds...

Optimising Ankle Foot Orthoses for children with Cerebral Palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

NARCIS (Netherlands)

Kerkum, Y.L.; Harlaar, J.; Buizer, A.I.; van den Noort, J.C.; Becher, J.G.; Brehm, M.A.

2013-01-01

Background: Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of

Optimising Ankle Foot Orthoses for children with cerebral palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

NARCIS (Netherlands)

Kerkum, Yvette L.; Harlaar, Jaap; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Brehm, Merel-Anne

2013-01-01

Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of walking energy

Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy

Science.gov (United States)

Xing, Guibo; Fuentes-Afflick, Elena; Danielson, Beate; Smith, Lloyd H.; Gilbert, William M.

2011-01-01

OBJECTIVE: Racial and ethnic disparities in cerebral palsy have been documented, but the underlying mechanism is poorly understood. We determined whether low birth weight accounts for ethnic disparities in the prevalence of cerebral palsy and whether socioeconomic factors impact cerebral palsy within racial and ethnic groups. METHODS: In a retrospective cohort of 6.2 million births in California between 1991 and 2001, we compared maternal and infant characteristics among 8397 infants with cerebral palsy who qualified for services from the California Department of Health Services and unaffected infants. RESULTS: Overall, black infants were 29% more likely to have cerebral palsy than white infants (relative risk: 1.29 [95% confidence interval: 1.19–1.39]). However, black infants who were very low or moderately low birth weight were 21% to 29% less likely to have cerebral palsy than white infants of comparable birth weight. After we adjusted for birth weight, there was no difference in the risk of cerebral palsy between black and white infants. In multivariate analyses, women of all ethnicities who did not receive any prenatal care were twice as likely to have infants with cerebral palsy relative to women with an early onset of prenatal care. Maternal education was associated with cerebral palsy in a dose-response fashion among white and Hispanic women. Hispanic adolescent mothers (aged cerebral palsy. CONCLUSIONS: The increased risk of cerebral palsy among black infants is primarily related to their higher risk of low birth weight. Understanding how educational attainment and use of prenatal care impact the risk of cerebral palsy may inform new prevention strategies. PMID:21339278

Pelvic-Spinal Analysis and the Impact of Onabotulinum toxin A Injections on Spinal Balance in one Child With Cerebral Palsy

Directory of Open Access Journals (Sweden)

Emmanuelle Chaléat-Valayer MD

2016-11-01

Full Text Available Background: In children with cerebral palsy, primary (eg, abnormal muscle tone and weakness and secondary impairments (eg, contractures can modify pelvic-spinal alignment. The main aim of this article was to establish a new approach to pelvic-spinal analysis in children with cerebral palsy, taking into account the whole pelvis-spine complex, illustrated by a case study. Methods: This is a case study of an ambulatory child with cerebral palsy (spastic diplegia who underwent analysis of the pelvic-spine complex from X-ray images taken in standing position from C2 to the proximal femur. Pelvic shape was characterized by the pelvic incidence angle, which is the sum of sacral slope and pelvic tilt, before and after the treatment by regular onabotulinumtoxinA injections into the hip flexors, and the use of soft lumbar brace over 5 years. Results: The sagittal balance of the spine was improved following the treatment, with a reduction in lumbar lordosis and sacral slope. The reduction in lumbar hyperextension likely reduced the risk of spondylolysis, low back pain, and degenerative spondylolisthesis in adulthood. Conclusion: A biomechanical approach to the evaluation of the pelvic-spinal complex offers new perspectives to increase the understanding of spinal balance in children with cerebral palsy, providing more options for treatment, such as onabotulinumtoxinA.

Prevalence of cerebral palsy in Uganda: a population-based study.

Science.gov (United States)

Kakooza-Mwesige, Angelina; Andrews, Carin; Peterson, Stefan; Wabwire Mangen, Fred; Eliasson, Ann Christin; Forssberg, Hans

2017-12-01

Few population-based studies of cerebral palsy have been done in low-income and middle-income countries. We aimed to examine cerebral palsy prevalence and subtypes, functional impairments, and presumed time of injury in children in Uganda. In this population-based study, we used a nested, three-stage, cross-sectional method (Iganga-Mayuge Health and Demographic Surveillance System [HDSS]) to screen for cerebral palsy in children aged 2-17 years in a rural eastern Uganda district. A specialist team confirmed the diagnosis and determined the subtype, motor function (according to the Gross Motor Function Classification System [GMFCS]), and possible time of brain injury for each child. Triangulation and interviews with key village informants were used to identify additional cases of suspected cerebral palsy. We estimated crude and adjusted cerebral palsy prevalence. We did χ 2 analyses to examine differences between the group screened at stage 1 and the entire population and regression analyses to investigate associations between the number of cases and age, GMFCS level, subtype, and time of injury. We used data from the March 1, 2015, to June 30, 2015, surveillance round of the Iganga-Mayuge HDSS. 31 756 children were screened for cerebral palsy, which was confirmed in 86 (19%) of 442 children who screened positive in the first screening stage. The crude cerebral palsy prevalence was 2·7 (95% CI 2·2-3·3) per 1000 children, and prevalence increased to 2·9 (2·4-3·6) per 1000 children after adjustment for attrition. The prevalence was lower in older (8-17 years) than in younger (cerebral palsy was the most common subtype (45 [46%] of 97 children) followed by bilateral cerebral palsy (39 [40%] of 97 children). 14 (27%) of 51 children aged 2-7 years had severe cerebral palsy (GMFCS levels 4-5) compared with only five (12%) of 42 children aged 8-17 years. Few children (two [2%] of 97) diagnosed with cerebral palsy were born preterm. Post-neonatal events were the

The relation of breech presentation at term to cerebral palsy

DEFF Research Database (Denmark)

Krebs, L; Topp, M; Langhoff-Roos, J

1999-01-01

OBJECTIVE: To examine the relation between breech delivery and cerebral palsy, considering the influence of intrauterine growth, low Apgar score at birth, and mode of delivery. DESIGN: Register-based, case-control study. POPULATION: A cohort of infants with cerebral palsy born between 1979 and 1986...... in East Denmark, identified by linkage of the cerebral palsy register with the national birth register. Discharge letters from births of breech infants with cerebral palsy were reviewed. MAIN OUTCOME MEASURES: Presentation, mode of delivery, gestational age, birthweight, Apgar score, type of cerebral...

Surgical management of spasticity | Enslin | South African Medical ...

African Journals Online (AJOL)

The management of patients with cerebral palsy and other causes of spasticity is a challenge to an entire rehabilitation team and to caregivers. In South Africa, neurosurgeons have had limited involvement in this field owing to a perceived lack of options, leaving the care of these patients largely in the hands of paediatric ...

The MM-CGI Cerebral Palsy: modification and pretesting of an instrument to measure anticipatory grief in parents whose child has cerebral palsy.

Science.gov (United States)

Al-Gamal, Ekhlas; Long, Tony

2014-07-01

To establish the potential of a modified version of the MM-CGI Childhood Cancer to assess anticipatory grief in parents of children with cerebral palsy, to amend the existing scale for use with the specific patient group, to test the psychometric properties of the modified version (MM-CGI Cerebral Palsy) and to review the clinical potential of the new scale. Parents of children with cerebral palsy may experience reactions similar to parents of children with other enduring or life-limiting conditions, and anticipatory grief may be one such psychological reaction. While the burden of caring is sometimes balanced by positive perceptions of the child, which enhance coping ability, for many parents the outcome is damage to their physical and mental health and impaired family functioning. A cross-sectional, descriptive, correlational design. The MM-CGI Cerebral Palsy was administered in structured interviews with 204 parents. Standardised measures of caregivers' depression, stress and perceived social support were also administered. Mothers and fathers were recruited from healthcare centres and schools for special education. Cronbach's alpha was used to assess internal consistency, and Pearson's product-moment correlation was used to assess construct validity. The subscales were each found to measure a single dimension of anticipatory grief, and significant correlations were established with existing instruments. The instrument demonstrated excellent internal consistency reliability and good construct validity. The MM-CGI Cerebral Palsy could be useful for diagnosing anticipatory grief among parents of children with cerebral palsy. This preliminary work moves the programme on to testing in intervention studies. In the absence of an existing measure for the assessment of anticipatory grief, specifically in parents of children with cerebral palsy, the MM-CGI Cerebral Palsy could prove to be an effective assessment tool for clinicians and researchers. © 2013 John Wiley

OCULAR FINDINGS IN CHILDREN WITH CEREBRAL PALSY ...

African Journals Online (AJOL)

Cerebral palsy is commonly associated with ocular abnormalities which often impact on their development and education. There is paucity of studies on this in Nigeria. We decided to study/ determine the prevalence of ocular abnormalities among children with cerebral palsy that attended the neurology clinic of University of ...

Multiple nutritional deficiencies in cerebral palsy compounding physical and functional impairments

Directory of Open Access Journals (Sweden)

P G Hariprasad

2017-01-01

Full Text Available Introduction: Cerebral palsy (CP refers to a spectrum of disorders causing physical and intellectual morbidity. Macro and micro nutrient deficiencies often contribute to the subnormal physical and mental capabilities of them. Objectives: To assess the growth, nutritional status, physical and functional ability and quality of life in cerebral palsy children and to determine any relation with their gross motor and functional capabilities. Method: The study was conducted at a Tertiary Care Centre, with the participants in the age group 1-16 years. A pretested evaluation tool was prepared which included Anthropometric measurements, tests for hemoglobin and Vitamin D estimation, evidence of micronutrient deficiencies, Dietary patterns, Epidemiological factors, Functional assessment using GMFM (Gross Motor Function Measure and FIM (Functional Independent Measurement scales and Quality of life (QOL assessment. The data was statistically analyzed. Results: Out of the 41 children, 30 had quadriplegia, 3 had hemiplegia and 8 had spastic diplegia. 34 (82.9% were severely underweight, 35 (85.4% had severe stunting and 38 (92.7% had severe wasting. Micronutrient deficiencies were noted like vitamin B complex deficiency in 37 (90.2%, vitamin A deficiency in 31 (75.6%, low vitamin D levels in 27 (65.9% and insufficient levels in 9 (22%, severe anemia in 5 (12.2% and moderate anemia in 26 (63.4%.The gross motor and functional scores were suboptimum in the majority of patients and the care givers had significant impairment in the quality of life. Conclusion: Majority of children with cerebral palsy had multiple nutritional deficiencies, gross motor and functional disabilities. QOL of the children and their care givers were suboptimum. A comprehensive package that address dietary intake, correction of micronutrient deficiencies especially anemia and vitamin D deficiency, physical and emotional support is recommended for the wellbeing of the affected children.

Orthopedic surgery in cerebral palsy: Instructional course lecture

Directory of Open Access Journals (Sweden)

Deepak Sharan

2017-01-01

Full Text Available Orthopedic surgery (OS plays an important role in the management of cerebral palsy (CP. The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS, orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a “last resort” intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.

Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children.

Science.gov (United States)

Pavão, Silvia L; Santos, Adriana N; Oliveira, Ana B; Rocha, Nelci A C F

2015-01-01

The purpose of this study was to compare postural control in typically developing (TD) children and children with cerebral palsy (CP) during the sit-to-stand (STS) movement and to assess the relationship between static (during static standing position) and dynamic postural control (during STS movement) in both groups. The center of pressure (CoP) behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II) was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP) and mediolateral (ML) amplitudes of CoP displacement and the area and velocity of CoP oscillation. According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement.

[Research on brain white matter network in cerebral palsy infant].

Science.gov (United States)

Li, Jun; Yang, Cheng; Wang, Yuanjun; Nie, Shengdong

2017-10-01

Present study used diffusion tensor image and tractography to construct brain white matter networks of 15 cerebral palsy infants and 30 healthy infants that matched for age and gender. After white matter network analysis, we found that both cerebral palsy and healthy infants had a small-world topology in white matter network, but cerebral palsy infants exhibited abnormal topological organization: increased shortest path length but decreased normalize clustering coefficient, global efficiency and local efficiency. Furthermore, we also found that white matter network hub regions were located in the left cuneus, precuneus, and left posterior cingulate gyrus. However, some abnormal nodes existed in the frontal, temporal, occipital and parietal lobes of cerebral palsy infants. These results indicated that the white matter networks for cerebral palsy infants were disrupted, which was consistent with previous studies about the abnormal brain white matter areas. This work could help us further study the pathogenesis of cerebral palsy infants.

Quantitative analysis of the corpus callosum in children with cerebral palsy and developmental delay: correlation with cerebral white matter volume

International Nuclear Information System (INIS)

Panigrahy, Ashok; Barnes, Patrick D.; Robertson, Robert L.; Sleeper, Lynn A.; Sayre, James W.

2005-01-01

This study was conducted to quantitatively correlate the thickness of the corpus callosum with the volume of cerebral white matter in children with cerebral palsy and developmental delay. Material and methods: A clinical database of 70 children with cerebral palsy and developmental delay was established with children between the ages of 1 and 5 years. These children also demonstrated abnormal periventricular T2 hyperintensities associated with and without ventriculomegaly. Mid-sagittal T1-weighted images were used to measure the thickness (genu, mid-body, and splenium) and length of the corpus callosum. Volumes of interest were digitized based on gray-scale densities to define the hemispheric cerebral white matter on axial T2-weighted and FLAIR images. The thickness of the mid-body of the corpus callosum was correlated with cerebral white matter volume. Subgroup analysis was also performed to examine the relationship of this correlation with both gestational age and neuromotor outcome. Statistical analysis was performed using analysis of variance and Pearson correlation coefficients. There was a positive correlation between the thickness of the mid-body of the corpus callosum and the volume of cerebral white matter across all children studied (R=0.665, P=0.0001). This correlation was not dependent on gestational age. The thickness of the mid-body of the corpus callosum was decreased in the spastic diplegia group compared to the two other groups (hypotonia and developmental delay only; P<0.0001). Within each neuromotor subgroup, there was a positive correlation between thickness of the mid-body of the corpus callosum and volume of the cerebral white matter. (orig.)

Quantitative analysis of the corpus callosum in children with cerebral palsy and developmental delay: correlation with cerebral white matter volume

Energy Technology Data Exchange (ETDEWEB)

Panigrahy, Ashok [Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA (United States); Barnes, Patrick D. [Stanford University Medical Center, Department of Radiology, Lucile Salter Packard Children' s Hospital, Palo Alto, CA (United States); Robertson, Robert L. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States); Sleeper, Lynn A. [New England Research Institute, Watertown, MA (United States); Sayre, James W. [UCLA Medical Center, Departments of Radiology and Biostatistics, Los Angeles, CA (United States)

2005-12-01

This study was conducted to quantitatively correlate the thickness of the corpus callosum with the volume of cerebral white matter in children with cerebral palsy and developmental delay. Material and methods: A clinical database of 70 children with cerebral palsy and developmental delay was established with children between the ages of 1 and 5 years. These children also demonstrated abnormal periventricular T2 hyperintensities associated with and without ventriculomegaly. Mid-sagittal T1-weighted images were used to measure the thickness (genu, mid-body, and splenium) and length of the corpus callosum. Volumes of interest were digitized based on gray-scale densities to define the hemispheric cerebral white matter on axial T2-weighted and FLAIR images. The thickness of the mid-body of the corpus callosum was correlated with cerebral white matter volume. Subgroup analysis was also performed to examine the relationship of this correlation with both gestational age and neuromotor outcome. Statistical analysis was performed using analysis of variance and Pearson correlation coefficients. There was a positive correlation between the thickness of the mid-body of the corpus callosum and the volume of cerebral white matter across all children studied (R=0.665, P=0.0001). This correlation was not dependent on gestational age. The thickness of the mid-body of the corpus callosum was decreased in the spastic diplegia group compared to the two other groups (hypotonia and developmental delay only; P<0.0001). Within each neuromotor subgroup, there was a positive correlation between thickness of the mid-body of the corpus callosum and volume of the cerebral white matter. (orig.)

Comparative study of muscular tonus in spastic tetra paretic cerebral palsy in children with predominantly cortical and subcortical lesions in computerized tomography of the skull

International Nuclear Information System (INIS)

Iwabe, Cristina; Piovesana, Ana Maria Sedrez Gonzaga

2003-01-01

The objective was to compare distribution and intensity of muscular tonus in spastic tetra paretic cerebral palsy (CP), correlating the clinical data with lesion location in the central nervous system. Twelve children aged two to four years old with predominantly cortical lesions (six children) and subcortical lesions (six children) were included. The tonus was analyzed in the upper (UULL) and lower limbs (LLLL) based on Durigon and Piemonte protocol. The result showed that there was no significant difference regarding tonus intensity and distribution in the UULL and LLLL in both groups. Comparing the upper and lower limbs of subjects in the same group, the LLLL presented more asymmetry and higher tonus intensity than the UULL. It was concluded that in this study children with CP as a result of predominantly cortical or subcortical lesions present a similar deficit in tonus modulation, causing a symmetric and homogeneous distribution of hypertonicity, which is predominant in the LLLL. (author)

The cranial MRI in severe cerebral palsy

International Nuclear Information System (INIS)

Yamada, Kazutaka; Itoh, Masahiro; Fueki, Noboru; Hirasawa, Kyoko; Suzuki, Noriko; Kurata, Kiyoko; Sato, Junichi; Morimatsu, Yoshio; Yagishita, Akira.

1993-01-01

The magnetic resonance examination was performed in 38 patients with severe cerebral palsy (CP; 15 males and 23 females) who had both motor delay (unable to move anywhere) and mental retardation (I.Q. or D.Q. below 30). Neuroimaging findings were compared with the CP type, etiology, and grade of understanding of language. Cranial magnetic resonance imagings (MRI) in CP were divided into five types. In type 1, nine predominantly showed cyst-liked ventricles and periventricular hyperintensity on T 2 -weighted imaging (PVH) and only scarred basal ganglia and thalamus were visible. All suffered from neonatal asphyxia and the clinical type was rigospastic tetraplegia (RST). In type 2, eleven predominantly showed PVH and hyperintensity on T 2 -weighted (HT2) in basal ganglia and thalamus. All suffered from neonatal asphyxia and the clinical type was RST or rigospastic diplegia. In type 3, five showed PVH and three had cortical atrophy. All suffered from neonatal asphyxia and the clinical type was spastic diplegia. In type 4, four predominantly showed HT2 in putamen and thalamus. Three had cortical atrophy. All suffered from neonatal asphyxia. The clinical type was athetotic CP (ATH). In type 5, nine predominantly showed HT2 in globus pallidus. Four had cortical atrophy and two had hippocampal atrophy. All suffered from neonatal jaundice and the clinical type was ATH. All patients who suffered from neonatal asphyxia and spastic CP had MRI in PVH. All patients who suffered from neonatal asphyxia and ATH showed HT2 in putamen and thalamus. Almost patients who suffered from neonatal jaundice and ATH showed HT2 in globus pallidus. With athetotic CP, cases with atrophy of the cerebral cortex and/or hippocampus were lower grade of understanding of language than no atrophy of both. The results of studies of MRI are in agreement with neuropathological findings. (author)

The use of instrumented gait analysis for individually tailored interdisciplinary interventions in children with cerebral palsy

DEFF Research Database (Denmark)

Rasmussen, Helle Mätzke; Pedersen, Niels Wisbech; Overgaard, Søren

2015-01-01

in gait following individually tailored interventions when IGA is used are superior to those following ‘care as usual’. Methods/Design A prospective, single blind, randomised, parallel group study will be conducted. Children aged 5 to 8 years with spastic CP, classified at Gross Motor Function...... Classification System levels I or II, will be included. The interventions under investigation are: 1) individually tailored interdisciplinary interventions based on the use of IGA, and 2) ‘care as usual’. The primary outcome is gait measured by the Gait Deviation Index. Secondary outcome measures are: walking......Abstract Background Children with cerebral palsy (CP) often have an altered gait. Orthopaedic surgery, spasticity management, physical therapy and orthotics are used to improve the gait. Interventions are individually tailored and are planned on the basis of clinical examinations and standardised...

Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy.

Science.gov (United States)

Santos, Maria Teresa Botti Rodrigues; Nascimento, Karla Santos; Carazzato, Simone; Barros, Alina Oliveira; Mendes, Fausto Medeiros; Diniz, Michele Baffi

2017-08-01

The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm 2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm 2 ; irradiance: 3 W/cm 2 ; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.

Probability of walking in children with cerebral palsy in Europe

DEFF Research Database (Denmark)

Beckung, E.; Hagberg, G.; Uldall, P.

2008-01-01

cerebral palsy, as well as to IQ level, active epilepsy, and severe visual and hearing impairment. Severe cerebral palsy, defined as both the inability to walk and an IQ of ...OBJECTIVES: The purpose of this work was to describe walking ability in children with cerebral palsy from the Surveillance of Cerebral Palsy in Europe common database through 21 years and to examine the association between walking ability and predicting factors. PATIENTS AND METHODS: Anonymous data...... on 10042 children with cerebral palsy born between 1976 and 1996 were gathered from 14 European centers; 9012 patients were eligible for the analyses. RESULTS: Unaided walking as the primary way of walking at 5 years of age was reported for 54%, walking with assistive devices was reported for 16...

Mobility Experiences of Adolescents with Cerebral Palsy

Science.gov (United States)

Palisano, Robert J.; Shimmell, Lorie J.; Stewart, Debra; Lawless, John J.; Rosenbaum, Peter L.; Russell, Dianne J.

2009-01-01

The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts…

Gastrostomy tube feeding of children with cerebral palsy

DEFF Research Database (Denmark)

Dahlseng, Magnus O; Andersen, Guro L; DA Graca Andrada, Maria

2012-01-01

To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries.......To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries....

Risk Factors For Epilepsy In Children With Cerebral Palsy | Lagunju ...

African Journals Online (AJOL)

Epilepsy is said to occur in 15-90% of children with cerebral palsy and this poses additional economic and psychological stress on affected children and their families. Objectives To describe the risk factors for epilepsy in children with cerebral palsy. Methods One hundred and seventy six children with cerebral palsy seen at ...

Cerebral Palsy Checklist: Babies & Preschoolers (Birth to age 5)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Cerebral Palsy Checklist: Babies & Preschoolers KidsHealth / For Parents / Cerebral Palsy Checklist: Babies & Preschoolers What's in this article? Step ...

Treadmill training with partial body weight support compared with conventional gait training for low-functioning children and adolescents with nonspastic cerebral palsy: a two-period crossover study.

Science.gov (United States)

Su, Ivan Y W; Chung, Kenny K Y; Chow, Daniel H K

2013-12-01

Partial body weight-supported treadmill training has been shown to be effective in gait training for patients with neurological disorders such as spinal cord injuries and stroke. Recent applications on children with cerebral palsy were reported, mostly on spastic cerebral palsy with single subject design. There is lack of evidence on the effectiveness of such training for nonspastic cerebral palsy, particularly those who are low functioning with limited intellectual capacity. This study evaluated the effectiveness of partial body weight-supported treadmill training for improving gross motor skills among these clients. A two-period randomized crossover design with repeated measures. A crossover design following an A-B versus a B-A pattern was adopted. The two training periods consisted of 12-week partial body weight-supported treadmill training (Training A) and 12-week conventional gait training (Training B) with a 10-week washout in between. Ten school-age participants with nonspastic cerebral palsy and severe mental retardation were recruited. The Gross Motor Function Measure-66 was administered immediately before and after each training period. Significant improvements in dimensions D and E of the Gross Motor Function Measure-66 and the Gross Motor Ability Estimator were obtained. Our findings revealed that the partial body weight-supported treadmill training was effective in improving gross motor skills for low-functioning children and adolescents with nonspastic cerebral palsy. .

Association of Lead Levels and Cerebral Palsy

Science.gov (United States)

Bansal, Neha; Aggarwal, Anju; Faridi, M. M. A.; Sharma, Tusha; Baneerjee, B. D.

2017-01-01

Background: Cerebral palsy is a common motor disability in childhood. Raised lead levels affect cognition. Children with cerebral palsy may have raised lead levels, further impairing their residual cognitive motor and behavioral abilities. Environmental exposure and abnormal eating habits may lead to increased lead levels. Aims and Objectives: To measure blood lead levels in children with cerebral palsy and compare them with healthy neurologically normal children. To correlate blood lead levels with environmental factors. Material and Methods: Design: Prospective case-control study. Setting: Tertiary care hospital. Participants: Cases comprised 34 children with cerebral palsy, and controls comprised 34 neurologically normal, age- and sex-matched children. Methods: Clinical and demographic details were recorded as per proforma. Detailed environmental history was recorded to know the source of exposure to lead. These children were investigated and treated as per protocol. Venous blood was collected in ethylenediaminetetraacetic acid vials for analysis of blood lead levels. Lead levels were estimated by Schimadzu Flame AA-6800 (atomic absorption spectrophotometer). Data were analyzed using SPSS version 17. P pica were 12.33 ± 10.02 µg/dL in comparison to children with no history of pica, 6.70 ± 4.60 µg/dL (P = .029). No correlation was found between hemoglobin and blood lead levels in cases and controls. Conclusion: In our study, blood lead levels are raised in children with cerebral palsy. However, further studies are required to show effects of raised levels in these children. PMID:28491920

Cerebral Palsy Checklist: Teens & Young Adult (13 to 21)

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Cerebral Palsy Checklist: Teens & Young Adults KidsHealth / For Parents / Cerebral Palsy Checklist: Teens & Young Adults What's in this article? ...

Defining the mechanical properties of a spring-hinged ankle foot orthosis to assess its potential use in children with spastic cerebral palsy.

Science.gov (United States)

Kerkum, Yvette L; Brehm, Merel-Anne; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap

2014-12-01

A rigid ventral shelf ankle foot orthosis (AFO) may improve gait in children with spastic cerebral palsy (SCP) whose gait is characterized by excessive knee flexion in stance. However, these AFOs can also impede ankle range of motion (ROM) and thereby inhibit push-off power. A more spring-like AFO can enhance push-off and may potentially reduce walking energy cost. The recent development of an adjustable spring-hinged AFO now allows adjustment of AFO stiffness, enabling tuning toward optimal gait performance. This study aims to quantify the mechanical properties of this spring-hinged AFO for each of its springs and settings. Using an AFO stiffness tester, two AFO hinges and their accompanying springs were measured. The springs showed a stiffness range of 0.01-1.82 N · m · deg(-1). The moment-threshold increased with increasing stiffness (1.13-12.1 N · m), while ROM decreased (4.91-16.5°). Energy was returned by all springs (11.5-116.3 J). These results suggest that the two stiffest available springs should improve joint kinematics and enhance push-off in children with SCP walking with excessive knee flexion.

Postural Muscle Dyscoordination in Children With Cerebral Palsy

Directory of Open Access Journals (Sweden)

Jolanda C. van der Heide

2005-01-01

Full Text Available The present paper gives an overview of the knowledge currently available on muscular dyscoordination underlying postural problems in children with cerebral palsy (CP. Such information is a prerequisite for developing successful therapeutic interventions in children with CP. Until now, three children with CP functioning at GMFCS (Gross Motor Function Classification System level V have been documented. The children totally or partially lacked direction specificity in their postural adjustments and could not sit independently for more than 3 seconds. Some children functioning at GMFCS level IV have intact direction-specific adjustments, whereas others have problems in generating consistently direction-specific adjustments. Children at GMFCS levels I to III have an intact basic level of control but have difficulties in fine-tuning the degree of postural muscle contraction to the task-specific conditions, a dysfunction more prominently present in children with bilateral spastic CP than in children with spastic hemiplegia. The problems in the adaptation of the degree of muscle contraction might be the reason that children with CP, more often than typically developing children, show an excess of antagonistic coactivation during difficult balancing tasks and a preference for cranial-caudal recruitment during reaching. This might imply that both stereotypies might be regarded as functional strategies to compensate for the dysfunctional capacity to modulate subtly postural activity.

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

Science.gov (United States)

Kerkum, Yvette L; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap; Brehm, Merel-Anne

2015-01-01

Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (ppush-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Dutch Trial Register NTR3418.

Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy

Directory of Open Access Journals (Sweden)

Jae Meen Lee

2016-02-01

Full Text Available Neuroleptic malignant syndrome (NMS is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS surgery in a cerebral palsy (CP patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Use of paracetamol, ibuprofen or aspirin in pregnancy and risk of cerebral palsy in the child

DEFF Research Database (Denmark)

Petersen, Tanja Gram; Liew, Zeyan; Nybo Andersen, Anne-Marie

2018-01-01

Background: It has been debated whether mild analgesics, mainly paracetamol, adversely affect aspects of neurodevelopment. We examined whether mother's use of paracetamol, aspirin or ibuprofen in pregnancy is associated with increased risk of cerebral palsy (CP) in the child. Method: We included...... registers. We estimated the average causal effect of analgesics on risk of CP using marginal structural models with stabilized inverse probability weights. Results: Paracetamol use was reported in 49% of all pregnancies, aspirin in 3% and ibuprofen in 4%. Prenatal exposure to paracetamol ever in pregnancy......% CI: 1.0-2.5). Children ever prenatally exposed to aspirin in pregnancy had an elevated risk of bilateral spastic CP (aOR 2.4, 95% CI: 1.1-5.3) compared with unexposed. Conclusion: We observed an increased risk of spastic CP in children prenatally exposed to paracetamol and aspirin. Although we...

Genomic analysis identifies masqueraders of full-term cerebral palsy.

Science.gov (United States)

Takezawa, Yusuke; Kikuchi, Atsuo; Haginoya, Kazuhiro; Niihori, Tetsuya; Numata-Uematsu, Yurika; Inui, Takehiko; Yamamura-Suzuki, Saeko; Miyabayashi, Takuya; Anzai, Mai; Suzuki-Muromoto, Sato; Okubo, Yukimune; Endo, Wakaba; Togashi, Noriko; Kobayashi, Yasuko; Onuma, Akira; Funayama, Ryo; Shirota, Matsuyuki; Nakayama, Keiko; Aoki, Yoko; Kure, Shigeo

2018-05-01

Cerebral palsy is a common, heterogeneous neurodevelopmental disorder that causes movement and postural disabilities. Recent studies have suggested genetic diseases can be misdiagnosed as cerebral palsy. We hypothesized that two simple criteria, that is, full-term births and nonspecific brain MRI findings, are keys to extracting masqueraders among cerebral palsy cases due to the following: (1) preterm infants are susceptible to multiple environmental factors and therefore demonstrate an increased risk of cerebral palsy and (2) brain MRI assessment is essential for excluding environmental causes and other particular disorders. A total of 107 patients-all full-term births-without specific findings on brain MRI were identified among 897 patients diagnosed with cerebral palsy who were followed at our center. DNA samples were available for 17 of the 107 cases for trio whole-exome sequencing and array comparative genomic hybridization. We prioritized variants in genes known to be relevant in neurodevelopmental diseases and evaluated their pathogenicity according to the American College of Medical Genetics guidelines. Pathogenic/likely pathogenic candidate variants were identified in 9 of 17 cases (52.9%) within eight genes: CTNNB1 , CYP2U1 , SPAST , GNAO1 , CACNA1A , AMPD2 , STXBP1 , and SCN2A . Five identified variants had previously been reported. No pathogenic copy number variations were identified. The AMPD2 missense variant and the splice-site variants in CTNNB1 and AMPD2 were validated by in vitro functional experiments. The high rate of detecting causative genetic variants (52.9%) suggests that patients diagnosed with cerebral palsy in full-term births without specific MRI findings may include genetic diseases masquerading as cerebral palsy.

Pediatric Cerebral Palsy in Africa: Where Are We?

Science.gov (United States)

Donald, Kirsten A; Kakooza, Angelina M; Wammanda, Robinson D; Mallewa, Macpherson; Samia, Pauline; Babakir, Haydar; Bearden, David; Majnemer, Annette; Fehlings, Darcy; Shevell, Michael; Chugani, Harry; Wilmshurst, Jo M

2015-07-01

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular therapy input. Relevant guidelines are lacking. In order to guide services for children with existing disabilities, to effectively target the main etiologies and to develop preventive strategies for the continent, research priorities must include multicenter collaborative studies looking at the prevalence, risk factors, and treatment of cerebral palsy. © The Author(s) 2014.

Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children

Directory of Open Access Journals (Sweden)

Silvia L. Pavão

2015-02-01

Full Text Available OBJECTIVE: The purpose of this study was to compare postural control in typically developing (TD children and children with cerebral palsy (CP during the sit-to-stand (STS movement and to assess the relationship between static (during static standing position and dynamic postural control (during STS movement in both groups. METHOD: The center of pressure (CoP behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP and mediolateral (ML amplitudes of CoP displacement and the area and velocity of CoP oscillation. RESULTS: According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. CONCLUSIONS: Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement.

Correlations between computerized tomography of the head and motor developmental disturbances of children with cerebral palsy

International Nuclear Information System (INIS)

Chen, Yu-Herng

1981-01-01

Two hundred and eighty-two children with cerebral palsy (C.P.) and thirty-seven normal children were studied by computerized tomography (C.T.) of the head for finding out the correlations between the organic damage of the brain and the motor developmental disturbance. The abnormal findings of C.T. were: enlargement of the ventricular system, high density area, low density area and porencephalus, enlargement of the sulcus and anomaly of the medial structure. Enlargement of the ventricular system seemed to have correlation with spasticity; the portion and the extent of the enlargement corresponded to the affected extremities and the severity of the spasticity. Children of other types also showed various abnormal C.T. findings but, in general, less than that of spastic types. The prognosis of the motor development of C.P. children cannot be predicted by serial C.T. examinations strictly, because early treatment could cause improvement to that of these children. However, it is of worthy notice that C.T. is an effective method of helping to diagnose the motor developmental disturbance in earlier childhood. (author)

Sharing Experience dan Resiliensi: Studi atas Facebook Group Orang Tua Anak Cerebral Palsy

Directory of Open Access Journals (Sweden)

Safrina Rofasita

2017-06-01

[Orang tua yang mendapati anaknya terfonis sebagai anak Cerebral Palsy mengalami kedukaan mendalam yang mengakibatkan ketidakpercayaan diri, dan putus asa. Hal itu diakibatkan ketahanan terhadap stres (resiliensi rendah, oleh karena itu orang tua mengikuti sharing experiences penyandang Cerebral Palsy melalui Facebook Group orang tua anak Cerebral Palsy. Penelitian ini bertujuan menjawab pertanyaan adakah pengaruh sharing experiences penyandang Cerebral Palsy terhadap resiliensi orang tua anak Cerebral Palsy yang terhimpun dalam Facebook Group Orang Tua Anak Cerebral Palsy. Penelitian menggunakan methode kombinasi antara kuantitatif dan kualitatif. Penelitian menemukan bahwa Facebook Group berpengaruh pada peningkatan resiliensi orang tua anak cerebal palcy karena mereka mendapatkan pengetahuan dan informasi tambahan dari forum itu.

Treating cerebral palsy with aculaser therapy

Science.gov (United States)

Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Dar, Irfan

2008-03-01

A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensory-neural deafness and speech disorders. In all 250 childern were treated and the data was gathered during a period of 3 years from December 2003 till December 2006. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for minimum 6 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 171 children with Spasticity and Stiffness 147 showed marked improvement showing 87% success rate, out of 126 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 91 children showing 72% success rate, out of 48 children with Cortical Blindness 30 children showed improvement accounting for 63% efficacy rate, out of 105 children with Hearing Difficulties, 63 showed marked improvement accounting for 60% improvement rate, out of 190 children with Speech Disorders 122 showed improvement reflecting 64% improvement rate, out of 96 children with Hemiplegia 71 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 76 children with Quadriplegia 52 showed improvement in gross and fine motor functions showing 69% success rate and out of 58 children with Paraplegia of

Prevalence and risk factors for epilepsy in children with spastic cerebral palsy

Directory of Open Access Journals (Sweden)

Dedy Rahmat

2010-03-01

Conclusions The prevalence of epilepsy in spastic CP is 39%. The risk factors for epilepsy in spastic CP are post central nervous system infection, and ocurrence of seizure in the first year of life. [Paediatr Indones. 2010;50:11-7].

Cranial ultrasound findings in preterm infants predict the development of cerebral palsy

DEFF Research Database (Denmark)

Skovgaard, Ann Lawaetz; Zachariassen, Gitte

2017-01-01

record review. The cohort consisted of very preterm born children (gestational age ≤ 32 + 0) born from 2004 to 2008. For each infant, we obtained results from all cranial ultrasounds performed during hospitalisation. In 2014, patient records were evaluated for cerebral palsy, Gross Motor Function...... haemorrhagic infarction (PVHI), of whom two developed cerebral palsy. Nine children were diagnosed with periventricular leukomalacia (PVL), of whom six developed cerebral palsy. Cerebral palsy was detected in 14 children (6.4%), and one (0.5%) child was in need of a hearing assistive device. Severe brain...... injury (GMH-IVH3, PVHI or PVL) (p = 0.000) and being of male gender (p = 0.03) were associated with cerebral palsy in childhood. Conclusion: Severe brain injuries detected by neonatal cranial ultrasound in very preterm infants is associated with development of cerebral palsy in childhood....

Localization of Basal Ganglia and Thalamic Damage in Dyskinetic Cerebral Palsy.

Science.gov (United States)

Aravamuthan, Bhooma R; Waugh, Jeff L

2016-01-01

Dyskinetic cerebral palsy affects 15%-20% of patients with cerebral palsy. Basal ganglia injury is associated with dyskinetic cerebral palsy, but the patterns of injury within the basal ganglia predisposing to dyskinetic cerebral palsy are unknown, making treatment difficult. For example, deep brain stimulation of the globus pallidus interna improves dystonia in only 40% of patients with dyskinetic cerebral palsy. Basal ganglia injury heterogeneity may explain this variability. To investigate this, we conducted a qualitative systematic review of basal ganglia and thalamic damage in dyskinetic cerebral palsy. Reviews and articles primarily addressing genetic or toxic causes of cerebral palsy were excluded yielding 22 studies (304 subjects). Thirteen studies specified the involved basal ganglia nuclei (subthalamic nucleus, caudate, putamen, globus pallidus, or lentiform nuclei, comprised by the putamen and globus pallidus). Studies investigating the lentiform nuclei (without distinguishing between the putamen and globus pallidus) showed that all subjects (19 of 19) had lentiform nuclei damage. Studies simultaneously but independently investigating the putamen and globus pallidus also showed that all subjects (35 of 35) had lentiform nuclei damage (i.e., putamen or globus pallidus damage); this was followed in frequency by damage to the putamen alone (70 of 101, 69%), the subthalamic nucleus (17 of 25, 68%), the thalamus (88 of 142, 62%), the globus pallidus (7/35, 20%), and the caudate (6 of 47, 13%). Globus pallidus damage was almost always coincident with putaminal damage. Noting consistent involvement of the lentiform nuclei in dyskinetic cerebral palsy, these results could suggest two groups of patients with dyskinetic cerebral palsy: those with putamen-predominant damage and those with panlenticular damage involving both the putamen and the globus pallidus. Differentiating between these groups could help predict response to therapies such as deep brain

Focal treatment of spasticity using botulinum toxin A in cerebral palsy cases of GMFCS level V: evaluation of adverse effects

Directory of Open Access Journals (Sweden)

Ana Paula Tedesco

2014-08-01

Full Text Available Objective:To report on the experience of injections of botulinum toxin A (BTA in a series of patients with cerebral palsy of Gross Motor Function Classification System (GMFCS level V.Methods:This was a retrospective case series study on 33 patients with cerebral palsy of GMFCS level V who received 89 sessions of BTA application (of which 84 were Botox® and five were other presentations, in which the basic aim was to look for adverse effects.Results:The mean number of application sessions per patient was three, and the mean age at the time of each injection was 4 + 6 years (range: 1.6–13 years. The muscles that most frequently received injections were the gastrocnemius, hamstrings, hip adductors, biceps brachii and finger flexors. The mean total dose was 193 U and the mean dose per weight was 12.5 U/kg. Only one patient received anesthesia for the injections and no sedation was used in any case. No local or systemic adverse effects were observed within the minimum follow-up of one month.Conclusion:The absence of adverse effects in our series was probably related to the use of low doses and absence of sedation or anesthesia. According to our data, BTA can be safely used for patients with cerebral palsy of GMFCS level V, using low doses and preferably without sedation or anesthesia.

Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length.

Science.gov (United States)

Smith, Lucas R; Lee, Ki S; Ward, Samuel R; Chambers, Henry G; Lieber, Richard L

2011-05-15

Cerebral palsy (CP) results from an upper motoneuron (UMN)lesion in the developing brain. Secondary to the UMNl esion,which causes spasticity, is a pathological response by muscle - namely, contracture. However, the elements within muscle that increase passive mechanical stiffness, and therefore result in contracture, are unknown. Using hamstring muscle biopsies from pediatric patients with CP (n =33) and control (n =19) patients we investigated passive mechanical properties at the protein, cellular, tissue and architectural levels to identify the elements responsible for contracture. Titin isoform, the major load-bearing protein within muscle cells, was unaltered in CP. Correspondingly, the passive mechanics of individual muscle fibres were not altered. However, CP muscle bundles, which include fibres in their constituent ECM, were stiffer than control bundles. This corresponded to an increase in collagen content of CP muscles measured by hydroxyproline assay and observed using immunohistochemistry. In vivo sarcomere length of CP muscle measured during surgery was significantly longer than that predicted for control muscle. The combination of increased tissue stiffness and increased sarcomere length interact to increase stiffness greatly of the contracture tissue in vivo. These findings provide evidence that contracture formation is not the result of stiffening at the cellular level, but stiffening of the ECM with increased collagen and an increase of in vivo sarcomere length leading to higher passive stresses.

Cerebral palsy litigation: change course or abandon ship.

Science.gov (United States)

Sartwelle, Thomas P; Johnston, James C

2015-06-01

The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy. Electronic fetal monitoring has, however, increased the cesarian section rate, with the expected increase in mortality and morbidity risks to mothers and babies alike. This article explains why electronic fetal monitoring remains endorsed as efficacious in the worlds' labor rooms and courtrooms despite being such a feeble medical modality. It also reviews the reasons professional organizations have failed to condemn the use of electronic fetal monitoring in courtrooms. The failures of tort reform, special cerebral palsy courts, and damage limits to stem the escalating litigation are discussed. Finally, the authors propose using a currently available evidence rule-the Daubert doctrine that excludes "junk science" from the courtroom-as the beginning of the end to cerebral palsy litigation and electronic fetal monitoring's 40-year masquerade as science. © The Author(s) 2014.

Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS – a randomized controlled trial protocol for a stationary cycling intervention

Directory of Open Access Journals (Sweden)

Simms Victoria

2007-03-01

Full Text Available Abstract Background In the past, effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns. Current scientific evidence indicates that these concerns were unfounded and that therapeutic interventions focused on muscle strengthening can lead to improved functional ability. However, few studies have examined the potential benefits of cardiorespiratory fitness exercises in this patient population. Methods/design The rationale and design of a randomized controlled trial examining the effects of a stationary cycling intervention for children with CP are outlined here. Sixty children with spastic diplegic CP between the ages of 7 and 18 years and Gross Motor Function Classification System (GMFCS levels of I, II, or III will be recruited for this study. Participants will be randomly assigned to either an intervention (cycling or a control (no cycling group. The cycling intervention will be divided into strengthening and cardiorespiratory endurance exercise phases. During the strengthening phase, the resistance to lower extremity cycling will be progressively increased using a uniquely designed limb-loaded mechanism. The cardiorespiratory endurance phase will focus on increasing the intensity and duration of cycling. Children will be encouraged to exercise within a target heart rate (HR range (70 – 80% maximum HR. Thirty sessions will take place over a 10–12 week period. All children will be evaluated before (baseline and after (follow-up the intervention period. Primary outcome measures are: knee joint extensor and flexor moments, or torque; the Gross Motor Function Measure (GMFM; the 600 Yard Walk-Run test and the Thirty-Second Walk test (30 sec WT. Discussion This paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS; a Phase I randomized controlled trial

Association between type of cerebral palsy and the cognitive levels

Directory of Open Access Journals (Sweden)

Ratna Dewi Kusumaningrum

2009-07-01

Conclusion Our data showed that most patients with cerebral palsy had mental retardation of several cognitive level but there was no significant association between each type of cerebral palsy with cognitive levels.

Congenital Cytomegalovirus among Children with Cerebral Palsy.

Science.gov (United States)

Smithers-Sheedy, Hayley; Raynes-Greenow, Camille; Badawi, Nadia; Fernandez, Marian A; Kesson, Alison; McIntyre, Sarah; Leung, Kin-Chuen; Jones, Cheryl A

2017-02-01

To determine the proportion of children with cerebral palsy (CP) and cytomegalovirus (CMV) DNA detected retrospectively in their newborn screening cards (NBSC), to compare the proportion of children with CMV DNA in their NBSC across spastic subtypes of CP, and to compare the sex and other characteristics of children with CP and CMV detected on their NSBC with those in whom CMV DNA was not detected. Retrospective observational study. Data were extracted from patient records on children with CP (birth years 1996-2014) from 2 Australian state CP registers and state-wide paediatric rehabilitation services with consent. NBSCs were retrospectively analyzed for CMV DNA by nested polymerase chain reaction (PCR) using primers against gB. Positive samples were validated using real time PCR for CMV UL83. Of 401 children recruited, 323 (80.5%) had an available NBSC. Of these, 31 (9.6%; 95% CI, 6.8-13.3) tested positive for CMV DNA by nested PCR for CMV gB, of whom 28 (8.7%; 95% CI, 6.1-12.2) also had CMV DNA detected by real-time PCR for CMV UL83. Detection of CMV DNA was significantly associated with epilepsy, but not with clinical or epidemiologic characteristics, including sex and pattern of spasticity. CMV viremia in the newborn period, indicating congenital CMV infection, is highly prevalent among children with CP. Further research is needed to investigate the mechanisms and contribution of congenital CMV to the causal pathways to CP. Copyright © 2016 Elsevier Inc. All rights reserved.

Hypopituitarism in children with cerebral palsy.

Science.gov (United States)

Uday, Suma; Shaw, Nick; Krone, Ruth; Kirk, Jeremy

2017-06-01

Poor growth and delayed puberty in children with cerebral palsy is frequently felt to be related to malnutrition. Although growth hormone deficiency is commonly described in these children, multiple pituitary hormone deficiency (MPHD) has not been previously reported. We present a series of four children with cerebral palsy who were born before 29 weeks gestation who were referred to the regional endocrinology service, three for delayed puberty and one for short stature, in whom investigations identified MPHD. All patients had a height well below -2 standard deviation score (2nd centile) at presentation and three who had MRI scans had an ectopic posterior pituitary gland. We therefore recommend that the possibility of MPHD should be considered in all children with cerebral palsy and poor growth or delayed puberty. Early diagnosis and treatment is essential to maximise growth and prevent associated morbidity and mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964-1993. The North of England Collaborative Cerebral Palsy Survey.

Science.gov (United States)

Colver, A F; Gibson, M; Hey, E N; Jarvis, S N; Mackie, P C; Richmond, S

2000-07-01

To report epidemiological trends in cerebral palsy including analyses by severity. Descriptive longitudinal study in north-east England. Every child with suspected cerebral palsy was examined by a developmental paediatrician to confirm the diagnosis. Severity of impact of disability was derived from a parent completed questionnaire already developed and validated for this purpose. All children with cerebral palsy, not associated with any known postneonatal insult, born 1964-1993 to mothers resident at the time of birth in the study area. Cerebral palsy rates by year, birth weight, and severity. Severity of 30% and above defines the more reliably ascertained cases; children who died before assessment at around 6 years of age are included in the most severe group (70% and above). 584 cases of cerebral palsy were ascertained, yielding a rate that rose from 1.68 per 1000 neonatal survivors during 1964-1968 to 2.45 during 1989-1993 (rise = 0.77; 95% confidence interval 0.2-1.3). For the more reliably ascertained cases there was a twofold increase in rate from 0.98 to 1.96 (rise = 0.98; 95% confidence interval 0.5-1.4). By birth weight, increases in rates were from 29.8 to 74.2 per 1000 neonatal survivors rate of cerebral palsy has risen in spite of falling perinatal and neonatal mortality rates, a rise that is even more pronounced when the mildest and least reliably ascertained are excluded. The effect of modern care seems to be that many babies rates, and to monitor changes in the distribution of severity.

Storytelling: Enhancing Vocabularies For Cerebral Palsy Students

OpenAIRE

Aprilina, Raita Gina

2015-01-01

This paper reported on a study concerned with teaching vocabulary using storytelling technique in one of SLBs in Bandung. This study aimed to find out the cerebral palsy students' ability in English vocabulary before and after the treatment, and to find out whether storytelling significantly improved English vocabulary of students with cerebral palsy. This study used an experimental method with single subject research with A-B-A design which involved two participants. This study revealed that...

Health-related physical fitness for children with cerebral palsy

Science.gov (United States)

Maltais, Désirée B.; Wiart, Lesley; Fowler, Eileen; Verschuren, Olaf; Damiano, Diane L.

2014-01-01

Low levels of physical activity are a global health concern for all children. Children with cerebral palsy have even lower physical activity levels than their typically developing peers. Low levels of physical activity, and thus an increased risk for related chronic diseases, are associated with deficits in health-related physical fitness. Recent research has provided therapists with the resources to effectively perform physical fitness testing and physical activity training in clinical settings with children who have cerebral palsy, although most testing and training data to date pertains to those who walk. Nevertheless, based on the present evidence, all children with cerebral palsy should engage, to the extent they are able, in aerobic, anaerobic and muscle strengthening activities. Future research is required to determine the best ways to evaluate health-related physical fitness in non-ambulatory children with cerebral palsy and foster long-term changes in physical activity behavior in all children with this condition. PMID:24820339

Comparison of Efficacy and Side Effects of Oral Baclofen Versus Tizanidine Therapy with Adjuvant Botulinum Toxin Type A in Children With Cerebral Palsy and Spastic Equinus Foot Deformity.

Science.gov (United States)

Dai, Alper I; Aksoy, Sefika N; Demiryürek, Abdullah T

2016-02-01

This retrospective study aimed to compare the therapeutic response, including side effects, for oral baclofen versus oral tizanidine therapy with adjuvant botulinum toxin type A in a group of 64 pediatric patients diagnosed with static encephalopathy and spastic equinus foot deformity. Following botulinum toxin A treatment, clinical improvement led to the gradual reduction of baclofen or tizanidine dosing to one-third of the former dose. Gross Motor Functional Measure and Caregiver Health Questionnaire scores were markedly elevated post-botulinum toxin A treatment, with scores for the tizanidine (Gross Motor Functional Measure: 74.45 ± 3.72; Caregiver Health Questionnaire: 72.43 ± 4.29) group significantly higher than for the baclofen group (Gross Motor Functional Measure: 68.23 ± 2.66; Caregiver Health Questionnaire: 67.53 ± 2.67, P botulinum toxin A and a low dose of tizanidine in treating children with cerebral palsy appears to be more effective and has fewer side effects versus baclofen with adjuvant botulinum toxin A. © The Author(s) 2015.

Pain symptoms in patients with severe cerebral palsy: Prevalence ...

African Journals Online (AJOL)

Purpose: To evaluate the presence of pain in patients diagnosed with severe cerebral palsy (CP) according to the degree of motor function impairment. Methods: A cross-sectional study was conducted on students of the Association of Parents and Friends of Exceptional Children (APAE) diagnosed with cerebral palsy and ...

Bladder and Bowel Control in Children with Cerebral Palsy: Case-Control Study

Science.gov (United States)

Ozturk, Mustafa; Oktem, Faruk; Kisioglu, Nesimi; Demirci, Mustafa; Altuntas, Irfan; Kutluhan, Suleyman; Dogan, Malik

2006-01-01

Aim To determine the age of development of bladder and bowel control and the frequency of enuresis, encopresis, and urinary infections in children with cerebral palsy. Methods The study included 45 children with cerebral palsy who regularly attended a rehabilitation center in Isparta, Turkey, and two groups of age- and sex-matched children, 37 siblings of the children with cerebral palsy and 37 healthy children. Demographic data and information on the age of development of total bladder and bowel control and presence of possible urinary symptoms in children were collected from their caregivers by use of a questionnaire. Frequency of enuresis and encopresis was estimated among the children aged ≥5 years. A mid-way urinary sample was obtained from 40, 22, and 21 children in the cerebral palsy, siblings, and healthy children, respectively. Results The mean age of nighttime bladder and bowel control development was 47 months (95% confidence interval [CI], 35-58) and 45 (36-55) months, respectively, for the children with cerebral palsy, 35 months (95% CI, 24-46) and 26 months (95% CI, 24-28), respectively, for their siblings, and 27 months (95% CI, 22-33) and 25 months (95% CI, 23-27) months, respectively, for the healthy children. Among the children aged ≥5 years, enuresis was present in 11 of 34 children with cerebral palsy, 7 of 30 siblings, and 4 of 30 healthy children (P = 0.200), whereas encopresis was present in 5 children with cerebral palsy, one sibling, and one healthy child. Constipation was significantly more present in chidlren with cerebral palsy than in other two groups (P<0.001). Urine culture was positive in 13 children with cerebral palsy, 1 sibling, and 2 healthy chidlren (P = 0.024). There were no significant differences in other urinary symptoms and laboratory findings among the three groups. Conclusion The children with cerebral palsy gained bladder and bowel control at older age in comparison with their siblings and healthy children

Differential effects of rhythmic auditory stimulation and neurodevelopmental treatment/Bobath on gait patterns in adults with cerebral palsy: a randomized controlled trial.

Science.gov (United States)

Kim, Soo Ji; Kwak, Eunmi E; Park, Eun Sook; Cho, Sung-Rae

2012-10-01

To investigate the effects of rhythmic auditory stimulation (RAS) on gait patterns in comparison with changes after neurodevelopmental treatment (NDT/Bobath) in adults with cerebral palsy. A repeated-measures analysis between the pretreatment and posttreatment tests and a comparison study between groups. Human gait analysis laboratory. Twenty-eight cerebral palsy patients with bilateral spasticity participated in this study. The subjects were randomly allocated to either neurodevelopmental treatment (n = 13) or rhythmic auditory stimulation (n = 15). Gait training with rhythmic auditory stimulation or neurodevelopmental treatment was performed three sessions per week for three weeks. Temporal and kinematic data were analysed before and after the intervention. Rhythmic auditory stimulation was provided using a combination of a metronome beat set to the individual's cadence and rhythmic cueing from a live keyboard, while neurodevelopmental treatment was implemented following the traditional method. Temporal data, kinematic parameters and gait deviation index as a measure of overall gait pathology were assessed. Temporal gait measures revealed that rhythmic auditory stimulation significantly increased cadence, walking velocity, stride length, and step length (P rhythmic auditory stimulation (P rhythmic auditory stimulation (P rhythmic auditory stimulation showed aggravated maximal internal rotation in the transverse plane (P rhythmic auditory stimulation or neurodevelopmental treatment elicited differential effects on gait patterns in adults with cerebral palsy.

Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study.

Science.gov (United States)

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2009-12-01

Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data. We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %). In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images. Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia. Level 4.

Quality of Arithmetic Education for Children with Cerebral Palsy

Science.gov (United States)

Jenks, Kathleen M.; de Moor, Jan; van Lieshout, Ernest C. D. M.; Withagen, Floortje

2010-01-01

The aim of this exploratory study was to investigate the quality of arithmetic education for children with cerebral palsy. The use of individual educational plans, amount of arithmetic instruction time, arithmetic instructional grouping, and type of arithmetic teaching method were explored in three groups: children with cerebral palsy (CP) in…

The Association Between Maternal Age and Cerebral Palsy Risk Factors.

Science.gov (United States)

Schneider, Rilla E; Ng, Pamela; Zhang, Xun; Andersen, John; Buckley, David; Fehlings, Darcy; Kirton, Adam; Wood, Ellen; van Rensburg, Esias; Shevell, Michael I; Oskoui, Maryam

2018-05-01

Advanced maternal age is associated with higher frequencies of antenatal and perinatal conditions, as well as a higher risk of cerebral palsy in offspring. We explore the association between maternal age and specific cerebral palsy risk factors. Data were extracted from the Canadian Cerebral Palsy Registry. Maternal age was categorized as ≥35 years of age and less than 20 years of age at the time of birth. Chi-square and multivariate logistic regressions were performed to calculate odds ratios and their 95% confidence intervals. The final sample consisted of 1391 children with cerebral palsy, with 19% of children having mothers aged 35 or older and 4% of children having mothers below the age of 20. Univariate analyses showed that mothers aged 35 or older were more likely to have gestational diabetes (odds ratio 1.9, 95% confidence interval 1.3 to 2.8), to have a history of miscarriage (odds ratio 1.8, 95% confidence interval 1.3 to 2.4), to have undergone fertility treatments (odds ratio 2.4, 95% confidence interval 1.5 to 3.9), and to have delivered by Caesarean section (odds ratio 1.6, 95% confidence interval 1.2 to 2.2). These findings were supported by multivariate analyses. Children with mothers below the age of 20 were more likely to have a congenital malformation (odds ratio 2.4, 95% confidence interval 1.4 to 4.2), which is also supported by multivariate analysis. The risk factor profiles of children with cerebral palsy vary by maternal age. Future studies are warranted to further our understanding of the compound causal pathways leading to cerebral palsy and the observed greater prevalence of cerebral palsy with increasing maternal age. Copyright © 2018 Elsevier Inc. All rights reserved.

Análise do equilíbrio estático e de deformidades nos pés de crianças com paralisia cerebral Analysis of static balance and deformities on feet of children with cerebral palsy

Directory of Open Access Journals (Sweden)

Thaís Delamuta Ayres da Costa

2011-06-01

Full Text Available O presente estudo analisou, por meio de um sistema de baropodometria, os tipos de pé, a influência da visão no equilíbrio estático na postura ortostática e a distribuição da pressão plantar em 16 crianças, de 6 a 15 anos, com diagnóstico de paralisia cerebral. Os resultados indicaram que o pé valgo foi o mais comum dentre os tipos de paralisia cerebral estudadas, diparesia espástica, hemiparesia espástica direita, hemiparesia espástica esquerda e ataxia; o equilíbrio estático na postura ortostática de olhos vendados apresentou maior instabilidade do que quando com os olhos abertos; a distribuição de pressão plantar não apresentou significância estatística e não houve correlação significativa entre a idade e as variáveis de equilíbrio e de distribuição da pressão plantar. Desse modo, conclui-se que a visão é um fator importante no controle postural de crianças com paralisia cerebral.The present study analyzed through baropodometry system, the feet's types, the vision's influence during static balance on orthostatic posture and the plantar pressure distribution in 16 children, aged from 6 to 15 years-old with diagnostic of cerebral palsy. We noted that the valgus foot was more common on the sample studied, diparetic spastic, hemiparetic spastic right, and hemiparetic spastic left and ataxic; the static balance on orthostatic posture with closed eyes was more instable compared to the orthostatic posture with opened eyes. In relation to the distribution of plantar pressure, we did not observe statistical significance and there was no correlation between age and the balance's variables and the plantar pressure's distribution. Therefore, we concluded that the vision is an important factor on postural control in children with cerebral palsy.

De novo point mutations in patients diagnosed with ataxic cerebral palsy.

Science.gov (United States)

Parolin Schnekenberg, Ricardo; Perkins, Emma M; Miller, Jack W; Davies, Wayne I L; D'Adamo, Maria Cristina; Pessia, Mauro; Fawcett, Katherine A; Sims, David; Gillard, Elodie; Hudspith, Karl; Skehel, Paul; Williams, Jonathan; O'Regan, Mary; Jayawant, Sandeep; Jefferson, Rosalind; Hughes, Sarah; Lustenberger, Andrea; Ragoussis, Jiannis; Jackson, Mandy; Tucker, Stephen J; Németh, Andrea H

2015-07-01

Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain.

Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

International Nuclear Information System (INIS)

Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W.

1997-01-01

The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84±17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78±10.36), mild defect ( 2 test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients

Efficacy of gait trainer as an adjunct to traditional physical therapy on walking performance in hemiparetic cerebral palsied children: a randomized controlled trial.

Science.gov (United States)

Gharib, Nevein Mm; El-Maksoud, Gehan M Abd; Rezk-Allah, Soheir S

2011-10-01

To assess the effects of additional gait trainer assisted walking exercises on walking performance in children with hemiparetic cerebral palsy. A randomized controlled study. Paediatric physical therapy outpatient clinic. Thirty spastic hemiparetic cerebral palsied children of both sexes (10-13 years - 19 girls and 11 boys). Children were randomly assigned into two equal groups; experimental and control groups. Participants in both groups received a traditional physical therapy exercise programme. Those in the experimental group received additional gait trainer based walking exercises which aimed to improve walking performance. Treatment was provided three times per week for three successive months. Children received baseline and post-treatment assessments using Biodex Gait Trainer 2 assessment device to evaluate gait parameters including: average step length, walking speed, time on each foot (% of gait cycle) and ambulation index. Children in the experimental group showed a significant improvement as compared with those in the control group. The ambulation index was 75.53±7.36 (11.93 ± 2.89 change score) for the experimental group and 66.06 ± 5.48 (2.13 ± 4.43 change score) for the control group (t = 3.99 and P = 0.0001). Time of support for the affected side was 42.4 ± 3.37 (7 ± 2.20 change score) for the experimental group and 38.06 ± 4.63 (3.33 ± 6.25 change score) for the control group (t = 2.92 and P = 0.007). Also, there was a significant improvement in step length and walking speed in both groups. Gait trainer combined with traditional physiotherapy increase the chance of improving gait performance in children with spastic hemiparetic cerebral palsy.

Risk Factors for Malnutrition Among Children With Cerebral Palsy in Botswana.

Science.gov (United States)

Johnson, Allison; Gambrah-Sampaney, Claudia; Khurana, Esha; Baier, James; Baranov, Esther; Monokwane, Baphaleng; Bearden, David R

2017-05-01

Children with cerebral palsy in low-resource settings are at high risk of malnutrition, which further increases their risk of poor health outcomes. However, there are few available data on specific risk factors for malnutrition among children with cerebral palsy in the developing world. We performed a case-control study among children with cerebral palsy receiving care at a tertiary care hospital in Gaborone, Botswana. Children with cerebral palsy and malnutrition were identified according to World Health Organization growth curves and compared with subjects with cerebral palsy without malnutrition. Risk factors for malnutrition were identified using multivariable logistic regression models. These risk factors were then used to generate a Malnutrition Risk Score, and Receiver Operating Characteristic curves were used to identify optimal cutoffs to identify subjects at high risk of malnutrition. We identified 61 children with cerebral palsy, 26 of whom (43%) met criteria for malnutrition. Nonambulatory status (odds ratio 13.8, 95% confidence interval [CI] 3.8-50.1, P malnutrition. A Malnutrition Risk Score was constructed based on these risk factors, and receiver operating characteristic curve analysis demonstrated excellent performance characteristics of this score (area under the curve 0.92, 95% CI 0.89-0.94). Malnutrition is common among children with cerebral palsy in Botswana, and a simple risk score may help identify children with the highest risk. Further studies are needed to validate this screening tool and to determine optimal nutritional interventions in this population. Copyright © 2017 Elsevier Inc. All rights reserved.

Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy.

Science.gov (United States)

de Gooijer-van de Groep, Karin L; de Vlugt, Erwin; de Groot, Jurriaan H; van der Heijden-Maessen, Hélène C M; Wielheesen, Dennis H M; van Wijlen-Hempel, Rietje M S; Arendzen, J Hans; Meskers, Carel G M

2013-07-23

Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: "spasticity" vs. "contracture"). Differentiation between these components is hard to achieve by common manual tests. We applied an assessment instrument to obtain quantitative measures of neural and non-neural contributions to ankle joint stiffness in CP. Twenty-three adolescents with CP and eleven healthy subjects were seated with their foot fixated to an electrically powered single axis footplate. Passive ramp-and-hold rotations were applied over full ankle range of motion (RoM) at low and high velocities. Subject specific tissue stiffness, viscosity and reflexive torque were estimated from ankle angle, torque and triceps surae EMG activity using a neuromuscular model. In CP, triceps surae reflexive torque was on average 5.7 times larger (p = .002) and tissue stiffness 2.1 times larger (p = .018) compared to controls. High tissue stiffness was associated with reduced RoM (p therapy.

Epidemiology of cerebral palsy in Southern Denmark

DEFF Research Database (Denmark)

Frøslev-Friis, Christina; Dunkhase-Heinl, Ulrike; Andersen, Johnny Dohn Holmgren

2015-01-01

INTRODUCTION: The aim of this study was to describe the prevalence, subtypes, severity and neuroimaging findings of cerebral palsy (CP) in a cohort of children born in Southern Denmark. Risk factors were analysed and aetiology considered. METHODS: A population-based cohort study covering 17...... prevention of CP is possible if the numbers of preterm births and multiple pregnancies can be reduced. FUNDING: The Danish Cerebral Palsy Follow-up Programme is supported by the foundation "Ludvig og Sara Elsass Fond". TRIAL REGISTRATION: 2008-58-0034....

Lipid myopathy associated with renal tubular acidosis and spastic diplegia in two brothers.

Science.gov (United States)

Tung, Y C; Tsau, Y K; Chu, L W; Young, C; Shen, Y Z

2001-07-01

Lipid myopathy is a group of disorders involving mitochondrial fatty acid oxidation. We describe two brothers, 3 years 8 months old and 2 years 9 months old, respectively, with progressive spastic diplegia, developmental delay, failure to thrive, and chronic metabolic acidosis who had lipid myopathy and renal tubular acidosis. Brain magnetic resonance imaging revealed demyelinating changes in the periventricular white matter, which was compatible with spastic diplegia. These symptoms may be related to errors in fatty acid metabolism. Cerebral palsy had been misdiagnosed in both of these patients at another hospital. Therefore, for patients with late-onset and progressive spastic diplegia, detailed investigations for underlying diseases are warranted.

Multilevel Botulinum Toxin A (Abobotulinum Toxin A Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience

Directory of Open Access Journals (Sweden)

O. A. Klochkova

2016-01-01

Full Text Available Background: The contemporary application of Botulinum toxin A (BTA in cerebral palsy (CP implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months. Multilevel BTA injections were indicated for the majority (n = 634, 87.6% of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U, the repeated injections doses up to 45 U/kg (1000 U (in most centers. The median intervals between the repeated injections were 180–200 days in 484 (66.9% patients and 140–180 days in 157 (24.7% patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.

European study of frequency of participation of adolescents with and without cerebral palsy

DEFF Research Database (Denmark)

Michelsen, Susan I; Flachs, Esben M; Damsgaard, Mogens T

2014-01-01

Children with cerebral palsy participate less in everyday activities than children in the general populations. During adolescence, rapid physical and psychological changes occur which may be more difficult for adolescents with impairments. Within the European SPARCLE project we measured frequency...... respectively linear and logistic regression. Adolescents with cerebral palsy spent less time with friends and had less autonomy in their daily life than adolescents in the general populations. Adolescents with cerebral palsy participated much less in sport but played electronic games at least as often...... populations. Regional variation existed. For example adolescents with cerebral palsy in central Italy were most disadvantaged according to decisional autonomy, while adolescents with cerebral palsy in east Denmark and northern England played sports as often as their general populations. Participation...

Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results.

Science.gov (United States)

Bonnechère, Bruno; Omelina, Lubos; Jansen, Bart; Van Sint Jan, Serge

2017-02-01

Cerebral palsy (CP) leads to various clinical signs mainly induced by muscle spasticity and muscle weakness. Among these ones impaired balance and posture are very common. Traditional physical therapy exercise programs are focusing on this aspect, but it is difficult to motivate patients to regularly perform these exercises, especially at home without therapist supervision. Specially developed serious games (SG) could therefore be an interesting option to motivate children to perform specific exercise for balance improvement. Ten CP children participated in this study. Patients received four sessions of SG included into conventional therapy (1 session of 30 min a week during 4 weeks). Trunk control and balance were assessed using Trunk Control Motor Scale (TCMS) before and after interventions. Children presented a significant improvement in TCMS global score after interventions [37.6 (8.7) and 39.6 (9.5) before and after interventions, respectively, p = 0.04]. SG could therefore be an interesting option to integrate in the conventional treatment of CP children. Implication for Rehabilitation Cerebral palsy (CP) leads to balance issues. Rehabilitation exercises are not performed (enough) at home. Serious games (SG) could increase patients' motivation. SG increase balance control of CP children.

Maternal Infections during Pregnancy and Cerebral Palsy

DEFF Research Database (Denmark)

Miller, Jessica; Pedersen, Lars Henning; Streja, Elani

2013-01-01

BACKGROUND: Cerebral palsy (CP) is a common motor disability in childhood. We examined the association between maternal infections during pregnancy and the risk of congenital CP in the child. METHODS: Liveborn singletons in Denmark between 1997 and 2003 were identified from the Danish National...... the Danish Cerebral Palsy Registry. Adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated by Cox proportional hazard models. RESULTS: Of the 440 564 singletons with follow-up data, 840 were diagnosed with congenital CP. Maternal genito-urinary tract infections (HR 2.1, 95% CI 1.4, 3...

Pathophysiology of muscle contractures in cerebral palsy.

Science.gov (United States)

Mathewson, Margie A; Lieber, Richard L

2015-02-01

Patients with cerebral palsy present with a variety of adaptations to muscle structure and function. These pathophysiologic symptoms include functional deficits such as decreased force production and range of motion, in addition to changes in muscle structure such as decreased muscle belly size, increased sarcomere length, and altered extracellular matrix structure and composition. On a cellular level, patients with cerebral palsy have fewer muscle stem cells, termed satellite cells, and altered gene expression. Understanding the nature of these changes may present opportunities for the development of new muscle treatment therapies. Published by Elsevier Inc.

Sleep disorders in children with cerebral palsy: An integrative review.

Science.gov (United States)

Lélis, Ana Luíza P A; Cardoso, Maria Vera L M; Hall, Wendy A

2016-12-01

Sleep disorders are more prevalent in children with cerebral palsy. The review aimed to identify and synthesize information about the nature of sleep disorders and their related factors in children with cerebral palsy. We performed an electronic search by using the search terms sleep/child*, and sleep/cerebral palsy in the following databases: Latin American literature on health sciences, SCOPUS, medical publications, cumulative index to nursing and allied health literature, psycinfo, worldcat, web of science, and the Cochrane library. The selection criteria were studies: available in Portuguese, English or Spanish and published between 2004 and 2014, with results addressing sleep disorders in children (ages 0-18 y) with a diagnosis of cerebral palsy. 36,361 abstracts were identified. Of those, 37 papers were selected, and 25 excluded. Twelve papers were incorporated in the study sample: eight quantitative studies, three reviews, and one case study. Eleven types of sleep disorders were identified, such as difficult morning awakening, insomnia, nightmares, difficulties in initiating and maintaining nighttime sleep (night waking), and sleep anxiety. Twenty-one factors were linked to sleep disorders, which we classified as intrinsic factors associated with common comorbidities accompanying cerebral palsy, and extrinsic aspects, specifically environmental and socio-familial variables, and clinical-surgical and pharmacological interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment : A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

NARCIS (Netherlands)

Salavati, M.; Rameckers, E. A. A.; Waninge, A.; Krijnen, W. P.; Steenbergen, B.; van der Schans, C. P.

Purpose: To investigate whether the adapted version of the Gross Motor Function Measure 88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result

Volumetric Magnetic Resonance Imaging Study of Brain and Cerebellum in Children with Cerebral Palsy.

Science.gov (United States)

Kułak, Piotr; Maciorkowska, Elżbieta; Gościk, Elżbieta

2016-01-01

Introduction. Quantitative magnetic resonance imaging (MRI) studies are rarely used in the diagnosis of patients with cerebral palsy. The aim of present study was to assess the relationships between the volumetric MRI and clinical findings in children with cerebral palsy compared to control subjects. Materials and Methods. Eighty-two children with cerebral palsy and 90 age- and sex-matched healthy controls were collected. Results. The dominant changes identified on MRI scans in children with cerebral palsy were periventricular leukomalacia (42%) and posthemorrhagic hydrocephalus (21%). The total brain and cerebellum volumes in children with cerebral palsy were significantly reduced in comparison to controls. Significant grey matter volume reduction was found in the total brain in children with cerebral palsy compared with the control subjects. Positive correlations between the age of the children of both groups and the grey matter volumes in the total brain were found. Negative relationship between width of third ventricle and speech development was found in the patients. Positive correlations were noted between the ventricles enlargement and motor dysfunction and mental retardation in children with cerebral palsy. Conclusions. By using the voxel-based morphometry, the total brain, cerebellum, and grey matter volumes were significantly reduced in children with cerebral palsy.

Learn More About Cerebral Palsy

Centers for Disease Control (CDC) Podcasts

2008-03-30

This podcast describes the causes, preventions, types, and signs and symptoms of cerebral palsy.  Created: 3/30/2008 by National Center on Birth Defects and Developmental Disabilities.   Date Released: 3/21/2008.

Relationships between Isometric Muscle Strength, Gait Parameters, and Gross Motor Function Measure in Patients with Cerebral Palsy.

Science.gov (United States)

Shin, Hyung Ik; Sung, Ki Hyuk; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Lee, In Hyeok; Park, Moon Seok

2016-01-01

This study investigated the correlation between isometric muscle strength, gross motor function, and gait parameters in patients with spastic cerebral palsy and to find which muscle groups play an important role for gait pattern in a flexed knee gait. Twenty-four ambulatory patients (mean age, 10.0 years) with spastic cerebral palsy who were scheduled for single event multilevel surgery, including distal hamstring lengthening, were included. Preoperatively, peak isometric muscle strength was measured for the hip flexor, hip extensor, knee flexor, and knee extensor muscle groups using a handheld dynamometer, and three-dimensional (3D) gait analysis and gross motor function measure (GMFM) scoring were also performed. Correlations between peak isometric strength and GMFM, gait kinematics, and gait kinetics were analyzed. Peak isometric muscle strength of all muscle groups was not related to the GMFM score and the gross motor function classification system level. Peak isometric strength of the hip extensor and knee extensor was significantly correlated with the mean pelvic tilt (r=-0.588, p=0.003 and r=-0.436, p=0.033) and maximum pelvic obliquity (r=-0.450, p=0.031 and r=-0.419, p=0.041). There were significant correlations between peak isometric strength of the knee extensor and peak knee extensor moment in early stance (r=0.467, p=0.021) and in terminal stance (r=0.416, p=0.043). There is no correlation between muscle strength and gross motor function. However, this study showed that muscle strength, especially of the extensor muscle group of the hip and knee joints, might play a critical role in gait by stabilizing pelvic motion and decreasing energy consumption in a flexed knee gait.

Biomechanical bases of rehabilitation of children with cerebral palsy

Science.gov (United States)

Davlet'yarova, K. V.; Korshunov, S. D.; Kapilevich, L. V.

2015-11-01

Biomechanical analysis and the study results of children's with cerebral palsy (CP) muscles bioelectrical activity while walking on a flat surface are represented. Increased flexion in the hip and shoulder joints and extension in the elbow joint in children with cerebral palsy were observed, with the movement of the lower limbs had less smooth character in comparison with the control group. Herewith, the oscillation amplitude was significantly increased, and the frequency in the m. gastrocnemius and m. lateralis was decreased. It was shown, that the dynamic stereotype of walking in children with cerebral palsy was characterized by excessive involvement of m. gastrocnemius and m.latissimus dorsi in locomotion. Thus, resulting biomechanical and bioelectrical parameters of walking should be considered in the rehabilitation programs development.

Motion Tracking of Infants in Risk of Cerebral Palsy

DEFF Research Database (Denmark)

Olsen, Mikkel Damgaard

Every year 2-3 out of 1000 infants are born with cerebral cerebral palsy. Among others, the disorder often affects motor, cognitive and perceptual skills. The disorder is usually detected when the infants are old enough the crawl and walk, i.e. when the infant is 1-2 years old. However, studies...... show that the infant’s movements are affected already in the first year of life and methods exist for assessing the movements. The methods often require observation of the movements and qualitative evaluation of these. A more objective measure is desired in order to be able to diagnose cerebral palsy...... for automatic assessment of infant movement. This includes a preliminary study on automatic classification of movements related to cerebral palsy. The contributions included in this thesis can be divided into two groups. The first two contributions consider the analysis in order to estimate and track the body...

The effects of a 12-week program of static upper extremity weight bearing exercises on weight bearing in children with hemiplegic type of cerebral palsy

Directory of Open Access Journals (Sweden)

P. Jayaraman

2010-01-01

Full Text Available The  major  objective  of  this  study  was  to  quantify  the  effects  of a  12-week  program  of  weight  bearing  exercises  on  weight  borne  through  the hand and grip pressures in children with hemiplegic cerebral palsy. This study also sought to monitor the change in spasticity immediately following weight-bearing  exercises.  A  quasi-experimental,  one  group  pre-test,  post-test  study  was used. Eleven children with hemiplegic type of cerebral palsy from a special school in KwaZulu Natal participated after fully informed written consent. The intervention consisted of a 12-week program of weight bearing. The Tekscan Grip system was used to quantify weight borne through the hand during extended arm prone and quadruped positions and whilst holding a pencil and a tumbler. The modified Ashworth grading of spasticity was used to monitor spasticity. The data was analysed using the random effects GLS model Wald Chi Square test. Significant increases in contact pressure in extended arms prone (p=0,012 and quadruped (p=0,002 and when holding a pencil (p=0,045 was noted post-test compared to pre-test. Significant increases in contact area of the hand was also noted in prone (p=0,000, quadruped (p=0, 03 at assessment 7 and when holding a pencil (p=0,035.  A significant decrease in spasticity during elbow extension (p=0,004, and wrist flexion (p=0,026 and extension (p=0,004 was noted. An overall significant effect of static weight bearing exercises on weight borne through the hands, grip strength and spasticity justifies the use of static weight-bearing in therapy.

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy.

Science.gov (United States)

Whitney, Daniel G; Singh, Harshvardhan; Miller, Freeman; Barbe, Mary F; Slade, Jill M; Pohlig, Ryan T; Modlesky, Christopher M

2017-01-01

Nonambulatory children with severe cerebral palsy (CP) have underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Ambulatory children with mild spastic CP and typically developing children (4 to 11years; 12/group) were compared. Magnetic resonance imaging was used to estimate cortical bone, bone marrow and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Accelerometer-based activity monitors worn on the ankle were used to assess physical activity. There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44%) than controls (both pChildren with CP also had lower cortical bone volume (30%), cortical bone width in the posterior (16%) and medial (32%) portions of the shaft, total bone width in the medial-lateral direction (15%), Z in the medial-lateral direction (34%), J (39%) and muscle volume (39%), and higher bone marrow fat concentration (82.1±1.8% vs. 80.5±1.9%), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0±8.0% vs. 16.1±3.3%) than controls (all pfat infiltration estimates, except posterior cortical bone width, were still present (all pchildren with CP compared to controls emerged (pchildren with mild spastic CP exhibit an underdeveloped bone architecture and low bone strength in the midtibia and a greater infiltration of fat in the bone marrow and surrounding musculature compared to typically

Aculaser therapy for the treatment of cerebral palsy

Science.gov (United States)

Anwar, Shahzad; Nazir Khan, Malik M.; Nadeem Khan, Malik M.; Qazi, Faiza M.; Awan, Abid H.; Ammad, Haseeb U.

2012-03-01

A single, open and non comparative study was conducted at Anwar Shah Trust for C.P. & Paralysis in collaboration with the Departments of Neurology and Neurosurgery, Children Hospital Lahore, Pakistan to evaluate the effects of ACULASER THERAPY in childern suffering from Cerebral Palsy (C.P.) and associated Neurological Disorders like epilepsy, cortical blindness, spasticity, hemiplegia, paraplegia, diplegia, quadriplegia, monoplegia, sensoryneural deafness and speech disorders. In all 500 children were treated and the data was gathered during a period of 4 years from December 2006 till December 2010. These children were further classified according to the type of C.P. (spastic, athetoid, mixed) they suffered from and associated Neurological Disorders. This article shows results in C.P. childern who were treated with ACULASER THERAPY for a minimum of 08 weeks and more or had minimum of 15 treatment sessions and more. This article also shows that those childern who were given a break in the treatment for 1 month to 1 year did not show any reversal of the signs and symptoms. Analysis of the data showed that out of 342 children with Spasticity and Stiffness 294 showed marked improvement showing 87% success rate, out of 252 children with Epileptic fits, there was a significant reduction in the intensity, frequency and duration of Epileptic fits in 182 children showing 72% success rate, out of 96 children with Cortical Blindness 60 children showed improvement accounting for 63% efficacy rate, out of 210 children with Hearing Difficulties, 126 showed marked improvement accounting for 60% improvement rate, out of 380 children with Speech Disorders 244 showed improvement reflecting 64 % improvement rate, out of 192 children with Hemiplegia 142 showed improvement in movement, tone and power accounting for 74% improvement rate, out of 152 children with Quadriplegia 104 showed improvement in gross and fine motor functions showing 69% success rate and out of 116 children with

T2 Relaxometry MRI Predicts Cerebral Palsy in Preterm Infants.

Science.gov (United States)

Chen, L-W; Wang, S-T; Huang, C-C; Tu, Y-F; Tsai, Y-S

2018-01-18

T2-relaxometry brain MR imaging enables objective measurement of brain maturation based on the water-macromolecule ratio in white matter, but the outcome correlation is not established in preterm infants. Our study aimed to predict neurodevelopment with T2-relaxation values of brain MR imaging among preterm infants. From January 1, 2012, to May 31, 2015, preterm infants who underwent both T2-relaxometry brain MR imaging and neurodevelopmental follow-up were retrospectively reviewed. T2-relaxation values were measured over the periventricular white matter, including sections through the frontal horns, midbody of the lateral ventricles, and centrum semiovale. Periventricular T2 relaxometry in relation to corrected age was analyzed with restricted cubic spline regression. Prediction of cerebral palsy was examined with the receiver operating characteristic curve. Thirty-eight preterm infants were enrolled for analysis. Twenty patients (52.6%) had neurodevelopmental abnormalities, including 8 (21%) with developmental delay without cerebral palsy and 12 (31.6%) with cerebral palsy. The periventricular T2-relaxation values in relation to age were curvilinear in preterm infants with normal development, linear in those with developmental delay without cerebral palsy, and flat in those with cerebral palsy. When MR imaging was performed at >1 month corrected age, cerebral palsy could be predicted with T2 relaxometry of the periventricular white matter on sections through the midbody of the lateral ventricles (area under the receiver operating characteristic curve = 0.738; cutoff value of >217.4 with 63.6% sensitivity and 100.0% specificity). T2-relaxometry brain MR imaging could provide prognostic prediction of neurodevelopmental outcomes in premature infants. Age-dependent and area-selective interpretation in preterm brains should be emphasized. © 2018 by American Journal of Neuroradiology.

Quality of life as assessed by adults with cerebral palsy.

Science.gov (United States)

Maestro-Gonzalez, Alba; Bilbao-Leon, M Cruz; Zuazua-Rico, David; Fernandez-Carreira, Jose M; Baldonedo-Cernuda, Ricardo F; Mosteiro-Diaz, M Pilar

2018-01-01

We explored the quality of life of adults with cerebral palsy without an intellectual disability and the predictors of quality of life. Because cerebral palsy is a disease that manifests in childhood, much of the research into quality of life for those dealing with it focuses on children; there are few studies that evaluate the quality of life of adults with cerebral palsy. Therefore, it is important to consider their perceptions in order to improve their general wellbeing and self-determination. This was a descriptive, cross-sectional study. Quality of life was measured using the GENCAT Quality of Life Scale. Demographic and personal variables were also collected and examined. Participants comprised 75 adults (58.7 percent men, mean age = 40.84 years) with cerebral palsy who were members of the National Cerebral Palsy Association of Spain between 2014 and 2015. A linear multivariate model was examined as well. The overall mean score indicator of participants' quality of life was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. Examining the level of qualification, we found significant differences in the factors "personal development" and "self-determination," and those with a university education obtained higher scores than their less-educated counterparts. Having a partner was related to higher quality of life standard scores. After constructing a linear model, it was observed that maintaining sexual relationships was another factor that increased participants' quality of life. This study highlights the importance of social and romantic relationships to achieve a better quality of life in adults with cerebral palsy who do not have an intellectual disability. Social integration and sexuality education programs should be developed to improve their quality of life.

Gait Deviation Index, Gait Profile Score and Gait Variable Score in children with spastic cerebral palsy

DEFF Research Database (Denmark)

Rasmussen, Helle Mätzke; Nielsen, Dennis Brandborg; Pedersen, Niels Wisbech

2015-01-01

Abstract The Gait Deviation Index (GDI) and Gait Profile Score (GPS) are the most used summary measures of gait in children with cerebral palsy (CP). However, the reliability and agreement of these indices have not been investigated, limiting their clinimetric quality for research and clinical...... to good reliability with ICCs of 0.4–0.7. The agreement for the GDI and the logarithmically transformed GPS, in terms of the standard error of measurement as a percentage of the grand mean (SEM%) varied from 4.1 to 6.7%, whilst the smallest detectable change in percent (SDC%) ranged from 11.3 to 18...

Histological chorioamnionitis is associated with cerebral palsy in preterm neonates.

Science.gov (United States)

Horvath, Boldizsár; Grasselly, Magda; Bodecs, Tamas; Boncz, Imre; Bodis, József

2012-08-01

To determine the interaction between histological chorioamnionitis and unexplained neonatal cerebral palsy among low birth weight infants. We studied 141 preterm infants below 1500 g delivered between 2000 and 2010. Clinical data, neonatal neuroimaging, laboratory results, the histopathological features of the placenta and gastric smear within the first hour of delivery, were evaluated. Cerebral palsy was detected in 11 out of 141 preterm newborns (7.8%). The incidence of silent histological chorioamnionitis was 33.6% (43 of 128 cases). Chorioamniontis was significantly associated with the risk of unexplained cerebral palsy (p=0.024). There were also significant correlations between maternal genital infections and chorioamnionitis (p=0.005), and between maternal infections and a positive smear of neonatal gastric aspirates (p=0.000). The rate of cesarean section was 67.4% (95 out of 141 deliveries), and elective cesarean section was performed in 68 cases. Intrauterine exposure to maternal infection was associated with a marked increase in the risk of cerebral palsy in preterm infants. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Sudden onset odontoid fracture caused by cervical instability in hypotonic cerebral palsy.

Science.gov (United States)

Shiohama, Tadashi; Fujii, Katsunori; Kitazawa, Katsuhiko; Takahashi, Akiko; Maemoto, Tatsuo; Honda, Akihito

2013-11-01

Fractures of the upper cervical spine rarely occur but carry a high rate of mortality and neurological disabilities in children. Although odontoid fractures are commonly caused by high-impact injuries, cerebral palsy children with cervical instability have a risk of developing spinal fractures even from mild trauma. We herein present the first case of an odontoid fracture in a 4-year-old boy with cerebral palsy. He exhibited prominent cervical instability due to hypotonic cerebral palsy from infancy. He suddenly developed acute respiratory failure, which subsequently required mechanical ventilation. Neuroimaging clearly revealed a type-III odontoid fracture accompanied by anterior displacement with compression of the cervical spinal cord. Bone mineral density was prominently decreased probably due to his long-term bedridden status and poor nutritional condition. We subsequently performed posterior internal fixation surgically using an onlay bone graft, resulting in a dramatic improvement in his respiratory failure. To our knowledge, this is the first report of an odontoid fracture caused by cervical instability in hypotonic cerebral palsy. Since cervical instability and decreased bone mineral density are frequently associated with cerebral palsy, odontoid fractures should be cautiously examined in cases of sudden onset respiratory failure and aggravated weakness, especially in hypotonic cerebral palsy patients. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation.

Science.gov (United States)

Rose, Jessica; Cahill-Rowley, Katelyn; Butler, Erin E

2017-11-01

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait. © 2017 International Center for Artificial Organs and

Study of the correlation of brainstem auditory evoked potentials and magnetic resonance imaging in children with spastic cerebral palsy

International Nuclear Information System (INIS)

Fobe, Lisete Pessoa de Oliveira

1999-01-01

Central auditory evaluation in 21 children with cerebral palsy was done with brainstem auditory evoked potentials (BAEP) and correlated with brain magnetic resonance imaging findings (MRI); 12 boys and 9 girls between 5 and 12 years old were studied. All children had follow-up at the Institute of Orthopedics and Traumatology of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. The control group was done with 17 children, 10 boys and 7 girls (mean age 8.06 years, SD 2.27 years). The BAEP abnormalities were: decrease of latency of wave V; decrease of latency III-V and I-IV intervals at the right side. All patients has MRI supratentorial abnormalities and 11 had brainstem atrophy. The MRI pathologic findings were: ventricular enlargement (n=17 or 80.95%), cortical/subcortical atrophy (n=15 or 71.42%), left brainstem atrophy (n=11 or 52.38%), periventricular leukomalacia (n=10 or 47.61%), infarction in the left middle cerebral artery territory (n=6 or 28.57%), and malformations such as schizencephaly and colpocephaly (n=5 or 23.80%). The findings of the decrease latencies in children with cerebral palsy suggest the contribution of decussating auditory fibers at the lower and upper pons and midbrain, the lack of homogeneity of the surrounding volume of the conductor fibres and the presence of several concurrently active potential generators sources, should be facilitating mechanisms for the nervous input to brainstem. (author)

Study of the correlation of brainstem auditory evoked potentials and magnetic resonance imaging in children with spastic cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

Fobe, Lisete Pessoa de Oliveira [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina]. E-mail: lispessoa@yahoo.com

1999-12-01

Central auditory evaluation in 21 children with cerebral palsy was done with brainstem auditory evoked potentials (BAEP) and correlated with brain magnetic resonance imaging findings (MRI); 12 boys and 9 girls between 5 and 12 years old were studied. All children had follow-up at the Institute of Orthopedics and Traumatology of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. The control group was done with 17 children, 10 boys and 7 girls (mean age 8.06 years, SD 2.27 years). The BAEP abnormalities were: decrease of latency of wave V; decrease of latency III-V and I-IV intervals at the right side. All patients has MRI supratentorial abnormalities and 11 had brainstem atrophy. The MRI pathologic findings were: ventricular enlargement (n=17 or 80.95%), cortical/subcortical atrophy (n=15 or 71.42%), left brainstem atrophy (n=11 or 52.38%), periventricular leukomalacia (n=10 or 47.61%), infarction in the left middle cerebral artery territory (n=6 or 28.57%), and malformations such as schizencephaly and colpocephaly (n=5 or 23.80%). The findings of the decrease latencies in children with cerebral palsy suggest the contribution of decussating auditory fibers at the lower and upper pons and midbrain, the lack of homogeneity of the surrounding volume of the conductor fibres and the presence of several concurrently active potential generators sources, should be facilitating mechanisms for the nervous input to brainstem. (author)

Cerebral palsy in eastern Denmark: declining birth prevalence but increasing numbers of unilateral cerebral palsy in birth year period 1986-1998

DEFF Research Database (Denmark)

Ravn, Susanne Holst; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data...... are registered. The total cerebral palsy birth prevalence has been significantly decreasing since the birth period 1983-1986 with 3.0 per 1000 live births until the period 1995-1998 with 2.1 per 1000 live births. The overall decrease was seen in preterm infants (...

Cerebral palsy in eastern Denmark: declining birth prevalence but increasing numbers of unilateral cerebral palsy in birth year period 1986-1998

DEFF Research Database (Denmark)

Ravn, Susanne Holst; Flachs, Esben Meulengracht; Uldall, Peter

2010-01-01

The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data are regis......The Cerebral Palsy Registry in eastern Denmark has been collecting cases using a uniform data sampling procedure since birth year 1979. Children are included by two child neurologists and an obstetrician. Information on pregnancy, birth, neonatal period, impairments and demographic data...

Cerebral palsy characterization by estimating ocular motion

Science.gov (United States)

González, Jully; Atehortúa, Angélica; Moncayo, Ricardo; Romero, Eduardo

2017-11-01

Cerebral palsy (CP) is a large group of motion and posture disorders caused during the fetal or infant brain development. Sensorial impairment is commonly found in children with CP, i.e., between 40-75 percent presents some form of vision problems or disabilities. An automatic characterization of the cerebral palsy is herein presented by estimating the ocular motion during a gaze pursuing task. Specifically, After automatically detecting the eye location, an optical flow algorithm tracks the eye motion following a pre-established visual assignment. Subsequently, the optical flow trajectories are characterized in the velocity-acceleration phase plane. Differences are quantified in a small set of patients between four to ten years.

Vibration therapy in patients with cerebral palsy: a systematic review

Science.gov (United States)

Ritzmann, Ramona; Stark, Christina; Krause, Anne

2018-01-01

The neurological disorder cerebral palsy (CP) is caused by unprogressive lesions of the immature brain and affects movement, posture, and the musculoskeletal system. Vibration therapy (VT) is increasingly used to reduce the signs and symptoms associated with this developmental disability. The purpose of this narrative review was systematically to appraise published research regarding acute and long-term effects of VT on functional, neuromuscular, and structural parameters. Systematic searches of three electronic databases identified 28 studies that fulfilled the inclusion criteria. Studies were analyzed to determine participant characteristics, VT-treatment protocols, effect on gross motor function (GMF), strength, gait, posture, mobility, spasticity, reflex excitability, muscle tone, mass, and bone strength within this population, and outcome measures used to evaluate effects. The results revealed that one acute session of VT reduces reflex excitability, spasticity, and coordination deficits. Subsequently, VT has a positive effect on the ability to move, manifested for GMF, strength, gait, and mobility in patients with CP. Effects persist up to 30 minutes after VT. Long-term effects of VT manifest as reduced muscle tone and spasticity occurring concomitantly with improved movement ability in regard to GMF, strength, gait, and mobility, as well as increased muscle mass and bone-mineral density. Posture control remained unaffected by VT. In conclusion, the acute and chronic application of VT as a nonpharmacological approach has the potential to ameliorate CP symptoms, achieving functional and structural adaptations associated with significant improvements in daily living. Even though further studies including adult populations validating the neuromuscular mechanisms underlying the aforementioned adaptations should be fostered, growing scientific evidence supports the effectiveness of VT in regard to supplementing conventional treatments (physiotherapy and drugs

Brain MRI and single photon emission computed tomography in severe athetotic cerebral palsy. A comparative study with mental and motor disorders

International Nuclear Information System (INIS)

Yamada, Kazutaka; Tsuzura, Shigenobu; Matsuda, Hiroshi.

1995-01-01

Single photon emission computed tomography (SPECT) using N-isopropyl-p-[ 123 I]-iodoamphetamine ( 123 I-IMP) was performed in twelve patients with severe athetotic cerebral palsy (Ath; 5 males and 7 females) who had both motor delay (unable to move) and mental retardation (I.Q, or D.Q, below 30). The neuroimaging findings of those patients were compared with those of patients mental and motor disorders. In five caes suffering from neonatal asphyxia, SPECT demonstrated a decreased regional cerebral blood flow (rCBF) in corpus striatum, thalamus, orbitofrontal areas, pericentral gyrus areas, prefrontal areas and medial temporal areas. In seven cases suffering from neonatal jaundice, SPECT demonstrated a decreased rCBF in orbito-frontal areas, prefrontal areas and medial temporal areas. SPECT showed hypoperfusion of peri-central gyrus areas in cases with complications of spastic palsy. The decreased rCBF in medial temporal areas mostly corresponded to an alteration in hippocampal formation as assessed by magnetic resonance imaging (MRI). Cases with hypoperfusion of bilateral medial temporal areas showed a lower score of language understanding than those with the unilateral damage. In cases with hypofusion of bilateral prefrontal areas and bilateral medial temporal areas, the grade of understanding of language was almost below 12 months. In cases with hypoperfusion of orbitofrontal areas, psychomotor hypersensitivity had been observed. Those results suggest that IMP-SPECT and MRI of the brain is useful tool for neurological assessment in handicapped patients with athetotic cerebral palsy. (author)

Brain MRI and single photon emission computed tomography in severe athetotic cerebral palsy. A comparative study with mental and motor disorders

Energy Technology Data Exchange (ETDEWEB)

Yamada, Kazutaka; Tsuzura, Shigenobu [Metropolitan Medical Center of the Severely Handicapped, Fuchu, Tokyo (Japan); Matsuda, Hiroshi

1995-07-01

Single photon emission computed tomography (SPECT) using N-isopropyl-p-[{sup 123}I]-iodoamphetamine ({sup 123}I-IMP) was performed in twelve patients with severe athetotic cerebral palsy (Ath; 5 males and 7 females) who had both motor delay (unable to move) and mental retardation (I.Q, or D.Q, below 30). The neuroimaging findings of those patients were compared with those of patients mental and motor disorders. In five caes suffering from neonatal asphyxia, SPECT demonstrated a decreased regional cerebral blood flow (rCBF) in corpus striatum, thalamus, orbitofrontal areas, pericentral gyrus areas, prefrontal areas and medial temporal areas. In seven cases suffering from neonatal jaundice, SPECT demonstrated a decreased rCBF in orbito-frontal areas, prefrontal areas and medial temporal areas. SPECT showed hypoperfusion of peri-central gyrus areas in cases with complications of spastic palsy. The decreased rCBF in medial temporal areas mostly corresponded to an alteration in hippocampal formation as assessed by magnetic resonance imaging (MRI). Cases with hypoperfusion of bilateral medial temporal areas showed a lower score of language understanding than those with the unilateral damage. In cases with hypofusion of bilateral prefrontal areas and bilateral medial temporal areas, the grade of understanding of language was almost below 12 months. In cases with hypoperfusion of orbitofrontal areas, psychomotor hypersensitivity had been observed. Those results suggest that IMP-SPECT and MRI of the brain is useful tool for neurological assessment in handicapped patients with athetotic cerebral palsy. (author).

Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy.

Science.gov (United States)

Chen, Kai; Ren, Yupeng; Gaebler-Spira, Deborah; Zhang, Li-Qun

2014-01-01

A portable rehabilitation robot incorporating intelligent stretching, robot-guided voluntary movement training with motivating games and tele-rehabilitation was developed to provide convenient and cost-effective rehabilitation to children with cerebral palsy (CP) and extend rehabilitation care beyond hospital. Clinicians interact with the patients remotely for periodic evaluations and updated guidance. The tele-assisted stretching and active movement training was done over 6-week 18 sessions on the impaired ankle of 23 children with CP in their home setting. Treatment effectiveness was evaluated using biomechanical measures and clinical outcome measures. After the tele-assisted home robotic rehabilitation intervention, there were significant increases in the ankle passive and active range of motion, muscle strength, a decrease in spasticity, and increases in balance and selective control assessment of lower-extremity.

Assessment Impact of Foot Sensory Modulation on Inhibition of Hypertonicity of the Lower Limb in Children with Diplegia Spastic

Directory of Open Access Journals (Sweden)

Saeed Fatoureh-Chi

2005-01-01

Full Text Available Objective: The purpose of this study was to assess impact of foot sensory modulation on inhibition of hypertonicity of the lower limb in children with diplegia spastic cerebral palsy. Materials & Methods: 24 selected children (aged 2.5 to 4.5 years were randomly assigned to a control and experimental groups. Muscle tone was assessed using modified Ashworth scale, passive Range of motion by goniameter (Pedretti, neurodevelopmental level by Bobath scale. All children were pre-post tested in an interval of ten weeks. Results: Significant reduction was observed in hypertonicity of hip extensor (p<0/1 and ankle planter flexor (P<0/05. Significant increase was observed in passive Range of motion of hip flexion (P<0/1, knee extension (P<0/05 and ankle dorsi flexion (P<0/05. There was found no significant difference of reduction in hypertonicity of knee flexor and improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip extensor (P<0/05 and improvement of neurodevelopmental level (P<0/05. Conclusion: Impact of sensory modulation on children with diplegia spastic cerebral palsy reduces spasticity of lower limb and also extends joints domain of motion.

Anestesia e paralisia cerebral Anestesia y parálisis cerebral Anesthesia and cerebral palsy

Directory of Open Access Journals (Sweden)

Március Vinícius M Maranhão

2005-12-01

riesgo, fisiopatología, cuadro clínico, diagnóstico, terapéuticas utilizadas bien como evaluación pre-operatoria, medicación pre-anestésica, manoseo intra y posoperatorio, analgesia posoperatoria y dolor crónico. CONCLUSIONES: El anestesista desempeña un papel importante en la disminución de la morbidez y mortalidad anestésico-quirúrgica en pacientes portadores de parálisis cerebral. El conocimiento de la fisiopatología de los diferentes tipos de parálisis cerebral bien como de las enfermedades asociadas y sus terapéuticas es imprescindible, pues permite al anestesista anticipar y precaver complicaciones intra y posoperatorias en este tipo de paciente.BACKGROUND AND OBJECTIVES: Cerebral palsy (CP is a non-progressive disease induced by CNS injury, which leads to patients' motor impairment. CP patients are often submitted to surgical procedures due to usual diseases and some surgical situations related with CP. The aim of this article was to review cerebral palsy aspects of interest to anesthesiologists to allow an adequate pre, intra and postoperative management of these patients. CONTENTS: This article addresses cerebral palsy aspects such as etiology, classification, risk factors, pathophysiology, clinical presentation, diagnosis and therapies and, in addition to preoperative evaluation, preanesthetic medication, intra and postoperative management, postoperative analgesia and chronic pain. CONCLUSIONS: Anesthesiologists play an important role in decreasing anesthetic-surgical morbidity and mortality of cerebral palsy patients. The understanding of different aspects of cerebral palsy pathophysiologies, in addition to those of associated diseases and their therapies is paramount, because it allows anesthesiologists to anticipate and prevent intra and postoperative complications in this type of patient.

CT findings of cerebral palsy and behaviour development

International Nuclear Information System (INIS)

Sakamoto, Zenji

1987-01-01

It is well recognized that CT scan is very useful in the early diagnosis of cerebral palsy. The author has studied this time the CT scan findings of cerebral palsy children in their relations to the type of palsy, cause of palsy, complications in the central nervous system, and prognosis of behaviour development, in order to predict the prognosis of behaviour development. Dilatation of the contralateral cerebral ventricle was found in 82 % of hemiplegic type. Abnormal EEG was found in 73 %, but their behaviour development was satisfactory, with good development of speech regardless to the side of palsy. This might be helped by compensational function of the brain due to plasticity. Diplegia presented bilateral moderate dilatation of ventricles with favorable prognosis. Tetraplegia was caused mostly by asphyxia or congenital anomaly and revealed marked dilatation of ventricles or severe cortical atrophy. Some cases presented diffuse cortical low-density, often associated with abnormal EEG, and their prognosis was worst. Athetosis had normal CT finding or mild ventricular dilatation, but all cases of ataxia presented normal CT findings. Hypotonia had mild ventricular dilatation. Two of three mixed type cases had normal CT findings and another had mild ventricular dilatation. No correlation was found between ventricular dilatation and behaviour development, but statistically significant difference was found in the cases with 30 % or more Evans' ratio (P < 0.05). Prognosis of severe ventricular dilatation cases was poor. (author)

Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

Energy Technology Data Exchange (ETDEWEB)

Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W. [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

1997-07-01

The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84{+-}17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78{+-}10.36), mild defect (<50MQ : n=9, MQ=66.11{+-}13.87). The degree of rCBF decrease between the two groups was evaluated by {chi}{sup 2} test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients.

Pain in young people aged 13 to 17 years with cerebral palsy

DEFF Research Database (Denmark)

Parkinson, Kathryn N; Dickinson, Heather O; Arnaud, Catherine

2013-01-01

To determine the prevalence and associations of self- and parent-reported pain in young people with cerebral palsy (CP).......To determine the prevalence and associations of self- and parent-reported pain in young people with cerebral palsy (CP)....

The Cerebral Palsy Research Registry: Development and Progress Toward National Collaboration in the United States

Science.gov (United States)

Hurley, Donna S.; Sukal-Moulton, Theresa; Msall, Michael E.; Gaebler-Spira, Deborah; Krosschell, Kristin J.; Dewald, Julius P.

2011-01-01

Cerebral palsy is the most common neurodevelopmental motor disability in children. The condition requires medical, educational, social, and rehabilitative resources throughout the life span. Several countries have developed population-based registries that serve the purpose of prospective longitudinal collection of etiologic, demographic, and functional severity. The United States has not created a comprehensive program to develop such a registry. Barriers have been large population size, poor interinstitution collaboration, and decentralized medical and social systems. The Cerebral Palsy Research Registry was created to fill the gap between population and clinical-based cerebral palsy registries and promote research in the field. This is accomplished by connecting persons with cerebral palsy, as well as their families, to a network of regional researchers. This article describes the development of an expandable cerebral palsy research registry, its current status, and the potential it has to affect families and persons with cerebral palsy in the United States and abroad. PMID:21677201

THE EFFECTIVENESS OF CONDUCTIVE EDUCATION ON MOTOR SKILLS IN CHILDREN WITH CEREBRAL PALSY

Directory of Open Access Journals (Sweden)

Negin Khoshvaght

2017-12-01

Full Text Available Background: Cerebral palsy is a nonprogressive neuro-developmental disorders that are caused by damage to the developing brain and affect movement and posture. Children with cerebral palsy suffer difficulty in motor function (coordination and control.The present inquiry investigated the impact of conductive education on motor skills in children having cerebral palsy. Methods: A quasi-experimental research was done using pretest-posttest and control group design. The study subjects consisted of all children with cerebral palsy in Shiraz. A sample of 30 subjects was randomly chosen to employ convenience sampling procedure and classified to two groups of treatment (15 subjects and control (15 subjects. The pretest was performed for both groups, and the experimental group received conductive education in 20 sessions. While the control subjects did not have this education, finally, the post-test was performed for both groups. The Lincoln-Oseretsky test was used to measure motor skills. The data were analyzed using ANCOVA and MANCOVA. Results: The results showed that conductive education had a significant effect on motor skills (P<0.001 and its subscales such as speed of movement (P<0.001, general static coordination (P<0.001, general dynamic coordination (P<0.001, dynamic manual coordination (P<0.001, synchronous-asymmetrical voluntary movements (P<0.001, and asynchronous-asymmetrical voluntary movements (P<0.001 in children with cerebral palsy. Conclusion: The findings indicated the effectiveness of conductive education on cerebral palsy children’s motor skills. Therefore, it is recommended to design and implement a conductive education program to improve motor skills of cerebral palsy children.

Theory of Mind and Irony Comprehension in Children with Cerebral Palsy

Science.gov (United States)

Caillies, Stephanie; Hody, Anais; Calmus, Arnaud

2012-01-01

The main goal of the present study was to characterise the pragmatic abilities of French children with cerebral palsy through their understanding of irony and other people's mental states. We predicted that children with cerebral palsy would have difficulty understanding false-belief and ironic remarks, due to the executive dysfunction that…

The Reliability of Quality of Upper Extremity Skills Test in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Nazila Akbar-Fahimi

2012-01-01

Full Text Available Objective: The aim of this study was to survey the reliability of Intra-rater and Inter-rater with and without video camera assessment in children with spastic cerebral palsy. Materials & Methods: In this cross-sectional study, we validate the Quality of Upper Extremity Skill Test questionnaire. Fifty children with hemiplegia aged 19 to 95 months (mean age 61.31 ± 25.7 month were enrolled in our study using non random available approach. After obtaining parents’ consent, intra-rater assessment was performed in one session and intera rater assessment with camera after 10 days. Then, the third examiner did the reassessment using film observation of 46 children from 50. Spearman correlation for survey the reliability of intra-rater & inter rater with & without video recording assessment & gross motor function classification system 66 for determined functionality of child were used. Results: Intra-rater correlation was 0.774-0.996, Inter-rater correlation was 0.663-0.998 and correlation for video camera assessment was 0.710-0.974 for the first and third evaluation and 0.652-0.938 for second and third evaluation. P value for sub scales and total score was P<0.01. Conclusion: There is a high correlation in Intra rater and inter rater assessment with and without video recording in Quality of Upper Extremity Skill Test in children with cerebral palsy. So that it can be used as a reliable test to evaluate Quality of Upper Extremity Skills in these children.

Handling the Cerebral Palsied Child: Multi-Level Skills Transfer in Pakistan.

Science.gov (United States)

Miles, M.; Frizzell, Yvonne

1990-01-01

The majority of children with cerebral palsy in developing countries have no access to trained therapists; for example, in Pakistan, there is less than one trained general physiotherapist per million population. In Pakistan, cerebral palsy handling skills were taught to a group of parents, teachers, and paraprofessionals in a series of practical…

A Stepwise Approach: Decreasing Infection in Deep Brain Stimulation for Childhood Dystonic Cerebral Palsy.

Science.gov (United States)

Johans, Stephen J; Swong, Kevin N; Hofler, Ryan C; Anderson, Douglas E

2017-09-01

Dystonia is a movement disorder characterized by involuntary muscle contractions, which cause twisting movements or abnormal postures. Deep brain stimulation has been used to improve the quality of life for secondary dystonia caused by cerebral palsy. Despite being a viable treatment option for childhood dystonic cerebral palsy, deep brain stimulation is associated with a high rate of infection in children. The authors present a small series of patients with dystonic cerebral palsy who underwent a stepwise approach for bilateral globus pallidus interna deep brain stimulation placement in order to decrease the rate of infection. Four children with dystonic cerebral palsy who underwent a total of 13 surgical procedures (electrode and battery placement) were identified via a retrospective review. There were zero postoperative infections. Using a multistaged surgical plan for pediatric patients with dystonic cerebral palsy undergoing deep brain stimulation may help to reduce the risk of infection.

Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: a randomised controlled trial methods paper

Directory of Open Access Journals (Sweden)

Imms Christine

2010-07-01

Full Text Available Abstract Background Use of Botulinum toxin-A (BoNT-A for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A. Methods/Design A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental or bimanual occupational therapy group (control. Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale. Discussion The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy versus bimanual occupational therapy (a bimanual therapy on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion

NARCIS (Netherlands)

Kerkum, Yvette L.; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Harlaar, Jaap; Brehm, Merel-Anne

2015-01-01

Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion

NARCIS (Netherlands)

Kerkum, Y.L.; Buizer, A.I.; van den Noort, J.C.; Becher, J.G.; Harlaar, J.; Brehm, M.A.

2015-01-01

Introduction: Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off

Self-reported quality of life of adolescents with cerebral palsy

DEFF Research Database (Denmark)

Colver, Allan; Rapp, Marion; Eisemann, Nora

2015-01-01

compared QoL against matched controls in the general population. We used multivariable regression to relate QoL of adolescents with cerebral palsy to impairments (cross-sectional analysis) and to childhood QoL, pain, psychological problems, and parenting stress (longitudinal analysis). FINDINGS: Severity...... QoL. Child psychological problems and parenting stress in childhood or their worsening between childhood and adolescence predicted only small reductions in adolescent QoL. INTERPRETATION: Individual and societal attitudes should be affected by the similarity of the QoL of adolescents with and without...... cerebral palsy. Adolescents with cerebral palsy need particular help to maintain and develop peer relationships. Interventions in childhood to alleviate psychological difficulties, parenting stress, and especially pain, are justified for their intrinsic value and for their longer term effect on adolescent...

Executive function in relation to arithmetic development in children with cerebral palsy

NARCIS (Netherlands)

Jenks, K.M.; de Moor, J.; van Lieshout, E.C.D.M.

2009-01-01

Background: Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. Methods: Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n

MR findings of cerebral palsy

International Nuclear Information System (INIS)

Yoon, Sang Hum; Chang, Seung Kuk; Cho, Mee Young; Park, Dong Woo; Kim, Jong Deok; Eun, Choong Ki

1994-01-01

To evaluate the MR findings of brain damage in cerebral palised patients and to correlate it with gestational age and the time of damage. A retrospective analysis was performed in 40 patients who underwent MR scanning for evaluation of brain lesion in clinically diagnosed cerebral palsy. Authors classified the patients into two groups as premature and full-term and compared MR findings of the two groups. Abnormal MR findings were noted in 28 cases (70%). Five out of 6 patients who had been born prematurely showed isolate periventricular white matter lesions. Twenty-three out of 34 patients who had been born at full-term showed abnormal MR findings. Of these 23 patients, migration anomalies in 7 patients, isolate periventricular white matter lesions in 3 patients, and other combined periventricular subcortical white matter and deep gray matter lesions in 14 patients were seen. At least, 10 patients(43%) of full term group showed abnormal MRI findings reflecting intrauterine brain damage and all 5 patients of premature group showed isolate periventricular white matter lesions suggesting immaturity of brain. MRI is thought to be very useful in the assessment of brain damage for the patients with cerebral palsy by recognizing the location of the lesion and estimating the time of damage

MR findings of cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

Yoon, Sang Hum; Chang, Seung Kuk; Cho, Mee Young; Park, Dong Woo; Kim, Jong Deok; Eun, Choong Ki [Pusan Paik Hospital, Pusan (Korea, Republic of)

1994-11-15

To evaluate the MR findings of brain damage in cerebral palised patients and to correlate it with gestational age and the time of damage. A retrospective analysis was performed in 40 patients who underwent MR scanning for evaluation of brain lesion in clinically diagnosed cerebral palsy. Authors classified the patients into two groups as premature and full-term and compared MR findings of the two groups. Abnormal MR findings were noted in 28 cases (70%). Five out of 6 patients who had been born prematurely showed isolate periventricular white matter lesions. Twenty-three out of 34 patients who had been born at full-term showed abnormal MR findings. Of these 23 patients, migration anomalies in 7 patients, isolate periventricular white matter lesions in 3 patients, and other combined periventricular subcortical white matter and deep gray matter lesions in 14 patients were seen. At least, 10 patients(43%) of full term group showed abnormal MRI findings reflecting intrauterine brain damage and all 5 patients of premature group showed isolate periventricular white matter lesions suggesting immaturity of brain. MRI is thought to be very useful in the assessment of brain damage for the patients with cerebral palsy by recognizing the location of the lesion and estimating the time of damage.

GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol.

Science.gov (United States)

Thomas, Rachel E; Johnston, Leanne M; Boyd, Roslyn N; Sakzewski, Leanne; Kentish, Megan J

2014-02-07

Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus

Regional vulnerability of longitudinal cortical association connectivity: Associated with structural network topology alterations in preterm children with cerebral palsy.

Science.gov (United States)

Ceschin, Rafael; Lee, Vince K; Schmithorst, Vince; Panigrahy, Ashok

2015-01-01

Preterm born children with spastic diplegia type of cerebral palsy and white matter injury or periventricular leukomalacia (PVL), are known to have motor, visual and cognitive impairments. Most diffusion tensor imaging (DTI) studies performed in this group have demonstrated widespread abnormalities using averaged deterministic tractography and voxel-based DTI measurements. Little is known about structural network correlates of white matter topography and reorganization in preterm cerebral palsy, despite the availability of new therapies and the need for brain imaging biomarkers. Here, we combined novel post-processing methodology of probabilistic tractography data in this preterm cohort to improve spatial and regional delineation of longitudinal cortical association tract abnormalities using an along-tract approach, and compared these data to structural DTI cortical network topology analysis. DTI images were acquired on 16 preterm children with cerebral palsy (mean age 5.6 ± 4) and 75 healthy controls (mean age 5.7 ± 3.4). Despite mean tract analysis, Tract-Based Spatial Statistics (TBSS) and voxel-based morphometry (VBM) demonstrating diffusely reduced fractional anisotropy (FA) reduction in all white matter tracts, the along-tract analysis improved the detection of regional tract vulnerability. The along-tract map-structural network topology correlates revealed two associations: (1) reduced regional posterior-anterior gradient in FA of the longitudinal visual cortical association tracts (inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, optic radiation, posterior thalamic radiation) correlated with reduced posterior-anterior gradient of intra-regional (nodal efficiency) metrics with relative sparing of frontal and temporal regions; and (2) reduced regional FA within frontal-thalamic-striatal white matter pathways (anterior limb/anterior thalamic radiation, superior longitudinal fasciculus and cortical spinal tract) correlated with

Body-Sensor-Network-Based Spasticity Detection.

Science.gov (United States)

Misgeld, Berno J E; Luken, Markus; Heitzmann, Daniel; Wolf, Sebastian I; Leonhardt, Steffen

2016-05-01

Spasticity is a common disorder of the skeletal muscle with a high incidence in industrialised countries. A quantitative measure of spasticity using body-worn sensors is important in order to assess rehabilitative motor training and to adjust the rehabilitative therapy accordingly. We present a new approach to spasticity detection using the Integrated Posture and Activity Network by Medit Aachen body sensor network (BSN). For this, a new electromyography (EMG) sensor node was developed and employed in human locomotion. Following an analysis of the clinical gait data of patients with unilateral cerebral palsy, a novel algorithm was developed based on the idea to detect coactivation of antagonistic muscle groups as observed in the exaggerated stretch reflex with associated joint rigidity. The algorithm applies a cross-correlation function to the EMG signals of two antagonistically working muscles and subsequent weighting using a Blackman window. The result is a coactivation index which is also weighted by the signal equivalent energy to exclude positive detection of inactive muscles. Our experimental study indicates good performance in the detection of coactive muscles associated with spasticity from clinical data as well as measurements from a BSN in qualitative comparison with the Modified Ashworth Scale as classified by clinical experts. Possible applications of the new algorithm include (but are not limited to) use in robotic sensorimotor therapy to reduce the effect of spasticity.

Changes in Cardiorespiratory Responses and Kinematics with Hippotherapy in Youth with and without Cerebral Palsy

Science.gov (United States)

Rigby, Brandon Rhett; Gloeckner, Adam Robert; Sessums, Suzanne; Lanning, Beth Anne; Grandjean, Peter Walter

2017-01-01

Purpose: The purpose of this study was to characterize pelvic displacement and cardiorespiratory responses to simulated horseback riding and walking in youth with cerebral palsy and to compare responses to youth without cerebral palsy before and after 8 weeks of hippotherapy. Method: Eight youth with cerebral palsy (M[subscript age] = 10 ± 4…

What constitutes cerebral palsy in the twenty-first century?

DEFF Research Database (Denmark)

Smithers-Sheedy, Hayley; Badawi, Nadia; Blair, Eve

2014-01-01

AIM: Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide...... (SCPE; 1976-1998). An expert panel used a consensus building technique, which utilized the SCPE 'decision tree' and the original 'What constitutes cerebral palsy?' paper as frameworks. RESULTS: CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin...

Intervention for an Adolescent With Cerebral Palsy During Period of Accelerated Growth.

Science.gov (United States)

Reubens, Rebecca; Silkwood-Sherer, Debbie J

2016-01-01

The purpose of this case report was to describe changes in body functions and structures, activities, and participation after a biweekly 10-week program of home physical therapy and hippotherapy using a weighted compressor belt. A 13-year-old boy with spastic diplegic cerebral palsy, Gross Motor Function Classification System level II, was referred because of accelerated growth and functional impairments that limited daily activities. The Modified Ashworth Scale, passive range of motion, 1-Minute Walk Test, Timed Up and Down Stairs, Pediatric Balance Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Dimensions of Mastery Questionnaire 17 were examined at baseline, 5, and 10 weeks. Data at 5 and 10 weeks demonstrated positive changes in passive range of motion, balance, strength, functional activities, and motivation, with additional improvements in endurance and speed after 10 weeks. This report reveals enhanced body functions and structures and activities and improved participation and motivation.

Neonatal risk factors for cerebral palsy in very preterm babies: case-control study.

Science.gov (United States)

Murphy, D. J.; Hope, P. L.; Johnson, A.

1997-01-01

OBJECTIVE: To identify neonatal risk factors for cerebral palsy among very preterm babies and in particular the associations independent of the coexistence of antenatal and intrapartum factors. DESIGN: Case-control study. SETTING: Oxford health region. SUBJECTS: Singleton babies born between 1984 and 1990 at less than 32 weeks' gestation who survived to discharge from hospital: 59 with cerebral palsy and 234 randomly selected controls without cerebral palsy. MAIN OUTCOME MEASURES: Adverse neonatal factors expressed as odds ratios and 95% confidence intervals. RESULTS: Factors associated with an increased risk of cerebral palsy after adjustment for gestational age and the presence of previously identified antenatal and intrapartum risk factors were patent ductus arteriosus (odds ratio 2.3; 95% confidence interval 1.2 to 4.5), hypotension (2.3; 1.3 to 4.7), blood transfusion (4.8; 2.5 to 9.3), prolonged ventilation (4.8; 2.5 to 9.0), pneumothorax (3.5; 1.6 to 7.6), sepsis (3.6; 1.8 to 7.4), hyponatraemia (7.9; 2.1 to 29.6) and total parenteral nutrition (5.5; 2.8 to 10.5). Seizures were associated with an increased risk of cerebral palsy (10.0; 4.1 to 24.7), as were parenchymal damage (32; 12.4 to 84.4) and appreciable ventricular dilatation (5.4; 3.0 to 9.8) detected by cerebral ultrasound. CONCLUSION: A reduction in the rate of cerebral palsy in very preterm babies requires an integrated approach to management throughout the antenatal, intrapartum, and neonatal periods. PMID:9040385

Ocular defects in cerebral palsy

Directory of Open Access Journals (Sweden)

Katoch Sabita

2007-01-01

Full Text Available There is a high prevalence of ocular defects in children with developmental disabilities. This study evaluated visual disability in a group of 200 cerebral palsy (CP patients and found that 68% of the children had significant visual morbidity. These findings emphasize the need for an early ocular examination in patients with CP.

Lifetime costs of cerebral palsy

DEFF Research Database (Denmark)

Kruse, Marie; Michelsen, Susan Ishøy; Flachs, Esben Meulengracht

2009-01-01

This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs....... social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP.......This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs...... in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about euro860 000 for men and about euro800 000 for women. The largest component was social care costs...

Parental Stress and Related Factors in Parents of Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Hui-Yi Wang

2004-07-01

Full Text Available Children with cerebral palsy display prominent motor dysfunction associated with other developmental disorders. Parenting a child with cerebral palsy presents a number of challenges and stresses. The first purpose of this study was to compare parental stress in parents of children with cerebral palsy to that in parents of children with typical development. The second purpose was to analyze the correlations between parental stress and parents' characteristics, the child's characteristics, the child's earliest age when rehabilitation was first commenced, and weekly frequency of rehabilitation for the child. A convenience sample of 63 parents of children with cerebral palsy (mean age of children, 4.3 ± 1.8 years was recruited. Forty parents of children with typical development were recruited as a comparison group. All parents filled out the Chinese version of the Parenting Stress Index (PSI, which consists of child domain and parent domain scales. The scores reported by parents of children with cerebral palsy in the child domain, parent domain, and PSI total scale were significantly higher than those for parents in the comparison group. The child domain score was significantly correlated to the child's age and severity of motor disability. A significant correlation was also found between the parent domain score and the child's earliest age of commencing rehabilitation. The PSI total scale score was significantly associated with both the child's severity of motor disability and age of commencing rehabilitation. Clinical professionals should be concerned about parental stress in parents of children with cerebral palsy and provide resources to support such parents. We suggest some strategies to reduce parental stress by strengthening parents' child-care skills.

Caracterization of adults with cerebral palsy.

Science.gov (United States)

Margre, Anna L M; Reis, Maria G L; Morais, Rosane L S

2010-01-01

cerebral Palsy (CP) is a group of permanent disorders of the development of movement and posture that cause functional limitation and are attributed to non-progressive disorders which occur in the fetal or infant brain. In recent years, with the increase in life expectancy of individuals with CP, several studies have described the impact of musculoskeletal disabilities and functional limitations over the life cycle. to characterize adults with CP through sociodemographic information, classifications, general health, associated conditions, physical complications and locomotion. twenty-two adults with CP recruited from local rehabilitation centers in an inner town of Brazil participated in this study. A questionnaire was used to collect data on sociodemographic characteristics, comorbities, and physical complications. A brief physical therapy evaluation was carried out, and the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were applied. Data were analyzed through descriptive statistics. the mean age was 28.7 (SD 10.6) years, 86.4% of participants lived with parents, and 4.5% were employed. Most of the sample consisted of spastic quadriplegic subjects, corresponding to levels IV and V of the GMFCS and MACS. Different comorbidities and important physical complications such as scoliosis and muscle contractures were present. More than half of the participants were unable to walk. Most participants demonstrated important restrictions in social participation and lower educational level. Adults with CP can be affected by several physical complications and progressive limitations in gait.

ocular findings in children with cerebral palsy attending a tertiary

African Journals Online (AJOL)

ocular abnormalities among children with cerebral palsy that attended the neurology clinic of University of. Ilorin Teaching ... recognize faces or hand-held toys (Chen, Weinberg and Catalano ... palsy that is also blind/visually impaired pose a.

Bangladesh Cerebral Palsy Register (BCPR): a pilot study to develop a national cerebral palsy (CP) register with surveillance of children for CP.

Science.gov (United States)

Khandaker, Gulam; Smithers-Sheedy, Hayley; Islam, Johurul; Alam, Monzurul; Jung, Jenny; Novak, Iona; Booy, Robert; Jones, Cheryl; Badawi, Nadia; Muhit, Mohammad

2015-09-25

The causes and pathogenesis of cerebral palsy (CP) are all poorly understood, particularly in low- and middle-income countries (LMIC). There are gaps in knowledge about CP in Bangladesh, especially in the spheres of epidemiological research, intervention and service utilization. In high-income countries CP registers have made substantial contributions to our understanding of CP. In this paper, we describe a pilot study protocol to develop, implement, and evaluate a CP population register in Bangladesh (i.e., Bangladesh Cerebral Palsy Register - BCPR) to facilitate studies on prevalence, severity, aetiology, associated impairments and risk factors for CP. The BCPR will utilise a modified version of the Australian Cerebral Palsy Register (ACPR) on a secured web-based platform hosted by the Cerebral Palsy Alliance Research Institute, Australia. A standard BCPR record form (i.e., data collection form) has been developed in consultation with local and international experts. Using this form, the BPCR will capture information about maternal health, birth history and the nature of disability in all children with CP aged CP will be identified by using the community based Key Informants Method (KIM). Data from the completed BPCR record together with details of assessment by a research physician will be entered into an online data repository. Once implemented, BCPR will be, to the best of our knowledge, the first formalised CP register from a LMIC. Establishment of the BCPR will enable estimates of prevalence; facilitate clinical surveillance and promote research to improve the care of individuals with CP in Bangladesh.

Deficit in implicit motor sequence learning among children and adolescents with spastic cerebral palsy.

Science.gov (United States)

Gofer-Levi, Moran; Silberg, Tamar; Brezner, Amichai; Vakil, Eli

2013-11-01

Skill learning (SL) is learning as a result of repeated exposure and practice, which encompasses independent explicit (response to instructions) and implicit (response to hidden regularities) processes. Little is known about the effects of developmental disorders, such as Cerebral Palsy (CP), on the ability to acquire new skills. We compared performance of CP and typically developing (TD) children and adolescents in completing the serial reaction time (SRT) task, which is a motor sequence learning task, and examined the impact of various factors on this performance as indicative of the ability to acquire motor skills. While both groups improved in performance, participants with CP were significantly slower than TD controls and did not learn the implicit sequence. Our results indicate that SL in children and adolescents with CP is qualitatively and quantitatively different than that of their peers. Understanding the unique aspects of SL in children and adolescents with CP might help plan appropriate and efficient interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Epilepsy and cerebral palsy: characteristics and trends in children born in 1976-1998

DEFF Research Database (Denmark)

Sellier, Elodie; Uldall, Peter; Calado, Eulalia

2012-01-01

Although epilepsy is common in children with cerebral palsy (CP), no data exists on prevalence rates of CP and epilepsy.......Although epilepsy is common in children with cerebral palsy (CP), no data exists on prevalence rates of CP and epilepsy....

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

Directory of Open Access Journals (Sweden)

Yvette L Kerkum

Full Text Available Rigid Ankle-Foot Orthoses (AFOs are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP. While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years were prescribed with a ventral shell spring-hinged AFO (vAFO. The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05 was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power

The nature of arm movement in children with cerebral palsy when using computer-generated exercise games.

Science.gov (United States)

Weightman, Andrew; Preston, Nick; Levesley, Martin; Bhakta, Bipin; Holt, Raymond; Mon-Williams, Mark

2014-05-01

To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices. A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick's end point and the participant's shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group. Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants. Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems. A kinematic analysis of upper limb function of children with CP when using joystick devices is presented. Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement. The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory.

Science.gov (United States)

Jenks, Kathleen M; de Moor, Jan; van Lieshout, Ernest C D M

2009-07-01

Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n = 41) and mainstream education (n = 16) and controls in mainstream education (n = 16). Second grade executive function and working memory scores were used to predict third grade arithmetic accuracy and response time. Children with cerebral palsy in special education were less accurate and slower than their peers on all arithmetic tests, even after controlling for IQ, whereas children with cerebral palsy in mainstream education performed as well as controls. Although the performance gap became smaller over time, it did not disappear. Children with cerebral palsy in special education showed evidence of executive function and working memory deficits in shifting, updating, visuospatial sketchpad and phonological loop (for digits, not words) whereas children with cerebral palsy in mainstream education only had a deficit in visuospatial sketchpad. Hierarchical regression revealed that, after controlling for intelligence, components of executive function and working memory explained large proportions of unique variance in arithmetic accuracy and response time and these variables were sufficient to explain group differences in simple, but not complex, arithmetic. Children with cerebral palsy are at risk for specific executive function and working memory deficits that, when present, increase the risk for arithmetic difficulties in these children.

Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

Science.gov (United States)

Delabastita, Tijs; Desloovere, Kaat; Meyns, Pieter

2016-01-01

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in

A preliminary study of the effect of restricted gastrocnemius length on foot kinematics and plantar pressure patterns during gait in children with Cerebral Palsy

DEFF Research Database (Denmark)

Curtis, Derek

2008-01-01

  Summary/conclusion Kinematic foot modelling and pedobarography are complementary measurement methods for measuring foot biomechanics in children with cerebral palsy (CP). Pedobarography appears to be the most sensitive instrument measuring significantly decreased hindfoot and increased lateral......, range, 9-18 yrs) was tested twice using an EMED pedobarograph and a Vicon motion analysis system using the Oxford kinematic foot model to test the repeatability of the measurement methods and generate normal data. 8 children (4 girls, 4 boys, mean ± SD, 12 ± 2 yrs, range 8-15yr) with spastic CP...... forefoot mean plantar pressure and force in the children with gastrocnemius contracture, whilst the corresponding changes in foot kinematics were non-significant.   Introduction Foot deformity is common in CP and is often due to hypertonia and contracture in spastic muscles. The aim of this study...

Judesių ribojimo ir veidrodinio аtspindžio terаpijų poveikis vаikų, turinčių cerebrinį pаrаlyžių, rаnkos funkcijаi ir аpsitаrnаvimui.

OpenAIRE

Stasiulienė, Ksenija

2017-01-01

The aim of the research: Identification of constraint-induced movement therapy and mirror therapy effects for children with cerebral palsy (spastic hemiplegic) to hand function and self-care. The tasks of the research: 1. To evaluate constraint-induced movement therapy effects for children with cerebral palsy (spastic hemiplegic) to hand function and self-care. 2. To evaluate mirror therаpy effects on children with cerebral palsy (spastic hemiplegic) for hand function and self-care. 3. Ide...

Quality of life of mothers of children with cerebral palsy and their ...

African Journals Online (AJOL)

Quality of life of mothers of children with cerebral palsy and their agematched controls. BOA Adegoke, OO Adenuga, OA Olaleye, CO Akosile. Abstract. Background Caring for a child with cerebral palsy (CP) could negatively impact the quality of life (QoL) of the mothers who are usually the primary caregivers. Studies on the ...

Children's perceptions of their cerebral palsy and their impact on life satisfaction.

Science.gov (United States)

Chong, Jimmy; Mackey, Anna H; Broadbent, Elizabeth; Stott, N Susan

2012-01-01

To assess an individual child's cognitive and emotional perceptions of their cerebral palsy (CP) and how these are associated with their reported life satisfaction and their functional walking ability. Convenience sample of 48 children with cerebral palsy, GMFCS (Gross Motor Function Classification System) I-IV, mean age of 12.2 ± 2.5 years was recruited from tertiary level out-patient clinics. All children completed the Brief Illness Perception Questionnaire-Cerebral Palsy version (BIPQ-CP), Students' Life Satisfaction Scale (SLSS) and 1- and 6-min walk tests. Children with CP reported levels of global life satisfaction (mean score 31.4/42) equivalent to previous studies of typically developing children. Higher total SLSS scores were associated with lower concern about CP (rho = -0.61, p life satisfaction. Life satisfaction in this group of children was strongly associated with a child's perceptions of their CP but was not associated with functional walking ability. Although the cross-sectional nature of the study precludes assumptions of causality, understanding children's cognitive and emotional beliefs about their cerebral palsy would seem to be an important adjunct to clinical management.

Evaluation of the effect of the reduction of the hip spastic dislocation in adolescent and young adult with cerebral paralysis

International Nuclear Information System (INIS)

Contreras Calderon, Jose; Zambrano, Gladis Cecilia; Villanueva, Erland; Turriago, Camilo Andres

2006-01-01

We present the results obtained in the Instituto de Ortopedia Infantil Roosevelt for the treatment of the hip dislocation in adolescent patients and young adults with spastic cerebral palsy with the open reduction of the hip, accompanied by femoral osteotomy and, if as necessary, pelvic osteotomy. 14 hips (10 patients) were intervened from January of 1996 to July of 2003. Pain was completely released in 54 percent and improved in 36 percent of cases. Abduction improved in 63 percent of patients allowing the perinea cleaning in 63 percent and better tolerance to scar in 64% of the cases. Our complications were one patient developed a sacred pressure ulcer with the spica cast treated with a free flap transposition; one hip had redislocation at 31 months from surgery; another hip had instability without clinical repercussion; one patient had a not displaced supracondylar femoral fracture treated with immobilization. The results of our study showed that the open reduction of the spastic hip in adolescents and young adults is a procedure that improves, in most of the cases, the stability, mobility and pain of the hip and provides better quality life for these patients

Health issues in young adults with cerebral palsy: towards a life-span perspective.

NARCIS (Netherlands)

Hilberink, S.R.; Roebroeck, M.E.; Nieuwstraten, W.; Jalink, L.; Verheijden, J.M.; Stam, H.J.

2007-01-01

OBJECTIVE: To obtain better insight into the health issues of young adults with cerebral palsy. DESIGN: Cross-sectional. SUBJECTS: Two data sources were used: 54 adults with cerebral palsy (age range 25-36 years) and 48 physicians (members of the Netherlands Society of Physical and Rehabilitation

[Vegetative disorders in children with cerebral palsy. Results of an inquiry of parents].

Science.gov (United States)

Feldkamp, M; Bartmann, D; Süreth, H; Steinhausen, D

1976-08-01

Many of the disturbances resulting from dysregulations in the autonomous nervous system of children with cerebral palsy are rarely discussed in the doctor's praxis. Nevertheless, they are causes of trouble and worry for the parents. For this reason we started an inquiry into this matter. Questionnaires were sent to the parents of 452 C.P. patients. 374 were answered with sufficient care. The following factors were evaluated: sleep, bladder and bowel activity, temperature regulation, vomiting, sweating, blood circulation, growth. The C.P. children were compared to their own siblings especially to the next younger ones. The diagnoses were as follows: Spastic tetraplegia 197 patients. Spastic hemiplegia 44 patients, Athetosis 33 patients, Mixed cases of spasticity and athetosis 82 patients, Other 15 patients. The degrees of handicap in terms of motor development were: severe (unability to sit unsupported) 166 cases, moderate (unability to kneel or walk unsupported) 118 cases, mild (ability to kneel and/or walk unsupported) 87 cases. Summarized, the statements of the parents gave the following results: sleep disturbances: 169 cases (46%), constipation: 145 cases (39%), tendency towards temperature dysregulation: 112 cases (30%) , tendency towards increased vomiting: 91 cases (25%), sweating increased or decreased: 110 cases (30%), irregular and frequent voiding of bladder: 92 cases (25%), unstable regulation of blood circulation: 101 cases (27%), cold skin: 264 cases (71%), body-length deficit: 119 cases (32%), low-weight: 177 cases (48%), feet too small for age: 252 cases (68%). Results are related to diagnosis and severeness of handicap. In addition, it is discussed, whether there are relations between several of the investigated factors. The influence of the patients sex is discussed.

Biofeedback interventions for people with cerebral palsy: a systematic review protocol.

Science.gov (United States)

MacIntosh, Alexander; Vignais, Nicolas; Biddiss, Elaine

2017-01-13

Cerebral palsy is a life-long disability that affects motor control and activities of daily living. Depending on the type of cerebral palsy, some individuals may have trouble performing tasks with one or both of their arms and/or legs. Different strategies exist to help develop motor capacity. Biofeedback therapy is a commonly applied rehabilitation strategy. In biofeedback therapy, information about the motor behavior while completing a task is given back to the individual to help improve their performance. This can provide valuable information that would otherwise be unknown to the individual. Biofeedback may also have a unique method of operation in clinical populations, such as people with cerebral palsy. Therefore, it is important to identify the most effective mechanisms for specific populations. This review aims to evaluate the effects of biofeedback interventions that have been used towards improving motor performance and motor learning in people with cerebral palsy. Using a customized strategy, MEDLINE, CINAHL, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, SPORTDiscus, and PEDro databases will be searched. Two independent reviewers will screen titles and abstracts, review full texts for inclusion criteria, and extract data from relevant articles using a standardized template. Quality of evidence and risk of bias will be assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Several studies have investigated biofeedback-based interventions for people with cerebral palsy. However, there is a great variety and limited consensus regarding how to implement biofeedback mechanisms. This systematic review will consolidate the current evidence to direct future study and develop effective biofeedback rehabilitation strategies. PROSPERO ID: CRD42016047612.

Sensory Feedback Training for Improvement of Finger Perception in Cerebral Palsy

Directory of Open Access Journals (Sweden)

Tobias Blumenstein

2015-01-01

Full Text Available Purpose. To develop and to test a feedback training system for improvement of tactile perception and coordination of fingers in children and youth with cerebral palsy. Methods. The fingers of 7 probands with cerebral palsy of different types and severity were stimulated using small vibration motors integrated in the fingers of a hand glove. The vibration motors were connected through a microcontroller to a computer and to a response 5-button keyboard. By pressing an appropriate keyboard button, the proband must indicate in which finger the vibration was felt. The number of incorrect responses and the reaction time were measured for every finger. The perception and coordination of fingers were estimated before and after two-week training using both clinical tests and the measurements. Results. Proper functioning of the developed system in persons with cerebral palsy was confirmed. The tactile sensation of fingers was improved in five of seven subjects after two weeks of training. There was no clear tendency towards improvement of selective use of fingers. Conclusion. The designed feedback system could be used to train tactile perception of fingers in children and youth with cerebral palsy. An extensive study is required to confirm these findings.

Systematic review and meta-analysis of the effect of equine assisted activities and therapies on gross motor outcome in children with cerebral palsy.

Science.gov (United States)

Tseng, Sung-Hui; Chen, Hung-Chou; Tam, Ka-Wai

2013-01-01

To evaluate the literature on the efficacy of equine assisted activities and therapies (EAAT) on gross motor outcomes representing the ICF component of body functions and activity in children with cerebral palsy (CP). We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies of hippotherapy (HPOT) and therapeutic horseback riding (TR) for children with spastic CP. Gross motor outcomes, assessed via muscle activity and muscle tone, gait, posture and Gross Motor Function Measures (GMFM) were evaluated. Five TR studies and nine HPOT studies were included. Our meta-analysis indicated that short-term HPOT (total riding time 8-10 min) significantly reduced asymmetrical activity of the hip adductor muscles. HPOT could improve postural control in children with spastic CP, GMFCS level < 5. However, the evidence did not show a statistically significant effect on GMFM after long-term HPOT or TR (total riding time, 8-22 h) in children with spastic CP. This systematic review found insufficient evidence to support the claim that long-term TR or HPOT provide a significant benefit to children with spastic CP. We found no statistically significant evidence of either therapeutic effect or maintenance effects on the gross motor activity status in CP children.

Parental stress in mothers of children and adolescents with cerebral palsy

Directory of Open Access Journals (Sweden)

Maysa Ferreira Martins Ribeiro

2014-06-01

Full Text Available OBJECTIVES: to evaluate parental stress of mothers of children and adolescents with cerebral palsy; to verify whether parental stress undergoes variations according to the level of motor compromise, the child's phase of life, and sociodemographic variables.METHOD: a cross-sectional, descriptive study, with 223 mothers of children and adolescents with cerebral palsy.RESULTS: 45.3% of the mothers presented high levels of stress; there were differences in stress between mothers of children with mild and severe motor impairment; mothers of older children were more stressed than mothers of younger children and of adolescents; paid work and leisure activities reduced the stress.CONCLUSION: mothers of children and adolescents with cerebral palsy, whose children present mild to severe motor impairment are vulnerable to parental stress. Paid work and leisure activities were the factors that contributed most to reducing the stress.

Regional Cerebral Perfusion in Progressive Supranuclear Palsy

International Nuclear Information System (INIS)

Lee, Won Yong; Lee, Ki Hyeong; Yoon, Byung Woo; Lee, Sang Bok; Jeon, Beom S.; Lee, Kyung Han; Lee, Myung Chul

1996-01-01

Progressive supranuclear palsy (PSP) is a Parkinson-plus syndrome characterized clinically by supranuclear ophthalmoplegia, pseudobulbar palsy, axial rigidity, bradykinesia, postural instability and dementia. Presence of dementia and lack of cortical histopathology suggest the derangement of cortical function by pathological changes in subcortical structures in PSP, which is supported by the pattern of behavioral changes and measurement of brain metabolism using positron emission tomography. This study was done to examine whether there are specific changes of regional cerebral perfusion in PSP and whether there is a correlation between severity of motor abnormaility and degree of changes in cerebral perfusion. We measured regional cerebral perfusion indices in 5 cortical and 2 subcortical areas in 6 patients with a clinical diagnosis of PSP and 6 healthy age and sex matched controls using Tc-99m-HMPAO SPECT. Compared with age and sex matched controls, only superior frontal regional perfusion index was significantly decreased in PSP (p 0.05). We affirm the previous reports that perfusion in superior frontal cortex is decreased in PSP. Based on our results that there was no correlation between severity of motor abnormality and cerebral perfusion in the superior frontal cortex, nonmotoric symptoms including dementia needs to be looked at whether there is a correlation with the perfusion abnormality in superior frontal cortex

The effect of combined treatment with transcranial direct current stimulation on cerebral blood flow in patients with cerebral palsy

Directory of Open Access Journals (Sweden)

K. V. Yatsenko

2017-02-01

Full Text Available There is a close link between the activity of the brain and cerebral blood supply. Transcranial direct current stimulation (tDCS modulates the activity of the cerebral cortex and thus affects the cerebral blood flow. The aim of the study was to investigate the effect of combined treatment with tDCS on cerebral blood flow in patients with cerebral palsy (CP. Materials and Methods. 60 patients with various forms of cerebral palsy were examined and received the course of treatment. The comparison group was formed from 30 children who received the course of basic medical and rehabilitation procedures. The main group included 30 children who, in addition to the same therapy, received a course of tDCS. A transcranial Doppler ultrasound examination of head blood vessels was used for the study of cerebral hemodynamics in children with cerebral palsy before and after combined treatment with tDCS. Results. tDCS reduced asymmetry coefficient of blood flow velocity in the middle cerebral arteries (MCA by 12.3 %, whereas in the comparison group only by 2.5 %; in the anterior cerebral artery (ACA – 9.5 %, while in the comparison group – 0.8 %. tDCS significantly reduced the high mean blood flow velocity per cycle (MFV in the basilar artery (BA, MCA and ACA (21.7 %, 18.3 % and 7.8 %, respectively; in the comparison group no statistically significant positive dynamics was observed. tDCS significantly increased the low MVF in the BA, MCA and ACA (29.7 %, 21.2 % and 9.7 % respectively; a statistically significant increase of MVF by 9.9 % was only in the CMA in the comparison group of patients. Conclusions. Our data indicate that the use of tDCS in the combined treatment of CP patients improves cerebral hemodynamics in 87 % of patients, in contrast to 52 % in the comparison group. The addition of transcranial direct current stimulation method to the complex treatment of patients with cerebral palsy improves the effectiveness of treatment and may also

No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy.

Science.gov (United States)

Alhusaini, Adel A A; Crosbie, Jack; Shepherd, Roberta B; Dean, Catherine M; Scheinberg, Adam

2011-06-01

Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function. The aim of this study was to investigate non-neurally mediated calf-muscle tightness in children with cerebral palsy (CP) before and after botulinum toxin type A (BoNT-A) injection. Sixteen children with spastic CP (seven females, nine males; eight at Gross Motor Function Classification System level I, eight at level II; age range 4-10 y) and calf muscle spasticity were tested before and during the pharmaceutically active phase after injection of BoNT-A. Measures of passive muscle compliance and viscoelastic responses, hysteresis, and the gradient of the torque-angle curve were computed and compared before and after injection. Although there was a slight, but significant increase in ankle range of motion after BoNT-A injection and a small, significant decrease in the torque required to achieve plantigrade and 5° of dorsiflexion, no significant difference in myotendinous stiffness or hysteresis were detected after BoNT-A injection. Despite any effect on neurally mediated responses, the compliance of the calf muscle was not changed and the muscle continued to offer significant resistance to passive motion of the ankle. These findings suggest that additional treatment approaches are required to supplement the effects of BoNT-A injections when managing children with calf muscle spasticity. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

Position as a Cause of Deformity in Children with Cerebral Palsy (1976)

Science.gov (United States)

Scrutton, David

2008-01-01

Deformities in the child with cerebral palsy have been ascribed to muscle imbalance (Sharrard 1961) and increased tone (Pollock 1959) or to the type of cerebral palsy (Bobath and Bobath 1975). As far as we know, the position in which the child is nursed, especially during the first year of life, has not been considered as a cause of deformity. It…

Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures

Science.gov (United States)

Jóźwiak, Marek; Chen, Brian Po-Jung; Musielak, Bartosz; Fabiszak, Jacek; Grzegorzewski, Andrzej

2015-01-01

This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78–86%, 65% (Spastic); 1.5–6%, 9% (Dyskinetic); 6.5–9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40–51%, 47% (Level I + II); 14–19%, 12% (Level III); 34–41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general public's point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly. PMID:26257472

Genetic Variation in the Dopamine System Influences Intervention Outcome in Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Rochellys Diaz Heijtz

2018-02-01

Interpretation: Naturally occurring genetic variation in the dopamine system can influence treatment outcomes in children with cerebral palsy. A polygenic dopamine score might be valid for treatment outcome prediction and for designing individually tailored interventions for children with cerebral palsy.

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

Science.gov (United States)

Shepherd, Emily; Salam, Rehana A; Middleton, Philippa; Makrides, Maria; McIntyre, Sarah; Badawi, Nadia; Crowther, Caroline A

2017-08-08

Cerebral palsy is an umbrella term encompassing disorders of movement and posture, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. As there are diverse risk factors and causes, no one strategy will prevent all cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for their contribution to prevention. To summarise the evidence from Cochrane reviews regarding the effects of antenatal and intrapartum interventions for preventing cerebral palsy. We searched the Cochrane Database of Systematic Reviews on 7 August 2016, for reviews of antenatal or intrapartum interventions reporting on cerebral palsy. Two authors assessed reviews for inclusion, extracted data, assessed review quality, using AMSTAR and ROBIS, and quality of the evidence, using the GRADE approach. We organised reviews by topic, and summarised findings in text and tables. We categorised interventions as effective (high-quality evidence of effectiveness); possibly effective (moderate-quality evidence of effectiveness); ineffective (high-quality evidence of harm or of lack of effectiveness); probably ineffective (moderate-quality evidence of harm or of lack of effectiveness); and no conclusions possible (low- to very low-quality evidence). We included 15 Cochrane reviews. A further 62 reviews pre-specified the outcome cerebral palsy in their methods, but none of the included randomised controlled trials (RCTs) reported this outcome. The included reviews were high quality and at low risk of bias. They included 279 RCTs; data for cerebral palsy were available from 27 (10%) RCTs, involving 32,490 children. They considered interventions for: treating mild to moderate hypertension (two) and pre-eclampsia (two); diagnosing and preventing fetal compromise in labour (one); preventing preterm birth (four); preterm fetal maturation or neuroprotection (five); and managing preterm fetal compromise (one). Quality of

The cranial MRI in severe cerebral palsy; A comparative study with clinical data

Energy Technology Data Exchange (ETDEWEB)

Yamada, Kazutaka; Itoh, Masahiro; Fueki, Noboru; Hirasawa, Kyoko; Suzuki, Noriko; Kurata, Kiyoko (Metropolitan Medical Center of the Severely Handicapped, Tokyo (Japan)); Sato, Junichi; Morimatsu, Yoshio; Yagishita, Akira

1993-09-01

The magnetic resonance examination was performed in 38 patients with severe cerebral palsy (CP; 15 males and 23 females) who had both motor delay (unable to move anywhere) and mental retardation (I.Q. or D.Q. below 30). Neuroimaging findings were compared with the CP type, etiology, and grade of understanding of language. Cranial magnetic resonance imagings (MRI) in CP were divided into five types. In type 1, nine predominantly showed cyst-liked ventricles and periventricular hyperintensity on T[sub 2]-weighted imaging (PVH) and only scarred basal ganglia and thalamus were visible. All suffered from neonatal asphyxia and the clinical type was rigospastic tetraplegia (RST). In type 2, eleven predominantly showed PVH and hyperintensity on T[sub 2]-weighted (HT2) in basal ganglia and thalamus. All suffered from neonatal asphyxia and the clinical type was RST or rigospastic diplegia. In type 3, five showed PVH and three had cortical atrophy. All suffered from neonatal asphyxia and the clinical type was spastic diplegia. In type 4, four predominantly showed HT2 in putamen and thalamus. Three had cortical atrophy. All suffered from neonatal asphyxia. The clinical type was athetotic CP (ATH). In type 5, nine predominantly showed HT2 in globus pallidus. Four had cortical atrophy and two had hippocampal atrophy. All suffered from neonatal jaundice and the clinical type was ATH. All patients who suffered from neonatal asphyxia and spastic CP had MRI in PVH. All patients who suffered from neonatal asphyxia and ATH showed HT2 in putamen and thalamus. Almost patients who suffered from neonatal jaundice and ATH showed HT2 in globus pallidus. With athetotic CP, cases with atrophy of the cerebral cortex and/or hippocampus were lower grade of understanding of language than no atrophy of both. The results of studies of MRI are in agreement with neuropathological findings. (author).

Association of Early-Onset Spasticity and Risk for Cognitive Impairment With Mutations at Amino Acid 499 in SPAST.

Science.gov (United States)

Gillespie, Meredith K; Humphreys, Peter; McMillan, Hugh J; Boycott, Kym M

2018-04-01

Hereditary spastic paraplegia is a phenotypically and genetically heterogeneous group of neurodegenerative disorders characterized by lower extremity weakness and spasticity. Spastic paraplegia 4 (SPG4), caused by heterozygous mutations in the gene SPAST, typically causes a late-onset, uncomplicated form of hereditary spastic paraplegia in affected individuals. Additional clinical features in SPG4 have been reported on occasion, but no genotype-phenotype correlation has been established. Through targeted clinical testing, we identified 2 unrelated female patients with the same de novo p.Arg499His mutation in SPAST. Both patients presented with early-onset spasticity resulting in delayed motor milestones, which led to a diagnosis of cerebral palsy in one child and tethered cord in the other. Review of the literature identified several patients with mutations at amino acid 499 and early-onset symptoms associated with a risk of cognitive impairment. Early and accurate diagnosis of children with early-onset spasticity is important for informed prognosis and genetic counselling.

[Physical exercise for people with cerebral palsy: effects, recommendations and barriers].

Science.gov (United States)

Barak, Sharon; Hutzler, Yeshayahu; Dubnov-Raz, Gal

2014-05-01

The management goal of cerebral palsy (CP) is improving functionality, locomotion and independence. Treatment programs commonly encompass adapted physical activity (APA). This review summarizes the knowledge regarding the effects and recommendations for APA in persons with CP. In addition, barriers to APA in this population are reviewed. The available literature on benefits of APA to persons with CP has focused mainly on youth. The components of the APA programs generally consist of strength, aerobic and flexibility training. There is no empirical evidence that strength-training increases spasticity in people with CP. Furthermore, strength-training may increase strength and the ability to perform daily activities. Aerobic-training is especially important as persons with CP typically have low cardiorespiratory fitness and high prevalence of cardiac disease. However, limited published evidence exists on aerobic-training effects in this population. Nonetheless, the evidence suggests that aerobic-training in persons with CP can improve physiological outcomes, yet the influence of these changes on participation has not been investigated sufficiently. Stretching exercise is a common treatment for spasticity. Surprisingly, there is inconclusive evidence for the effectiveness of stretching exercise for persons with CP. Despite the importance attributed to APA for people with CP, low levels of physical activity have been reported in this population. However, when caregivers perceive greater benefits of exercise, individuals with CP are more likely to be active. In contrast, barriers to APA include costs of APA programs, limited means of transportation to APA facilities, lack of information regarding APA facilities and limited appropriate exercising equipment in the APA facilities.

Intensive gait training in toddlers with cerebral palsy: A pilot study

Directory of Open Access Journals (Sweden)

Anna Herskind

2016-07-01

Full Text Available Background: Reduced muscle growth may be involved in the development of contractures in children with cerebral palsy (CP. Here, we report data from a pilot study of intensive gait training in CP toddlers. Methods: Five children with CP aged 8-30 months performed activity-based gait training for one hour/day, five days/week for three consecutive months. Included children were diagnosed with spastic CP, had a Gross Motor Function Classification System (GMFCS score of I–II, and were not epileptic. All children wore pedometers during training. Before and after the training period, kinematic and qualitative gait analysis, clinical and objective evaluation of spasticity, Gross Motor Function Measure-66 (GMFM-66, and ultrasound of the affected medial gastrocnemius (MG muscle were performed. Two children were also tested before and after three months of receiving only standard care (SC. Results: On average 1410 steps/session were logged during 63 days of training. More steps were achieved at home than at a central facility. During training, MG muscle volume increased significantly, while it decreased for SC children. Gait improved qualitatively in all children, and GMFM-66 score improved in four of the five children. Similar improvements were seen among the SC children. Two children had pathologically increased muscle stiffness prior to training, which was reduced during training. Reflex stiffness was unchanged in all five children. Conclusions: This pilot study suggests that intensive gait training may increase muscle volume, improve walking skills and reduce passive muscle stiffness in toddlers with CP.

Gingivitis and salivary osmolality in children with cerebral palsy.

Science.gov (United States)

Santos, Maria Teresa Botti Rodrigues; Ferreira, Maria Cristina Duarte; Guaré, Renata Oliveira; Diniz, Michele Baffi; Rösing, Cassiano Kuchenbecker; Rodrigues, Jonas Almeida; Duarte, Danilo Antonio

2016-11-01

To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP). A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed. Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH 2 O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%. Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality. © 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy.

Science.gov (United States)

Park, Eun Sook; Rha, Dong Wook; Shin, Jung Soon; Kim, Soohyeon; Jung, Soojin

2014-11-01

The purpose of our study was to investigate the effects of hippotherapy on gross motor function and functional performance in children with spastic cerebral palsy (CP). We recruited 34 children (M:F=15:19, age: 3-12 years) with spastic CP who underwent hippotherapy for 45 minutes twice a week for 8 weeks. Twenty-one children with spastic CP were recruited for control group. The distribution of gross motor function classification system level and mean age were not significantly different between the two groups. Outcome measures, including the Gross Motor Function Measure (GMFM)-66, GMFM-88 and the Pediatric Evaluation of Disability Inventory: Functional Skills Scale (PEDI-FSS), were assessed before therapy and after the 8-weeks intervention as outcome measures. There were no significant differences between intervention and control groups in mean baseline total scores of GMFM-66, GMFM-88 or PEDI-FSS. After the 8-weeks intervention, mean GMFM-66 and GMFM-88 scores were significantly improved in both groups. However, the hippotherapy group had significantly greater improvement in dimension E and GMFM-66 total score than the control group. The total PEDI-FSS score and the sub-scores of its 3 domains were significantly improved in the hippotherapy group, but not in the control group. The results of our study demonstrate the beneficial effects of hippotherapy on gross motor function and functional performance in children with CP compared to control group. The significant improvement in PEDI-FSS scores suggests that hippotherapy may be useful to maximize the functional performance of children with CP.

IMPACT OF BODY WEIGHT SUPPORTED BACKWARD TREADMILL TRAINING ON WALKING SPEED IN CHILDREN WITH SPASTIC DIPLEGIA

Directory of Open Access Journals (Sweden)

Hamada El Sayed Abd Allah Ayoub

2016-10-01

Full Text Available Background: A lot of the ambulating children with spastic diplegia were able to walk with flexed hips, knees and ankles this gait pattern is known as crouch gait. The most needed functional achievement of diplegic children habilitation is to be able to walk appropriately. The development of an independent and efficient walking is one of the main objectives for children with cerebral palsy especially those with spastic diplegia. Method: Twenty children with spastic diplegia enrolled in this study, they were classified into two groups of equal number, eligibility to our study were ages ranged from seven to ten years, were able to ambulate, They had gait problems and abnormal gait kinematics. The control group (A received selected physical therapy program based on neurodevelopmental approach for such cases, while the study group (B received partial body weight supported backward treadmill training in addition to regular exercise program. Gait pattern was assessed using the Biodex Gait Trainer II for each group pre and post three months of the treatment program. Results: There was statistically significant improvement in walking speed in the study group (P<0.05 with significant difference when comparing post treatment results between groups (p<0.05. Conclusion: These findings suggested that partial body weight supported backward treadmill training can be included as a supplementary therapeutic modality to improve walking speed and functional abilities of children with diplegic cerebral palsy.

Regional Cerebral Perfusion in Progressive Supranuclear Palsy

Energy Technology Data Exchange (ETDEWEB)

Lee, Won Yong; Lee, Ki Hyeong; Yoon, Byung Woo; Lee, Sang Bok; Jeon, Beom S. [Samsung Medical Center, Seoul (Korea, Republic of); Lee, Kyung Han; Lee, Myung Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1996-03-15

Progressive supranuclear palsy (PSP) is a Parkinson-plus syndrome characterized clinically by supranuclear ophthalmoplegia, pseudobulbar palsy, axial rigidity, bradykinesia, postural instability and dementia. Presence of dementia and lack of cortical histopathology suggest the derangement of cortical function by pathological changes in subcortical structures in PSP, which is supported by the pattern of behavioral changes and measurement of brain metabolism using positron emission tomography. This study was done to examine whether there are specific changes of regional cerebral perfusion in PSP and whether there is a correlation between severity of motor abnormaility and degree of changes in cerebral perfusion. We measured regional cerebral perfusion indices in 5 cortical and 2 subcortical areas in 6 patients with a clinical diagnosis of PSP and 6 healthy age and sex matched controls using Tc-99m-HMPAO SPECT. Compared with age and sex matched controls, only superior frontal regional perfusion index was significantly decreased in PSP (p<0.05). There was no correlation between the severity of the motor abnormality and any of the regional cerebral perfusion indices (p>0.05). We affirm the previous reports that perfusion in superior frontal cortex is decreased in PSP. Based on our results that there was no correlation between severity of motor abnormality and cerebral perfusion in the superior frontal cortex, nonmotoric symptoms including dementia needs to be looked at whether there is a correlation with the perfusion abnormality in superior frontal cortex

Vertical and Horizontal Jump Capacity in International Cerebral Palsy Football Players.

Science.gov (United States)

Reina, Raúl; Iturricastillo, Aitor; Sabido, Rafael; Campayo-Piernas, Maria; Yanci, Javier

2018-05-01

To evaluate the reliability and validity of vertical and horizontal jump tests in football players with cerebral palsy (FPCP) and to analyze the jump performance differences between current International Federation for Cerebral Palsy Football functional classes (ie, FT5-FT8). A total of 132 international parafootballers (25.8 [6.7] y; 70.0 [9.1] kg; 175.7 [7.3] cm; 22.8 [2.8] kg·m -2 ; and 10.7 [7.5] y training experience) participated in the study. The participants were classified according to the International Federation for Cerebral Palsy Football classification rules, and a group of 39 players without cerebral palsy was included in the study as a control group. Football players' vertical and horizontal jump performance was assessed. All the tests showed good to excellent relative intrasession reliability scores, both in FPCP and in the control group (intraclass correlation = .78-.97, SEM jump, standing broad jump, 4 bounds for distance, and triple hop for distance dominant leg and nondominant leg. The control group performed higher/farther jumps with regard to all the FPCP classes, obtaining significant differences and moderate to large effect sizes (ESs) (.85 jump tests than players in the lower classes (ES = moderate to large, P jump tests performed in this study could be applied to the classification procedures and protocols for FPCP.

Early identification and intervention in cerebral palsy

DEFF Research Database (Denmark)

Herskind, Anna; Greisen, Gorm; Nielsen, Jens Bo

2015-01-01

Infants with possible cerebral palsy (CP) are commonly assumed to benefit from early diagnosis and early intervention, but substantial evidence for this is lacking. There is no consensus in the literature on a definition of 'early', but this review focuses on interventions initiated within...

Social integration of adults with cerebral palsy

DEFF Research Database (Denmark)

Michelsen, Susan Ishøy; Uldall, Peter; Hansen, Thomas

2006-01-01

Social integration and independence is the ultimate goal of habilitation and social support for patients with cerebral palsy (CP). Having a partner and having children provide support for social integration of adults with or without a disability. We studied 416 participants with CP born between...

Physical activity predicts quality of life and happiness in children and adolescents with cerebral palsy.

Science.gov (United States)

Maher, Carol Ann; Toohey, Monica; Ferguson, Monika

2016-01-01

To examine the associations between physical activity, health-related quality of life and happiness in young people with cerebral palsy. A total of 70 young people with cerebral palsy (45 males, 25 females; mean age 13 years 11 months, SD 2 years 0 month) took part in a cross-sectional, descriptive postal survey assessing physical activity (Physical Activity Questionnaire for Adolescents), functional ability (Gross Motor Function Classification System), quality of life (Pediatric Quality of Life Inventory 4.0) and happiness (single Likert-scale item). Relationships between physical activity, quality of life and happiness were examined using backward stepwise linear regression. Physical activity significantly predicted physical quality of life (R(2 )= 0.64, β = 6.12, p = 0.02), social quality of life (R(2 )= 0.28, β = 9.27, p happiness (R(2 )= 0.08, β = 0.9, p = 0.04). Physical activity was not associated with emotional or school quality of life. This study found a positive association between physical activity, social and physical quality of life, and happiness in young people with cerebral palsy. Findings underscore the potential benefits of physical activity for the wellbeing of young people with cerebral palsy, in addition to its well-recognised physical and health benefits. Physical activity is a key predictor of quality of life and happiness in young people with cerebral palsy. Physical activity is widely recognised as having physical health benefits for young people with cerebral palsy; however, this study also highlights that it may have important benefits for wellbeing, quality of life and happiness. This emphasises the need for clinical services and intervention studies aimed specifically at increasing physical activity amongst children and adolescents with cerebral palsy.

[Etiologies of cerebral palsy and classical treatment possibilities].

Science.gov (United States)

Maurer, Ute

2002-01-01

Cerebral palsy is a non-progressive disorder of the developing brain with different etiologies in the pre-, peri- or postnatal period. The most important of these diseases is cystic periventricular leukomalacia (PVL), followed by intra- and periventricular hemorrhage, hypoxic-ischemic encephalopathy, vascular disorders, infections or brain malformations. The underlying cause is always a damage of the first motor neuron. Prevalence of cerebral palsy in Europe is 2-3 per 1000 live births with a broad spectrum in different birth weight groups. Our own data concerning only pre-term infants in the NICU with birth weight below 1500 g (VLBW) are between 10%-20%. Established classical treatment methods include physiotherapy (Bobath, Vojta, Hippotherapy), methods of speech and occupational therapists (Castillo-Morales, Sensory Integration) and other therapeutical concepts (Petö, Affolter, Frostig).

Comparative study of muscular tonus in spastic tetra paretic cerebral palsy in children with predominantly cortical and subcortical lesions in computerized tomography of the skull; Estudo comparativo do tono muscular na paralisia cerebral tetraparetica em criancas com lesoes predominantemente corticais ou subcorticais na tomografia computadorizada de cranio

Energy Technology Data Exchange (ETDEWEB)

Iwabe, Cristina [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Neurologia; Piovesana, Ana Maria Sedrez Gonzaga [Universidade Estadual de Campinas, SP (Brazil). Ambulatorio Multidisciplinar de Paralisia Cerebral e Neurologia Infantil

2003-09-01

The objective was to compare distribution and intensity of muscular tonus in spastic tetra paretic cerebral palsy (CP), correlating the clinical data with lesion location in the central nervous system. Twelve children aged two to four years old with predominantly cortical lesions (six children) and subcortical lesions (six children) were included. The tonus was analyzed in the upper (UULL) and lower limbs (LLLL) based on Durigon and Piemonte protocol. The result showed that there was no significant difference regarding tonus intensity and distribution in the UULL and LLLL in both groups. Comparing the upper and lower limbs of subjects in the same group, the LLLL presented more asymmetry and higher tonus intensity than the UULL. It was concluded that in this study children with CP as a result of predominantly cortical or subcortical lesions present a similar deficit in tonus modulation, causing a symmetric and homogeneous distribution of hypertonicity, which is predominant in the LLLL. (author)

Quantifying the physical, social and attitudinal environment of children with cerebral palsy.

Science.gov (United States)

Dickinson, Heather O; Colver, Allan

2011-01-01

To develop an instrument to represent the availability of needed environmental features (EFs) in the physical, social and attitudinal environment of home, school and community for children with cerebral palsy. Following a literature review and qualitative studies, the European Child Environment Questionnaire (ECEQ) was developed to capture whether EFs needed by children with cerebral palsy were available to them: 24, 24 and 12 items related to the physical, social and attitudinal environments, respectively. The ECEQ was administered to parents of 818 children with cerebral palsy aged 8-12 years, in seven European countries. A domain structure was developed using factor analysis. Parents responded to 98% of items. Seven items were omitted from statistical models as the EFs they referred to were available to most children who needed them; two items were omitted as they did not fit well into plausible domains. The final domains, based on 51 items, were: Transport, Physical - home, Physical - community, Physical - school, Social support - home, Social support - community, Attitudes - family and friends, Attitudes - teachers and therapists, Attitudes - classmates. ECEQ was acceptable to parents and can be used to assess both the access children with cerebral palsy have to the EFs that they need and how available individual EFs are.

Incidence of epilepsy among patients with cerebral palsy

Directory of Open Access Journals (Sweden)

Pertin Sianturi

2006-08-01

Full Text Available Epilepsy is a chronic condition due to cerebral function disorders. Epilepsy occurs as a common complication of many neurological disorders such as cerebral palsy (CP that can affect further brain damage especially if they are with prolonged seizure. The incidence of epilepsy among patients with CP varies between 25-35%. The high incidence of epilepsy among patients with CP suggests that this disorder has common or related origins. We carried out the retrospective study to determine incidence of epilepsy among patients with CP registered within July 1988 to June 1998 in YPAC Medan and to determine whether the incidence of epilepsy differed according to type of CP. Data were compiled from medical records, including name, sex, parity, mothers age, prenatal, perinatal, and postnatal history, and EEG results. Data were analyzed using statistical computer program and its significance was evaluated by chi square test at p < 0,05. There were 67 cases with CP, 53 cases spastic CP, 13 cases mixed CP and one case dyskinetic CP. Of the 67 cases CP, 47,8% male, 52,2% female and mean age 50,3 (SD 36,9 months. There were 25 (37,3% patients CP associated with epilepsy, 72% general seizures, 20% partial seizures, and 8% infantile spasms. The incidence of epilepsy was significant different among patients with CP associated with type of CP and gestasional age, p < 0,05. We concluded that incidence of epilepsy among patients with CP in YPAC Medan was 37,3% and significantly different among patients with CP according to type CP and gestasional age.

Parental infertility and cerebral palsy in children

DEFF Research Database (Denmark)

Zhu, Jin Liang; Hvidtjørn, Dorte; Basso, Olga

2010-01-01

Children born after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) have been reported to have a higher risk of cerebral palsy (CP), perhaps due to the higher frequency of preterm birth, multiple births or vanishing embryo in the pregnancies. However, it has been suggested...

Educational Solutions for Children with Cerebral Palsy

Science.gov (United States)

Driver, Lynn; Omichinski, Donna Riccio; Miller, Nicole; Sandella, Danielle; Warschausky, Seth

2010-01-01

This paper characterizes educational strengths and needs of children with cerebral palsy (CP) and connects research findings from the University of Michigan's Adapted Cognitive Assessment Lab (ACAL) to current special educational requirements. It acknowledges the uniqueness of educating a child with significant motor and communication disabilities…

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory

NARCIS (Netherlands)

Jenks, K.M.; Moor, J.M.H. de; Lieshout, E.C.D.M. van

2009-01-01

Background - Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. Methods - Arithmetic ability was longitudinally assessed in children with cerebral palsy in special

Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy

International Nuclear Information System (INIS)

Trivedi, Richa; Gupta, Rakesh K.; Agarwal, Shruti; Rathore, Ram K.S.; Shah, Vipul; Goyel, Puneet; Paliwal, Vimal K.

2010-01-01

The purpose of this study was to determine whether tract-specific diffusion tensor imaging measures in somatosensory and motor pathways correlate with clinical grades as defined using the Gross Motor Function Classification System (GMFCS) in cerebral palsy (CP) children. Quantitative diffusion tensor tractography was performed on 39 patients with spastic quadriparesis (mean age = 8 years) and 14 age/sex-matched controls. All patients were graded on the basis of GMFCS scale into grade II (n = 12), grade IV (n = 22), and grade V (n = 5) CP and quantitative analysis reconstruction of somatosensory and motor tracts performed. Significant inverse correlation between clinical grade and fractional anisotropy (FA) was observed in both right and left motor and sensory tracts. A significant direct correlation of mean diffusivity values from both motor and sensory tracts was also observed with clinical grades. Successive decrease in FA values was observed in all tracts except for left motor tracts moving from age/sex-matched controls to grade V through grades II and IV. We conclude that white matter tracts from both the somatosensory and the motor cortex play an important role in the pathophysiology of motor disability in patients with CP. (orig.)

Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy

Energy Technology Data Exchange (ETDEWEB)

Trivedi, Richa; Gupta, Rakesh K. [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Radiodiagnosis, Lucknow (India); Agarwal, Shruti; Rathore, Ram K.S. [Indian Institute of Technology, Department of Mathematics and Statistics, Kanpur (India); Shah, Vipul [Bhargava Nursing Home, Pediatric Orthopedic Surgery unit, Lucknow (India); Goyel, Puneet [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Anesthesiology, Lucknow (India); Paliwal, Vimal K. [Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Neurology, Lucknow (India)

2010-08-15

The purpose of this study was to determine whether tract-specific diffusion tensor imaging measures in somatosensory and motor pathways correlate with clinical grades as defined using the Gross Motor Function Classification System (GMFCS) in cerebral palsy (CP) children. Quantitative diffusion tensor tractography was performed on 39 patients with spastic quadriparesis (mean age = 8 years) and 14 age/sex-matched controls. All patients were graded on the basis of GMFCS scale into grade II (n = 12), grade IV (n = 22), and grade V (n = 5) CP and quantitative analysis reconstruction of somatosensory and motor tracts performed. Significant inverse correlation between clinical grade and fractional anisotropy (FA) was observed in both right and left motor and sensory tracts. A significant direct correlation of mean diffusivity values from both motor and sensory tracts was also observed with clinical grades. Successive decrease in FA values was observed in all tracts except for left motor tracts moving from age/sex-matched controls to grade V through grades II and IV. We conclude that white matter tracts from both the somatosensory and the motor cortex play an important role in the pathophysiology of motor disability in patients with CP. (orig.)

Arithmetic difficulties in children with cerebral palsy are related to executive function and working memory.

NARCIS (Netherlands)

Jenks, K.M.; Moor, J.M.H. de; Lieshout, E.C. van

2009-01-01

BACKGROUND: Although it is believed that children with cerebral palsy are at high risk for learning difficulties and arithmetic difficulties in particular, few studies have investigated this issue. METHODS: Arithmetic ability was longitudinally assessed in children with cerebral palsy in special (n

The quality of life in children with cerebral palsy according to their personal and parents' report

OpenAIRE

Glinac Alma; Delalić Azra; Matović Lejla

2015-01-01

The aim of this study was to determine the effect of age, gender and socioeconomic status of family on the quality of life related to the health of children with cerebral palsy, according to the assessment of children themselves and one of the parents. Cross-sectional study included 76 children with cerebral palsy, with median age of 8.85, and 76 parents. The specific questionnaire, PedsQLTM Module cerebral palsy, Version 3.0, which includes age-adjusted questionnaire for children and a quest...

Pretend Play of Children with Cerebral Palsy

Science.gov (United States)

Pfeifer, Luzia Iara; Pacciulio, Amanda Mota; dos Santos, Camila Abrao; dos Santos, Jair Licio; Stagnitti, Karen Ellen

2011-01-01

Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the children's…

Efficacy of Mindfulness-Based Cognitive Therapy on Depressed Mothers with Cerebral Palsy Children

Directory of Open Access Journals (Sweden)

Zahra Sedaghati Barogh

2011-10-01

Full Text Available Objectives: Findings Demonstrated that Parent of Children With Cerebral Palsy Experience Elevated Level of Distress, Depression, Anxiety, Posttraumatic Stress Symptom and Subjective Symptom of Stress. Depression is a common condition that typically has a relapsing course. Effective interventions targeting relapse have the potential to dramatically reduce the point prevalence of the condition. Many of studies have shown that Mindfulness based cognitive therapy (MBCT is an intervention that has shown efficacy in reducing Depression syndrome and depressive relapse. In This Study, Effectiveness of Mindfulness–Based Cognitive Therapy (MBCT on Reduction of Depression in Mothers of Children with Cerebral Palsy was examined. Methods: Three Mothers Whose Children Had Cerebral Palsy Were Diagnosed to Have Depression Symptoms, Using Beck Depression Inventory II, Structured Clinical in This Experimental Signal–Case Study. After The Baseline was Determined, Subject Attended on Eight–Session Program of Mindfulness–Based Cognitive Therapy. Results: The Comparison of Baseline and Post–Test was Showed That Depression Symptom has decreased through MBC. Improvement Quotient for Depression of each Subject was good. Discussion: Data Showed that MBCT Reduced Depression Symptoms in Mothers of Children With Cerebral Palsy.

Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy

Directory of Open Access Journals (Sweden)

Walter Strobl

2015-05-01

Full Text Available Botulinum toxin A (BoNT-A is considered a safe and effective therapy for children with cerebral palsy (CP, especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.

[Influence of neonatal diseases and treatments on the development of cerebral palsy in preterm infant].

Science.gov (United States)

Yu, Tao; Rong, Luo; Wang, Qiu; You, Yi; Fu, Jun-Xian; Kang, Lin-Min; Wu, Yan-Qiao

2013-03-01

To investigated the risk factors of cerebral palsy development in preterm infants. This study included 203 preterm infants (gestation age neonatal period, were analyzed by multiple logistic regression analysis. Multivariate logistic analysis for the risk factors associated with cerebral palsy in neonatal period found significant differences in the occurrence of periventricular leukomalacia (PVL, OR = 39.87, P neonatal (OR = 2.18, P neonatal hyperbilirubinemia (OR = 1.72, P CPAP, OR = 0.21, P neonatal jaundice may increase the risk in the development of CP in preterm infant, while CPAP may decrease the risk of cerebral palsy.

Crossing boundaries : improving communication in cerebral palsy care

NARCIS (Netherlands)

Gulmans, J.; Gulmans, J.

2012-01-01

In the Netherlands, children with cerebral palsy are the largest diagnostic group treated in paediatric rehabilitation, requiring specialized health-, education- and social services of multiple professionals from diverse organizations. To provide ‘integrated care’ in these settings, effective care

Predictors for early diagnosis of cerebral palsy from national registry data

DEFF Research Database (Denmark)

Granild-Jensen, Jakob Bie; Rackauskaite, Gija; Flachs, Esben Meulengracht

2015-01-01

AIM: As early intervention is important in cerebral palsy (CP), an early diagnosis is desirable. The aim of this study was to establish the median diagnostic age of CP and to identify predictors of an early diagnosis in a population-based cohort. METHOD: Using the Danish National Cerebral Palsy...... of motor disability, cerebral ultrasonography results, epilepsy, gestational age, and degree of cognitive impairment. RESULTS: We found the overall median corrected diagnostic age of CP to be 11 months. Early diagnosis was associated with the type of CP, presence of epilepsy, a high degree of motor...... disability, and abnormalities in the cerebral ultrasonography. The gestational age was not associated with the diagnostic age. INTERPRETATION: The median diagnostic age implies that half of the Danish children with CP will be able to enter an early intervention program before 1 year of age. A late diagnosis...

Psychological problems in children with cerebral palsy: a cross-sectional European study.

Science.gov (United States)

Parkes, Jackie; White-Koning, Melanie; Dickinson, Heather O; Thyen, Ute; Arnaud, Catherine; Beckung, Eva; Fauconnier, Jerome; Marcelli, Marco; McManus, Vicki; Michelsen, Susan I; Parkinson, Kathryn; Colver, Allan

2008-04-01

To describe psychological symptoms in 8-12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. A cross-sectional multi-centre survey. Eight hundred and eighteen children with cerebral palsy, aged 8-12 years, identified from population-based registers of cerebral palsy in eight European regions and from multiple sources in one further region. The Strengths and Difficulties Questionnaire (SDQ)(P4-16) and the Total Difficulties Score (TDS) dichotomised into normal/borderline (TDS abnormal (TDS > 16). Multilevel, multivariable logistic regression to relate the presence of psychological symptoms to child and family characteristics. About a quarter of the children had TDS > 16 indicating significant psychological symptoms, most commonly in the domain Peer Problems. Better gross motor function, poorer intellect, more pain, having a disabled or ill sibling and living in a town were independently associated with TDS > 16. The risk of TDS > 16 was odds ratio (OR) = .2 (95% CI: .1 to .3) comparing children with the most and least severe functional limitations; OR = 3.2 (95%CI: 2.1 to 4.8) comparing children with IQ psychological problems, 95% said they had lasted over a year, 37% said they distressed their child and 42% said they burdened the family at least 'quite a lot'. A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.

Shared meanings of success, happiness, and health among adults with cerebral palsy and physiotherapists: implications for practice and research.

Science.gov (United States)

Gannotti, Mary E; Blanchard, Yvette; Blumberg, Lisa; LaRocco, Diana

2018-01-25

To describe shared meanings of success, happiness, and health of adults with cerebral palsy and physiotherapists. Ethnography employed open ended/semi-structured interviews and structured questionnaires (Satisfaction with Life Scale, Beck Depression Inventory-II ® , Oxford Happiness Questionnaire, Life Habits Questionnaire, Medical Outcomes Study-Social Support Survey, and PROMIS ® Pain Interference Scale). Content analysis of qualitative data and principal components analysis of questionnaire responses identified shared meanings. Fourteen adults with cerebral palsy and 15 physiotherapists (median age 46) had similar levels of education. For both groups, social achievements, personal goals, employment, and supporting a family defined success. Adults with cerebral palsy more frequently identified tenacity and persistence as important for success. Both groups described happiness as spending time with loved ones, recreational activities, and having purpose in life. Adults with cerebral palsy identified the importance of self-acceptance for happiness. For both, health included self-care of mind/spirit, cardiovascular and musculoskeletal wellness, and physical fitness (the ability to perform physical tasks). Analysis of questionnaire responses identified shared meanings (eigenvalue 41, 95% explained variance). Adults with cerebral palsy and physiotherapists share similar experiences, behaviors, and feelings about success, happiness, and health. This knowledge may improve communication, enhance evidence-based practice, and foster services to support wellbeing. Implications for rehabilitation Cerebral palsy is a life-long condition, but we know little about social and physical outcomes for adults with cerebral palsy. Lack of understanding about meanings of success, happiness, and health may be a barrier for consumers accessing and for providers delivering evidence-based services. Physiotherapists and adults with cerebral palsy share similar meanings (feelings

Comparison of digito-palmar dermatoglyphic traits in children with cerebral palsy and their close family members.

Science.gov (United States)

Polovina-Proloscić, Tajana; Milicić, Jasna; Cvjeticanin, Miljenko; Polovina, Andrea; Polovina, Svetislav

2009-09-01

Cerebral palsy is one of the main causes of severe disability in children. Sixty children (30 boys and 30 girls) were included in the study. Quantitative digito-palmar dermatoglyphic traits were analyzed. Prints of digito-palmar dermatoglyphs obtained from the children's parents (60 mothers and 60 fathers) and from 400 phenotypically healthy adults from the Zagreb ware used as control groups. Analysis of quantitative dermatoglyphic traits of the digito-palmar complex revealed statistically significant differences in a number of variables between the fathers and their children suffering from cerebral palsy (TRC 180.3 > 158.6), with a greater number of variables involved in male children with cerebral palsy. Some variables showed statistically significant differences in dermatoglyphic patterns between fathers and control group of healthy males as well as between boys with cerebral palsy and healthy control males. Differences in dermatoglyphic patterns were significantly lower between mothers and girls with cerebral palsy (TRC 152.1 mothers and healthy control females. Study results support the hypothesis on the possible role of genetic predisposition in the occurrence of central nervous system lesion, with a more pronounced paternal impact.

Correlations between risk factors and functional evolution in patients with spastic quadriplegia.

Science.gov (United States)

Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, L; Trăistaru, M R

2016-01-01

Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.

Incidence of epilepsy among patients with cerebral palsy (CP in Yayasan Pemeliharaan Anak Cacat (YPAC – Medan

Directory of Open Access Journals (Sweden)

Pertin Sianturi

2002-09-01

Full Text Available Epilepsy is a chronic condition due to cerebral function disorders. Epilepsy occurs as a common complication of many neurological disorders such as cerebral palsy (CP that can cause further brain damage if especially they are accompanied with prolonged seizure. The incidence of epilepsy among patients with CP varies, 25-35%. The high incidence of epilepsy among patients with CP suggests that these disorders has common or related origins. We carried out a retrospective study to determine the incidence of epilepsy among patients with CP registered July 1988 to June 1998 in YPAC Medan and to determine whether the incidence of epilepsy was different according to type of CP. Data was compiled from medical records, including name, sex, parity, mothers age, prenatal, perinatal, and postnatal history, and EEG resuts. Data were analysed using statistical computer program and its significance was evaluated by chi square test at p < 0.05. There were 67 cases with CP, 53 cases spastic CP, 13 cases mixed CP and one case dyskinetic CP. Of the 67 cases CP, 47.8% were male, 52.2% female with the mean age of 50.3 (SD 36.9 months. There were 25 (37.3% patients CP associated with epilepsy, 72% general seizures, 20% partial seizures, and 8% infantile spasm. The incidence of epilepsy was significantly different among patients with CP associated with the type of CP and gestational age, p < 0.05. We concluded that the incidence of epilepsy among patient with CP in YPAC Medan was 37.3% and showed significant difference in CP according to type and gestational age. (Med J Indones 2002; 11: 158-63 Keywords: epilepsy, cerebral palsy, obstetric history, gestational age

Gait Stability in Children with Cerebral Palsy

Science.gov (United States)

Bruijn, Sjoerd M.; Millard, Matthew; van Gestel, Leen; Meyns, Pieter; Jonkers, Ilse; Desloovere, Kaat

2013-01-01

Children with unilateral Cerebral Palsy (CP) have several gait impairments, amongst which impaired gait stability may be one. We tested whether a newly developed stability measure (the foot placement estimator, FPE) which does not require long data series, can be used to asses gait stability in typically developing (TD) children as well as…

Predictors of participation of adolescents with cerebral palsy

DEFF Research Database (Denmark)

Dang, Van Mô; Colver, Allan; Dickinson, Heather O

2014-01-01

We investigated whether childhood factors that are amenable to intervention (parenting stress, child psychological problems and pain) predicted participation in daily activities and social roles of adolescents with cerebral palsy (CP). We randomly selected 1174 children aged 8-12 years from eight...

How multi segmental patterns deviate in spastic diplegia from typical developed.

Science.gov (United States)

Zago, Matteo; Sforza, Chiarella; Bona, Alessia; Cimolin, Veronica; Costici, Pier Francesco; Condoluci, Claudia; Galli, Manuela

2017-10-01

The relationship between gait features and coordination in children with Cerebral Palsy is not sufficiently analyzed yet. Principal Component Analysis can help in understanding motion patterns decomposing movement into its fundamental components (Principal Movements). This study aims at quantitatively characterizing the functional connections between multi-joint gait patterns in Cerebral Palsy. 65 children with spastic diplegia aged 10.6 (SD 3.7) years participated in standardized gait analysis trials; 31 typically developing adolescents aged 13.6 (4.4) years were also tested. To determine if posture affects gait patterns, patients were split into Crouch and knee Hyperextension group according to knee flexion angle at standing. 3D coordinates of hips, knees, ankles, metatarsal joints, pelvis and shoulders were submitted to Principal Component Analysis. Four Principal Movements accounted for 99% of global variance; components 1-3 explained major sagittal patterns, components 4-5 referred to movements on frontal plane and component 6 to additional movement refinements. Dimensionality was higher in patients than in controls (p<0.01), and the Crouch group significantly differed from controls in the application of components 1 and 4-6 (p<0.05), while the knee Hyperextension group in components 1-2 and 5 (p<0.05). Compensatory strategies of children with Cerebral Palsy (interactions between main and secondary movement patterns), were objectively determined. Principal Movements can reduce the effort in interpreting gait reports, providing an immediate and quantitative picture of the connections between movement components. Copyright © 2017 Elsevier Ltd. All rights reserved.

A comparative study: use of a Brain-computer Interface (BCI) device by people with cerebral palsy in interaction with computers.

Science.gov (United States)

Heidrich, Regina O; Jensen, Emely; Rebelo, Francisco; Oliveira, Tiago

2015-01-01

This article presents a comparative study among people with cerebral palsy and healthy controls, of various ages, using a Brain-computer Interface (BCI) device. The research is qualitative in its approach. Researchers worked with Observational Case Studies. People with cerebral palsy and healthy controls were evaluated in Portugal and in Brazil. The study aimed to develop a study for product evaluation in order to perceive whether people with cerebral palsy could interact with the computer and compare whether their performance is similar to that of healthy controls when using the Brain-computer Interface. Ultimately, it was found that there are no significant differences between people with cerebral palsy in the two countries, as well as between populations without cerebral palsy (healthy controls).