Cerebral Palsy

Spontaneous fractures occur in seemingly normal bone with no apparent blunt-force trauma. Spontaneous fracture occurs primarily in two distinct groups of patients: the very active young and the elderly. Researchers and clinicians have used several terms interchangeably for spontaneous fracture, including pathologic fracture, fragility fracture, compression fracture, or fatigue or insufficiency fracture. Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure. Preliminary research observations indicate that spontaneous fracture may be a rare adverse outcome associated with bisphosphonates.

The relation between neuroradiological findings and upper limb function was examined in 53 children with hemiplegic cerebral palsy (CP). CT and MRI images of the children were classified into four groups (malformations, periventricular lesions, congenital cortical-subcortical lesions and postnatally acquired lesions). Additionally, each single affected neuroanatomical structure was noted. Clinical assessments included measures of activity (Melbourne Assessment of Unilateral Upper Limb Function and House Classification) and body functions (motor and sensory impairments). Comparative statistics and correlation analysis were used. Three children had a malformation, 28 a periventricular lesion, 14 a cortical-subcortical lesion and eight a postnatally acquired lesion. Children with periventricular lesions obtained the best motor functioning. Within this group, children with pure periventricular lesions performed significantly better compared to mixed lesions. The differences between congenital cortical-subcortical lesions and acquired lesions were not significant. Results further showed that middle cerebral artery infarctions and basal ganglia/thalamic lesions were significantly correlated to a worse performance. The type of lesion determined by the timing of the brain insult, and the location of the lesion distinguish children with hemiplegic CP regarding upper limb function. These insights are valuable for prognosis and may contribute to a better delineation of therapeutic interventions.

Children who have systemic diseases face a burden of disease distinctly greater than their healthy counterparts. Neglect or delay of addressing this burden can lead not only to significant morbidity for the child, but also to family dysfunction. This article addresses issues salient to the understanding of oral health burden in children and families living with systemic disease. Topics include the parent as caregiver, children who have cerebral palsy, juvenile arthritis, developmental delay, and organ diseases.

Individuals who have cerebral palsy (CP) face many physical challenges throughout their lifetimes in addition to societal barriers that can have an impact on quality of life. The ability to access appropriate dental care has long been an issue for people who have disabilities. Dentists should be integral members of teams of professionals involved in optimizing the health of individuals who have CP. As with all members of this interdisciplinary team, oral health care providers should have a thorough knowledge of the medical, cognitive, and rehabilitative issues associated with CP. With this knowledge the best possible health care can be provided.

Object The object of this study was to assess the detailed anatomical features and vascular relationships of the cisternal segment of the oculomotor nerve, and to assess the utility of MR imaging in oculomotor nerve palsy caused by abnormal compression related to arteries and tumors. Methods The anatomy of the oculomotor nerve was depicted using 3D Fourier transformation constructive interference in steady-state (CISS) MR imaging in 196 volunteers (392 total nerves), in 9 patients with paralysis of the oculomotor nerve, and in 1 preoperative patient with cholesteatoma in the pontine cistern. The vessels adjacent to the oculomotor nerve were detected and compared using 3D time-of-flight MR imaging. The 3D CISS multiplanar reconstruction (MPR) images of the oculomotor nerve in cadavers and in specimens from the cadavers were used to verify the oculomotor nerve shown in the 196 patients. The images were assessed with respect to the demonstration of the oculomotor nerve, the optimal display angles on MPR images, the visualized length of the nerve, neurovascular relationships, and abnormal compression caused by arteries and tumors. Results Three-dimensional CISS MR imaging depicted the cisternal segment of the oculomotor nerve with certainty in 100% of the patients in the transverse, sagittal, and coronal planes. Three-dimensional CISS imaging of the oculomotor nerve in 196 volunteers revealed similar results corresponding to 3D CISS MPR images of cadavers and cadaver specimens. The maximum visualized length of the oculomotor nerve was 14.61 +/- 2.33 mm. The angle between the oculomotor nerve and the median sagittal plane was 24.48 +/- 4.57 degrees on the left and 24.48 +/- 5.07 degrees on the right. The posterior cerebral artery was observed to contact the oculomotor nerve in 216 (55.1%) of 392 nerves, and the superior cerebellar artery was observed to contact the oculomotor nerve in 231 (58.9%) of 392 nerves. The abnormal nerve compression in 9 patients with paralysis of the oculomotor nerve was displayed well in all patients. The adjacent relationship of the oculomotor nerve in 1 preoperative patient with cholesteatoma in the pontine cistern was also demonstrated clearly. Conclusions Use of 3D CISS sequences and 3D time-of-flight sequences enables accurate identification of the cisternal segment of the oculomotor nerve, neurovascular relationships, and abnormal compression caused by arteries and tumors.

BACKGROUND AND PURPOSE:: Given the extensive literature on body weight-supported treadmill training (BWSTT) in adult rehabilitation, a systematic review was undertaken to explore the strength, quality, and conclusiveness of evidence supporting use of treadmill training and body weight support in those with pediatric motor disabilities. A secondary goal was to ascertain whether protocol guidelines for BWSTT are available to guide pediatric physical therapy practice. METHODS:: The database search included MEDLINE, EMBASE, CINAHL Plus, PEDro, Cochrane Library databases, and ERIC from January 1, 1980 to May 31, 2008 for articles that included treadmill training and body weight support for individuals under 21 years of age, with or at risk for a motor disability. We identified 277 unique articles from which 29 met all inclusion criteria. RESULTS:: Efficacy of treadmill training in accelerating walking development in Down syndrome has been well demonstrated. Evidence supporting efficacy or effectiveness of BWSTT in pediatric practice for improving gait impairments and level of activity and participation in those with cerebral palsy, spinal cord injury, and other central nervous system disorders remains insufficient, although many studies noted positive effects. DISCUSSION AND CONCLUSION:: The original evidence demonstrates efficacy of BWSTT in children with Down syndrome, but large-scale controlled trials are needed to support the use of BWSTT in other pediatric subgroups. Increased use of randomized designs, studies with treadmill training-only groups, and dosage studies are needed before practice guidelines can be formulated. Neural changes in response to training warrant exploration, especially given the capacity for change in developing nervous systems.

BACKGROUND: The purpose of this study was to elucidate relationships between quadriceps and hamstrings voluntary muscle fatigue and upper motor lesion impairments in cerebral palsy in order to gain a better understanding of their contribution to the observed fatigue resistance. METHODS: Seventeen ambulatory subjects with cerebral palsy (mean age: 17.0, SD=4.8 years) were recruited. Quantitative measures of strength, spasticity, cocontraction, and stiffness for both muscle groups were collected on an isokinetic dynamometer and entered in a factor analysis. The resulting factors were used as independent variables in a multiple regression analysis with quadriceps and hamstrings fatigue as dependent variables. FINDINGS: Five independent factors explained 90% of the variance. In order of loadings, higher hamstring cocontraction and spasticity and lower hamstring strength were associated with lower levels of hamstring fatigue. Higher quadriceps cocontraction and lower quadriceps strength were the most predictive of lower levels of quadriceps fatigue. INTERPRETATION: Greater motor impairments of the agonist muscle, particularly cocontraction, spasticity, and weakness, were associated with lower rates of muscle fatigue of the same muscle during performance of a voluntary fatigue protocol for the hamstrings and quadriceps. Muscles are highly adaptable; therefore, the results of this study suggest that the observed fatigue resistance may be due to the effect of the primary neural insult on motor unit recruitment and rate modulation or the result of secondary adaptations to spasticity, weakness, or excessive cocontraction.

Cerebral Palsy Causes

As skills sometimes affected by cerebral palsy are usually absent at birth, it is usually impossible to diagnose the disease before the child is missing key stages of development, such as the ability to crawl or grasp objects. However, observation of newborns can help detect those who are at particular risk of cerebral palsy.

Some risk factors: (more…)

Cerebral Palsy Causes

Although cerebral palsy syndrome is often congenital (present at birth), it is not hereditary. Rather, it is an error that occurs during development of the fetus or a problem during childbirth itself. Formerly, it was believed that the main cause was a lack of oxygen during birth, but today researchers think that it is true that in 10% of cases.

The fetus from a single cell, which divides repeatedly, ultimately producing billions of cells. At various stages, some of these cells specialize. We are witnessing the formation of various types of nerve cells that migrate to occupy their rightful place in the brain. This process is extremely complicated, and it is not surprising that, on occasion, some errors disrupt the formation of the brain. We are just beginning to understand normal brain development in the fetus, and we hope that this progress will allow us one day to discover the origin of various types of cerebral palsy. (more…)

Cerebral palsy is the name given to a group of neurological disorders present at birth or appearing during the first three years of life. These disorders have in common, namely that the brain lesions that are causing no worse over the years. They also cause all to some extent of damage to motor brain, disrupting the coordination and muscle strength.

In general, cerebral palsy affects a newborn on 500 and a newborn in 1 000, some of them are however only slightly disabled. It is the premature and newborn babies whose weight is insufficient are most at risk, the risk is 100 times higher in infants whose birth weight is less than 1.6 kilograms (3.5 pounds) that in babies whose weight is normal. In recent years, the number of new cases of cerebral palsy has actually increased slightly, mainly because of improved intensive care allows survival of more premature babies, but also because the salaries of the infertility resulting in an increase in multiple pregnancies during which the probability of giving birth to a baby with cerebral palsy is higher.