Cerebral Palsy

This study was undertaken to determine the effect of distal hamstring lengthening (DHL) on hip and knee sagittal kinematics, and to investigate the validity of modeled hamstring length for clinical use. Patient group consisted of 28 patients (56 limbs, mean age 7.4 years) with spastic diplegia who underwent bilateral DHL and tendo-Achilles lengthening with/without rectus femoris transfer (RFT) (DHL+RFT subgroup, 40 limbs; DHL subgroup, 16 limbs). Kinematic data was obtained by gait analysis, and hamstring lengths were obtained using a musculoskeletal modeling technique. Postoperatively, knee extension improved (p<0.001) without aggravating anterior pelvic tilt (p=0.565). However, DHL aggravated anterior pelvic tilt in the DHL subgroup (2.2 degrees , p=0.011). In terms of concurrent validity, hamstring length was found to be correlated with mean pelvic tilt (r=0.798, p<0.001) and popliteal angle (r=-0.425, p=0.001), but the correlation between hamstring length and knee flexion at initial contact was minimal (r=0.068, p=0.753). In terms of construct validity, DHL did not lengthen mean hamstring length (p=0.918). In conclusion, DHL appeared to significantly improve knee motion in patients with spastic diplegia. Furthermore, DHL did not increase pelvic tilt, when performed with RFT. Modeled hamstring length is believed to have limited validity in patients with cerebral palsy, because it does not reflect knee kinematics or postoperative change when DHL was combined with multilevel surgery.

BACKGROUND: Paediatric neurological disorders constitute a major cause of disability in childhood. Children in the developing countries are disproportionately affected and in addition face the added burden of poverty, inadequate health facilities, stigmatisation and lack of facilities for rehabilitative care. OBJECTIVE: To describe the spectrum of neurological disorders seen among Nigerian children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria. METHODS: All children presenting at the paediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 20 months were prospectively studied. Diagnoses were made from detailed history, thorough physical examination, with particular emphasis on the central nervous system and appropriate investigations as indicated. RESULTS: There were a total of 644 cases during the study period, 369 males and 275 females, giving a male to female ratio of 1.3:1. There were 1353 consultations at the paediatric neurology clinic and these accounted for 21.0% of the total 6,442 consultations at the paediatric specialist clinics in the hospital. The most frequent paediatric neurological disorders were epilepsy (45.3%), cerebral palsy (36.0%), neuro-muscular disorders (4.5%) and mental retardation (4.5%). CONCLUSION: Paediatric neurological disorders constitute a major reason for paediatric specialist care in Ibadan, Nigeria. Preventable causes play a major role in the aetiology of the major paediatric neurological disorders seen in this part of the world.

The aims of this study were to: (1) investigate the significance of muscle activation variability and coactivation for the ability to perform steady submaximal ankle torque (torque steadiness) in healthy children and those with cerebral palsy (CP), and (2) assess ankle function during isometric contractions in those children. Fourteen children with CP who walked with equinus foot deformity and 14 healthy (control) children performed maximal and steady submaximal ankle dorsi- and plantarflexions. Dorsiflexion torque steadiness was related to agonist and antagonist muscle activation variability as well as the plantarflexor coactivation level in children with CP (r > 0.624, P < 0.03). Moreover, children with CP displayed reduced maximal torque and submaximal torque steadiness of both dorsi- and plantarflexion compared with controls (P < 0.05). Both muscle groups may benefit from strength training, as they exhibit poor submaximal control and weakness in children with CP. Muscle Nerve, 2009.

BACKGROUND: Changes in the swallowing capabilities of adults with cerebral palsy as they age may impact on their health, safety, and well-being. METHOD: Thirty-two adults with cerebral palsy aged between 30 and 69 years participated in in-depth interviews about their experiences of changes in their swallowing and related management of their mealtimes within the last two years. A constant comparative qualitative analysis of the interviews elucidated the changes they experienced. RESULTS: Changes included increased coughing and choking, digestive or gastro-oesophageal symptoms, diet modification, loss of independence with psychosocial consequences. Participants reported unsatisfactory collaboration with service providers over mealtime management decisions and interventions. CONCLUSIONS: Adults with cerebral palsy may experience gradual changes in their swallowing and mealtime capabilities from as early as 30 years of age. Regular collaborative assessment and involvement of all stakeholders in decisions are important to facilitate compliance with recommendations, ongoing safety, and optimal well-being.

AIM: There were two aims to the study: (1) to provide local outcome data that would be useful in counselling prospective parents of triplets; and (2) to address the deficit in accurate contemporary data on neurodevelopmental outcome and neonatal morbidity for those infants weighing less than 1500 g at birth. METHODS: We reviewed the outcome of triplet pregnancies born at National Women’s Hospital / Auckland City Hospital (Auckland, New Zealand) for 1995-2005 inclusive. For this study triplet pregnancy was defined as a pregnancy beyond 20 weeks leading to registration of at least one birth. RESULTS: For the study period, 55 triplet pregnancies were identified. Forty-five percent of the pregnancies were reported as spontaneously conceived and 60% had no major complications other than premature delivery. One pregnancy spontaneously aborted; three fetuses from one pregnancy were stillborn, and four infants died in delivery suite. The median gestational age at birth was 32 (23-37) weeks and birth weight 1620 (530-2780) g. The median (range) Apgar score, for liveborns, was 8 (2-10) and 10 (4-10) for 1 and 5 minutes respectively. There were five neonatal deaths. Fifty-three infants, <1500g at birth, underwent formal developmental assessment. Three had cerebral palsy (2 hemiplegia and 1 spastic diplegia); one had marked motor delay and one hearing impairment requiring aids. The median Bayley II MDI was 95 (71-105) and PDI 94 (65-110). Outcomes were categorised in surviving triplets <1500 g as normal in 66%, mild abnormality in 17%, moderate abnormality in 15% and severely abnormal in only 2%. CONCLUSION: Although triplets represent a significant burden on the regional NICUs the outcome, including those <1500 g at birth, compares favourably with that reported.

This review provides an overview of results found in literature on objective measurements of upper limb movements in children with hemiplegic cerebral palsy (HCP). Seventeen articles were selected following a systematic search. Analysed tasks varied from simple reaching and gross motor functions to complex, fine motor tasks. Spatiotemporal characteristics have been extensively studied and longer movement durations, slower movement speed and reduced trajectory straightness at the affected upper limb, compared to the non-affected side or healthy children, were most frequently reported. Joint kinematics has been far less studied. The limited data confirm the clinical impression of children with HCP using less elbow extension and supination to reach for an object, which is compensated by increased trunk flexion. Increased trunk involvement was also reported during gross motor functions. Although three-dimensional (3D) movement analysis seems promising to provide additional insights in the pathological upper limb movements observed in HCP, future standardisation of the entire protocol is crucial. No consensus exists on the procedures for data collection, processing, analysing and reporting of results, or what upper limb tasks should be assessed. The International Society of Biomechanics recently proposed recommendations on the definition of upper limb joint coordinate systems and rotation sequences. These guidelines were not yet applied in these studies. Although the diverse methodological approaches used in the studies complicate the comparison of published results, some general conclusions could be drawn. A further standardisation of the protocol for 3D upper limb movement analysis will provide the foundation for comparable and repeatable results and eventually facilitate the selection and planning of treatment interventions.

AIM: To study the correlations between neurological signs and developmental performance, and to analyze the value of neurological signs in identification of developmental disabilities. METHODS: A group of 26 preterm infants (gestational age from 23 weeks to 36 weeks) was studied. The neurological assessment described by Amiel-Tison and Gosselin was performed at term age and repeated every 3 months up to the age of 2, when the sum of all adverse findings was categorized. According to the nature and associations of neurological and cranial signs, patients were divided into 5 categories: 1) cerebral palsy; 2) minimal cerebral palsy; 3) Amiel-Tison triad; 4) intermediate; and 5) normal. Developmental assessment using the Bayley Scales of Infant Development, second edition, was performed between the age of 2 and 3, and the Mental and Psychomotor Developmental Index was determined. RESULTS: The developmental performance was highest in the group of children without neurological signs and lowest in the group with cerebral palsy. There was a strong correlation between neurological signs and mental developmental performance (Spearman rho=0.71), while the correlation between neurological signs and psychomotor developmental performance was weaker (Spearman rho=0.54). CONCLUSION: Categorization of neurological assessment and identification of 3 minor neurological signs may be a valuable tool for early detection of children with developmental disabilities.

OBJECTIVE: The aim of this study was to investigate the effect of different ergonomic desk designs and pencil grip patterns on handwriting performance in children with hemiplegic cerebral palsy and healthy children. METHODS: Twenty-six children with left hemiplegic cerebral palsy and 32 typically developing children were included. The Minnesota Handwriting Assessment was used to evaluate handwriting abilities. Pencil grip posture was assessed with a 5-point rating system. Specifically designed adjustable desks and chairs were used. Four different desk types were used in this study: 1) regular desk; 2) regular desk with a 20 degrees inclination; 3) cutout desk; and 4) cutout desk with a 20 degrees inclination. RESULTS: Statistically significant differences were found between both groups in terms of handwriting ability (p < 0.001). There was no significant difference regarding grip scores between children with cerebral palsy and healthy children (p > 0.05). We found that children with cerebral palsy had better performance using cutout desks in relation to rate and spacing parameters of handwriting (p < 0.05). CONCLUSION: The results of our study demonstrated that the pencil grip patterns have no effect on the handwriting parameters in both children with cerebral palsy and healthy children. It is recommended that a cutout table be used to provide more upper extremity support in handwriting activities for students with cerebral palsy.

The functional state of agonists and antagonists involving in providing of supporting function of feet and walking in adolescences, aged 13-15 years, with cerebral palsy has been studied using electromyography and polymyography. The electromyographical examination showed infringements of reciprocal innervation and potentials of fasciculation on the curves received from resting muscles of symmetric extremities. Polymyographic curves revealed the elongation of latent time of muscle tension and full period of relaxation against a background of expressed amplitude decay of the dynamometer card. Results obtained are thought to facilitate the more effective implementation of different rehabilitative measures in the late residual disease stage.

Background: Illness severity measures predict death and illnesses in the newborn. It is unknown how well they predict brain lesions evident on ultrasound scans or neurodevelopmental dysfunctions in preterm infants. Methods: A total of 1,399 inborn infants born before the 28th week of gestation were given Scores for Neonatal Acute Physiology (SNAP-II and SNAPPE-II) based on data collected within the first 12 h of admission to the intensive care unit and had a protocol brain ultrasound scan read independently by 2 sonologists. Of the surviving 1,149 infants, 1,014 (88%) had a neurologic examination at approximately 24 months post-term equivalent, and 975 (85%) had a Bayley Scales of Infant Development assessment. SNAP-II and SNAPPE-II were dichotomized at arbitrary cut-offs (30 for SNAP-II and 45 for SNAPPE-II), using the highest quartile and decile of the week of gestation as a cut-off, and at a Z score of >1 standard deviation from an external mean. Results: After adjustment for gestational age, high SNAP-II and SNAPPE-II scores predicted intraventricular hemorrhage, moderate/severe ventriculomegaly and echodense lesions in cerebral white matter. Only 2 SNAP-II extremes, the highest decile for gestational age and a Z score >1, also predicted echolucent lesions in the white matter. Neither SNAP-II nor SNAPPE-II predicted any statistically significant diagnosis of cerebral palsy. MDI and PDI scores <55 were consistently predicted by both high SNAP-II and SNAPPE-II, whereas scores in the 55-69 range were inconsistently predicted. High SNAP-II and SNAPPE-II inconsistently predicted a positive screen for autism spectrum disorder and small head circumference at 24 months. Conclusion: The physiologic instability in the first 12 post-natal hours identified by illness severity scores conveys information about the risks of brain damage and neurodevelopmental dysfunctions. This risk information might reflect postnatal characteristics in the causal chain. On the other hand, high SNAP scores might be indicators of immaturity and vulnerability. Copyright © 2009 S. Karger AG, Basel.