Cerebral Palsy » Cerebral Palsy

The influence of the flexibility of the chair seat on pressure peak and distribution of the contact area in individuals with cerebral palsy during the execution of a task.

admin — Mon, 22 Nov 2010 08:50:21 +0000

This study aimed to determine the influence of flexibility of the chair seat surface on the pressure peak and on the contact area during the execution of a task of handling an object on the seated position by individuals with spastic cerebral palsy. Ten individuals of both genders with diagnosis of spastic cerebral palsy, who had some control to voluntarily move the body and the upper limbs, participated in this study. Quantification of data was carried out in two experimental situations: (1) execution of a task of fitting with upper limbs, and with the individual placed on an adapted canvas seat; (2) execution of a task of fitting with the participant positioned on an adapted wooden seat. Data obtained were submitted to a non-parametric and descriptive statistical analysis using the Wilcoxon test. Results indicated that the use of canvas seat increased the contact area and decreased the pressure peak and the medio-lateral displacement of centre pressure on the seated posture.

Intensive rehabilitation in children with cerebral palsy: our view on the neuronal group selection theory.

admin — Mon, 22 Nov 2010 08:50:19 +0000

Cerebral palsy (CP) is one of the major forms of developmental disorders. There are different approaches and controversies in rehabilitation treatment. The Neuronal Group Selection theory could provide theoretical explanation for Stojcevi? Polovina rehabilitation method. The aim of the study was to evaluate long-term impact of intensive and continuously performed rehabilitation on the motor autonomy level children with CR Motor autonomy levels, defined according to the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM), were analyzed in 24 children with CP at the beginning of the study and at the last visit. During rehabilitation, GMFM scores increased above the expected value of initial GMFCS level in the majority of patients. Intensive rehabilitation had significant influence on motor improvement in children with CP.

Infantile scurvy: two case reports.

admin — Mon, 22 Nov 2010 08:50:17 +0000

Background. Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. SCURVY, a disease of dietary ascorbic acid deficiency, is uncommon today. It still exists in high risk groups including economically disadvantaged populations with poor nutrition. The incidence of SCURVY in the pediatric population is very low. Cases Report. Here we report two cases of SCURVY revealed by subperiosteal hematoma in children with cerebral palsy and developmental delay. Conclusion. SCURVY is extremely rare in children. Musculoskeletal manifestations are prominent in pediatric SCURVY. Multiple subperiosteal hematomas are an important indicator for diagnosis.

Evaluating the Effect of Intensive Intervention in Children with Cerebral Palsy Using a Hypothetical Matched Control Group: A Preliminary Study.

admin — Mon, 22 Nov 2010 08:50:15 +0000

Yabunaka Y, Kondo I, Sonoda S, Saitoh E, Tsuruta Y, Konaka M, Konaka T, Kawarada S: Evaluating the effect of intensive intervention in children with cerebral palsy using a hypothetical matched control group: A preliminary study.

OBJECTIVE: To evaluate the effect of intensive intervention in children with cerebral palsy using a hypothetical matched control group based on motor growth curves.

DESIGN: For pretest-posttest design using a hypothetical control group, a convenient sample of 39 children with cerebral palsy who received intensive intervention without surgical treatment was assigned to the experimental group. The hypothetical matched control group was created based on motor growth curves. Gains in Gross Motor Function Measure-66 score after intensive treatment in the experimental group were compared with those in the hypothetical matched control group using a mixed design for repeated-measures two-way analysis of variance.

RESULTS: Gross motor function development in the experimental group was significantly accelerated compared with the hypothetical matched control group.

CONCLUSIONS: In this preliminary study, using a hypothetical control group, the effectiveness of intensive intervention in children with cerebral palsy has been demonstrated. Although it is desirable to have a baseline phase to make sure whether gross motor function in the hypothetical control group changes in a similar way to that in the experimental group before an intervention phase, the hypothetical control group design is well worth considering as a research design option in the field of cerebral palsy research.

Adaptor protein complex-4 (AP-4) deficiency causes a novel autosomal recessive cerebral palsy syndrome with microcephaly and intellectual disability.

admin — Mon, 22 Nov 2010 08:50:13 +0000

Background Cerebral palsy is a heterogeneous group of neurodevelopmental brain disorders resulting in motor and posture impairments often associated with cognitive, sensorial, and behavioural disturbances. Hypoxic-ischaemic injury, long considered the most frequent causative factor, accounts for fewer than 10% of cases, whereas a growing body of evidence suggests that diverse genetic abnormalities likely play a major role. Methods and results This report describes an autosomal recessive form of spastic tetraplegic cerebral palsy with profound intellectual disability, microcephaly, epilepsy and white matter loss in a consanguineous family resulting from a homozygous deletion involving AP4E1, one of the four subunits of the adaptor protein complex-4 (AP-4), identified by chromosomal microarray analysis. Conclusion These findings, along with previous reports of human and mouse mutations in other members of the complex, indicate that disruption of any one of the four subunits of AP-4 causes dysfunction of the entire complex, leading to a distinct ‘AP-4 deficiency syndrome’.

A regressed phase analysis for coupled joint systems.

admin — Mon, 22 Nov 2010 08:50:10 +0000

This study aims to address shortcomings of the relative phase analysis, a widely used method for assessment of coupling among joints of the lower limb. Goniometric data from 15 individuals with spastic diplegic cerebral palsy were recorded from the hip and knee joints during ambulation on a flat surface, and from a single healthy individual with no known motor impairment, over at least 10 gait cycles. The minimum relative phase (MRP) revealed substantial disparity in the timing and severity of the instance of maximum coupling, depending on which reference frame was selected: MRP(knee-hip) differed from MRP(hip-knee) by 16.1±14% of gait cycle and 50.6±77% difference in scale. Additionally, several relative phase portraits contained discontinuities which may contribute to error in phase feature extraction. These vagaries can be attributed to the predication of relative phase analysis on a transformation into the velocity-position phase plane, and the extraction of phase angle by the discontinuous arctangent operator. Here, an alternative phase analysis is proposed, wherein kinematic data is transformed into a profile of joint coupling across the entire gait cycle. By comparing joint velocities directly via a standard linear regression in the velocity-velocity phase plane, this regressed phase analysis provides several key advantages over relative phase analysis including continuity, commutativity between reference frames, and generalizability to many-joint systems.

Arm posture score and arm movement during walking: A comprehensive assessment in spastic hemiplegic cerebral palsy.

admin — Mon, 22 Nov 2010 08:50:08 +0000

Patients with hemiplegic cerebral palsy often have noticeably deviant arm posture and decreased arm movement. Here we develop a comprehensive assessment method for the upper extremity during walking. Arm posture score (APS), deviation of shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension and wrist flexion/extension were calculated from three-dimensional gait analysis. The APS is the root mean square deviation from normal, similar to Baker's Gait Profile Score (GPS) [1]. The total range of motion (ROM) was defined as the difference between the maximum and minimum position in the gait cycle for each variable. The arm symmetry, arm posture index (API) was calculated by dividing the APS on the hemiplegic side by that on the non-involved side, and the range of motion index (ROMI) by dividing the ROM on the hemiplegic side by that on the non-involved side. Using the APS, two groups were defined. Group 1 had minor deviations, with an APS under 9.0 and a mean of 6.0 (95% CI 5.0-7.0). Group 2 had more pronounced deviations, with an APS over 9.0 and a mean of 13.1 (CI 10.8-15.5) (p=0.000). Total ROM was 60.6 in group 1 and 46.2 in group 2 (p=0.031). API was 0.89 in group 1 and 1.70 in group 2 (p<0.001). ROMI was 1.15 in group 1 and 0.69 in group 2 (p=0.003). APS describes the amount of deviation, ROM provides additional information on movement pattern and the indices the symmetry. These comprehensive objective and dynamic measurements of upper extremity abnormality can be useful in following natural progression, evaluating treatment and making prognoses in several categories of patients.

Measuring tendon velocities using vector tissue Doppler imaging.

admin — Mon, 22 Nov 2010 08:50:07 +0000

We have developed a vector tissue Doppler imaging (vTDI) method to quantify the magnitude and direction of tissue motion. The goal of this study was to quantify the repeatability of vTDI in measuring the contraction velocity of the tibialis anterior (TA) tendon in patients with cerebral palsy and foot drop (impaired dorsiflexion). vTDI was implemented on Ultrasonix Sonix Touch ultrasound system with a 5-14-MHz linear array transducer. The array was electronically split into two transmit and two receive apertures to estimate velocity vectors. Transmit and receive beams were steered by ±15 deg. We conducted 42 trials on 7 subjects. Our preliminary results show that TA tendon velocities measured using vTDI have a strong linear correlation with the joint angular velocity estimated using a conventional 3-D motion capture system. We observed a peak velocity of 5.20±1.58 cm?s during dorsiflexion and 8.45±2.06 cm?s during the gravity-aided passive relaxation phase. The R(2) values for all 42 trials were 0.77±0.10. A second velocity measurement was made on three subjects after an interval of 4 weeks. We obtained repeatable velocity estimates with the standard deviation of the radius of action less than 0.13 cm. This demonstrates that vTDI is a feasible and reproducible method for measuring tendon velocities.

A Comparison of Interventions for Children With Cerebral Palsy to Improve Sitting Postural Control: A Clinical Trial.

admin — Mon, 22 Nov 2010 08:50:05 +0000

Background The ability to sit independently is fundamental for function but delayed in infants with cerebral palsy (CP). Studies of interventions directed specifically toward sitting in infants with CP have not been reported. Objective The purpose of this study was to compare 2 interventions for improving sitting postural control in infants with CP. Design For this randomized longitudinal study, infants under 2 years of age and at risk for CP were recruited for intervention directed toward sitting independence. Setting The intervention was conducted at home or at an outpatient facility. Patients and Intervention Fifteen infants with typical development (mean age at entry=5 months, SD=0.5) were followed longitudinally as a comparison for postural variables. Thirty-five infants with delays in achieving sitting were recruited. Infants with delays were randomly assigned to receive a home program (1 time per week for 8 weeks; mean age=15.5 months, SD=7) or a perceptual-motor intervention (2 times per week for 8 weeks; mean age=14.3 months, SD=3). Measurements The primary outcome measure was center-of-pressure (COP) data, from which linear and nonlinear variables were extracted. The Gross Motor Function Measure (GMFM) sitting subsection was the clinical outcome measure. RESULTS: /b> There was a main effect of time for the GMFM sitting subscale and for 2 of the COP variables. Interaction of group × time factors indicated significant differences between intervention groups on 2 COP measures, in favor of the group with perceptual-motor intervention. Limitations The small number of infants limits the ability to generalize the findings. CONCLUSIONS:/b> Although both groups made progress on the GMFM, the COP measures indicated an advantage for the group with perceptual-motor intervention. The COP measures appear sensitive for assessment of infant posture control and quantifying intervention response.

Determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy.

admin — Mon, 22 Nov 2010 08:50:01 +0000

Aim? To test a model of child, family, and service determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy (CP). Method? Participants were 288 children with CP, age range 6 to 12?years (mean 9y 8mo, SD 2y), and their parents from seven children’s hospitals. The sample comprised 166 (57.6%) males and 122 (42.4%) females, and between 40 (13.9%) and 74 (25.7%) children in each of the five levels of the Gross Motor Function Classification System. Children completed the Children’s Assessment of Participation and Enjoyment by interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, and two questionnaires. Structural equation modeling was used to test the model. Results? Fit statistics indicated a good model fit. The model explains 32% of the variance in intensity of participation. Path coefficients (p?0.05) indicate that higher gross motor function, higher enjoyment, more effective adaptive behavior, younger age, and higher family activity orientation are associated with higher intensity of participation. The path between services and participation was not significant. Interpretation? Intensity of participation of children with CP is influenced by multiple child and family determinants. Children’s gross motor function and behavior in life situations are important for participation; knowledge of activities the child and family enjoy has implications for opportunities for participation. Professionals are encouraged to address priorities for leisure and recreation identified by children with CP and their families.