Cerebral Palsy

Upper extremity (UE) joint kinetics is a topic that is not thoroughly explored in the current literature. Biped UE joints are not anatomically designed to be weight bearing, therefore it is important to quantify the forces and moments applied to them during aided gait. This study has employed a custom dynamic model to examine the UE kinetics during walker use in children with cerebral palsy (CP). Five children with spastic diplegic CP using both anterior and posterior walkers are analyzed in this study. The flexion/extension moment at the shoulder (glenohumeral) joint are compared between walker types using a Wilcoxon signed rank test. No significant differences between anterior and posterior walker were found in the maximum, minimum, or range of the moments. Further research is needed to determine the effects of walking aids on UE dynamics.

Walkers are prescribed with the notion that one type of walker will be better for a child than another. One underlying justification for this practice is the theory that one walker may produce less stress on the upper extremities as the patient uses the walker. Nevertheless, upper extremity joint loading is not typically analyzed during walker assisted gait in children with spastic diplegic cerebral palsy. It has been difficult to evaluate the theory of walker prescription based on upper extremity stresses because loading on the upper extremities however has not been quantified until recently. In this study, weight bearing on the glenohumeral joints was analyzed in five children with spastic diplegic cerebral palsy using both anterior and posterior walkers fitted with 6-axis handle transducers. Though walkers’ effects on the upper extremities proved to be similar between walker types, the differences between the walkers may have some clinical significance in the long run. In general, posterior walker use created larger glenohumeral joint forces. Though these differences are not statistically significant, over time and with repetitive loading they may be clinically significant.

Background and purpose: The purpose of this study is to present the results of deep cerebellar stimulation in spasticity as a main symptom of cerebral palsy (CP). Material and methods: Thirteen patients suffering from CP were surgically treated with deep cerebellar stimulation of the superior cerebellar peduncle region between April 2003 and April 2007. Outcome was evaluated in 11 out of 13 patients (two patients had their stimulators removed due to infections). The study group comprised 7 women and 4 men (age range: 16-27). Muscle tone was assessed with the 5-point Ashworth scale. Psychomotor status was evaluated with the questionnaire form prepared specially for this study. Each patient was evaluated four times: before surgery, as well as 6, 12, and 24 months after surgery. Results: A great reduction of muscle tone was observed, mostly in the first six months. An improvement in psychomotor status during 2-year follow-up was also noted. One patient (9.1%) started walking, and speech improved in 7 cases (63.6%). Among patients with epileptic attacks, we found a decrease in frequency and intensity of attacks. Reduction of pain associated with muscle tone and improvement of mood were noted in all patients. Inflammatory complications occurred in 3 out of 13 cases (23.1%) and led to removal of the stimulating systems. In one case the stimulator was re-implanted successfully and the patient was evaluated in the active group. Two other patients (15.4%) were excluded from the active group due to inflammatory complications. Conclusions: Deep cerebellar stimulation in patients suffering from spasticity in CP is an effective way of treatment; it reduces signs of illness and permits effective rehabilitation, as well as significantly improving the quality of life of these patients. As a non-ablative and reversible procedure it seems to be a safe method of treatment. The most serious complication of the procedure is infection within the operation site.

It is often assumed that co-contraction of antagonist muscles is responsible for increased resistance to passive movement in hypertonic dystonia. Although co-contraction may certainly contribute to hypertonia in some patients, the role of reflex activation has never been investigated. We measured joint torque and surface electromyographic activity during passive flexion and extension movements of the elbow in 8 children with hypertonic arm dystonia due to dyskinetic cerebral palsy. In all cases, we found significant phasic electromyographic activity in the lengthening muscle, consistent with reflex activity. By correlating activation with position or velocity of the limb, we determined that some children exhibit position-dependent activation, some exhibit velocity-dependent activation, and some exhibit a mixed pattern of activation. We conclude that involuntary or reflex muscle activation in response to stretch may be a significant contributor to increased tone in hypertonic dystonia, and we conjecture that this activation may be more important than co-contraction for determining the resistance to passive movement. (c) 2009 Movement Disorder Society.

PURPOSE: The dual purpose of this study was to identify areas of need as perceived by parents of children with cerebral palsy in three domains and to evaluate internal reliability of the Family Needs Assessment Tool (FNAT). DESIGN AND METHODS: The FNAT was distributed to parents and includes a demographic survey and three subscales: service, information, and obstacles to care. RESULTS: Parents identified services as their greatest need, followed by information and then obstacles to care. PRACTICE IMPLICATIONS: The FNAT may be utilized to evaluate parental perceptions of needs, and provide clinicians with information for program planning and assessing needs central to providing quality care.

Since the 1970s, the prevalence of multiple births (MBs) in the United States has increased significantly. This has been attributed, in large part, to iatrogenic MBs resulting from infertility treatments that include ovulation stimulation. A past study has indicated that children from MBs have an increased prevalence of cerebral palsy (CP). Other studies also have suggested an association between MBs and intellectual disabilities (ID) and autism spectrum disorders (ASDs); however, results have been inconsistent. From the Autism and Developmental Disabilities Monitoring (ADDM) Network, a surveillance project among several US populations, we obtained MB estimates among children born in 1994 and classified by 8 years of age as having: an ASD (n=1,626 total children from 11 sites; 50 born as part of an MB); CP (n=302 total children from 3 sites; 25 born as part of an MB); or ID (n=1,195 total children from 3 sites; 45 born as part of an MB). All three MB estimates were notably higher than age-adjusted expected estimates of naturally conceived MBs derived from 1971 US natality data. However, when MB estimates from the ADDM Network were compared with expected MB estimates derived from 1994 natality data for the states corresponding to the relevant ADDM Network sites, we observed no association with ASDs (observed/expected=1.08 [0.78-1.38]), a moderate, but not statistically significant association with ID (observed/expected=1.34 [0.95-1.73]), and a strong association with CP (observed/expected=2.96 [1.80-4.12]). Further investigation of specific types of MBs (natural vs. iatrogenic) is warranted.

here is developmental refinement of the proprioreceptive muscle afferent input to the rat ventral horn. This study explored the extent to which this occurs in the medulla. Muscle afferents were transganglionically labelled from the extensor digitorum communis forelimb muscle with cholera toxin B sub unit. Tracer amounts and transport times were adjusted for animal size. Immunohistochemistry revealed tracer localisation in the medulla and dorsal root ganglia. Labelled muscle afferent boutons were counted in the cuneate nucleus between postnatal days 7and 42, during which time a large decrease in the density of labelled boutons was observed qualitatively. Localisation of input to dorsolateral parts of the nucleus remained broadly the same at different ages, although disappearance of a marked innervation of ventromedial regions in more caudal sections was observed. Bouton counts were corrected for growth of the medulla with age, and any spread of tracer to adjacent muscles indicated by counts of labelled dorsal root ganglion neurons. There was a statistically significant, approximately 40% reduction in the number of muscle afferent boutons in the cuneate nucleus during this developmental period. Previous studies suggest that perturbations to the corticospinal input during a developmental critical period influence the eventual size of the muscle afferent input to the ventral horn. Corticocuneate fibres invade the nucleus during the same period and may influence reorganisation of its muscle afferent input, making it another potential site for aberrant reflex development in cerebral palsy.

OBJECTIVE: To determine the prevalence of motor impairments and activity limitations and their inter-relationships in Dutch children with spastic cerebral palsy. PATIENTS AND METHODS: In a population-based survey 119 children, age range 6-19 years, with spastic cerebral palsy were examined. Anthropometry, muscle tone, abnormal posture, joint range of motion, major orthopaedic impairments and gross motor functioning and manual ability were assessed or classified, in addition to limitations in mobility and self-care activities. Spearman’s correlation coefficients, bivariate post hoc analyses and univariate and multivariate logistic regression analyses were used. RESULTS: Children with spastic cerebral palsy had a lower body height and weight compared with typically developing peers. Forty percent had no range of motion deficits. Hip dislocations were rarely encountered. Motor impairments were associated with gross motor functioning and manual ability levels. Close to sixty-five percent walked independently. Children with diplegia and tetraplegia differed in activity limitations. Motor impairments and limitations in mobility and self-care activities were only modestly related in multivariate analyses. CONCLUSION: Distribution of cerebral palsy-related characteristics is consistent with that found in representative studies of other countries. The distinction between diplegia and tetraplegia is relevant from an activity point of view. The child’s activity limitations are not a mirror of the motor impairments, which suggests multifactorial influences. An activity-oriented rehabilitation approach goes beyond treating specific impairments.

OBJECTIVE: To quantify the level of everyday physical activity in adults with bilateral spastic cerebral palsy, and to study associations with personal and cerebral palsy-related characteristics. Participants and methods: Fifty-six adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation (SD) 5.8) years, 62% male) participated in the study. Approximately 75% had high gross motor functioning. Level of everyday physical activity was measured with an accelerometry-based Activity Monitor and was characterized by: (i) duration of dynamic activities (composite measure, percentage of 24 h); (ii) intensity of activity (motility, in gravitational acceleration (g)); and (iii) number of periods of continuous dynamic activity. Outcomes in adults with cerebral palsy were compared with those for able-bodied age-mates. RESULTS: Duration of dynamic activities was 8.1 (SD 3.7) % (116 min per day), and intensity of activity was 0.020 (SD 0.007) g; both outcomes were significantly lower compared with able-bodied age-mates. Of adults with cerebral palsy, 39% had at least one period of continuous dynamic activities lasting longer than 10 min per day. Gross motor functioning was significantly associated with level of everyday physical activity (Rs -0.34 to -0.48; p </= 0.01). CONCLUSION: Adults with bilateral spastic cerebral palsy, especially those with low-level gross motor functioning, are at risk for an inactive lifestyle.

A 45-year-old female developed mild dysesthesia and swelling, followed by ptosisand trigeminal pain, in the right side of the face. Her past medical history was unremarkable, and she had not been aware of any infectious sign. A local otolaryngologist administered glucocorticoid therapy that resolved the face pain, but the ptosis persisted. Neurological examination found complete right oculomotor nerve paresis and mild sensory loss in the first and second segments of the right trigeminal nerve. Blood examination found no abnormalities. Neuroimaging revealed a saccular aneurysm at the branching site of the posterior communicating artery, projecting posteriorly and adjacent to the dorsum sellae, without other intracranial abnormalities. Cerebral angiography demonstrated poor opacification of the superior ophthalmic vein and cavernous sinus on the right side. The patient underwent coil embolization under a diagnosis of symptomatic aneurysm, but her oculomotor neuropathy was only partially improved. We thought that the impairment of the oculomotor function by inflammatory reaction in the cavernous sinus and mechanical compression by the aneurysm had already persisted for too long for post-treatment recovery. We think that the simultaneous occurrence of Tolosa-Hunt syndrome and oculomotor nerve palsy may have resulted because trigeminal neuralgia had increased the blood pressure to induce rapid growth of the preexisting aneurysm, or the inflammatory reaction in the cavernous sinus had promoted the growth of the aneurysm, or that the association was by chance.