Cerebral Palsy

Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the 'activity limitation' perspective of International Classification of Functioning, Disability, and Health (ICF) and to investigate the relationship between the two classification systems in different subtypes of cerebral palsy (CP). This prospective cross-sectional study was performed on 448 children with CP ranging from 4 to 15 years of age. Activity limitations were studied with the GMFCS for gross motor function and MACS for manual ability. The Spearman's correlation coefficient, contingency coefficient, and Cramer's V coefficient were used to assess the strength and significance of the association between GMFCS and MACS. The overall agreement between GMFCS and MACS was found to be 41%. The agreement was 42% in spastic children, 40% in dyskinetic children, 50% in ataxic children, and 28% in mixed type children. The overall kappa value was kappa=0.235 (P<0.001). The kappa coefficient was 0.252 in spastic children, 0.245 in dyskinetic children, 0.318 in ataxic children, and 0.023 in mixed type children. All the kappa coefficients except the value for the mixed type were found to be significant. The usage of two different classification systems, GMFCS and MACS, to describe the capacity and performance in children with CP as defined by the ICF provides an easy and quick classification tool for indicating 'activity limitations' of ICF in children with CP. The next step in research should be to highlight the other domains such as participation restrictions in these children.Ziel dieser Studie war die Evaluierung der Leistung und Leistungsfähigkeit laut Definition des GMFCS (System zur Messung und Klassifikation motorischer Funktionen) und des MACS (System der Klassifikation der manuellen Fähigkeiten) aus der Perspektive der 'Einschränkungen der Aktivitäten' der internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) sowie die Untersuchung der Beziehung zwischen beiden Klassifikationssystemen in unterschiedlichen Subtypen der Zerebralparese (CP). An dieser prospektiven Querschnittsstudie nahmen insgesamt 448 Kinder mit CP im Alter von 4 bis 15 Jahren teil. Einschränkungen der Aktivität wurden anhand der Systeme GMFCS für körpermotorische Fähigkeiten und MACS für manuelle Fähigkeiten untersucht. Der Korrelationskoeffizient nach Spearman, der Kontingenzkoeffizient und der Cramer-V-Koeffizient wurden zur Beurteilung der Intensität und Bedeutung der Verbindung zwischen GMFCS und MACS herangezogen. Insgesamt stimmten die Systeme GMFCS und MACS zu 41% überein. Die Ubereinstimmung lag bei Kindern mit spastischer CP bei 42%, bei Kindern mit dyskinetischer CP bei 40%, bei Kindern mit ataktischer CP bei 50% und bei Kindern mit einer Mischform der CP bei 28%. Der Gesamtwert kappa lag bei kappa=0.235 (P<0.001). Der kappa-Koeffizient lag bei Kindern mit spastischer CP bei 0.252, bei Kindern mit dyskinetischer CP bei 0.245, bei Kindern mit ataktischer CP bei 0.318 und bei Kindern mit einer Mischform der CP bei 0.023. Alle kappa-Koeffizienten mit Ausnahme des Wertes für die Mischform der Zerebralparese erwiesen sich als signifikant. Die Verwendung von zwei unterschiedlichen Klassifikationssystemen – GMFCS und MACS – zur Beschreibung der Leistungsfähigkeit und Leistung von Kindern mit CP laut ICF-Definition ist ein Klassifikationstool, mit dem sich Einschränkungen der Aktivitäten" bei Kindern mit CP leicht und schnell aufzeigen lassen. Als nächstes sollte die Forschung andere Domänen wie beispielsweise die Einschränkungen bei der Partizipation (Teilhabe) dieser Kinder am Leben in der Gesellschaft hervorheben.Nuestro propósito en este estudio fue evaluar el rendimiento y la capacidad, según el Sistema de Clasificación de la Función Motora Global (SCFMG) y el Sistema de Clasificación de la Destreza Manual (SCDM), en lo relativo al dominio limitaciones para la ejecución de actividades de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), e investigar la relación entre dichos dos sistemas de clasificación en los distintos subtipos de la parálisis cerebral infantil (PCI). En este estudio transversal prospectivo participaron 448 niños de entre 4 y 15 años de edad con PCI. Para la exploración de las limitaciones para la realización de actividades se utilizaron el SCFMG, en el caso de la función motora global, y el SCDM, en el caso de la destreza manual. Para determinar la magnitud y significación de la asociación entre el SCFMG y el SCDM se utilizaron el coeficiente de correlación de Spearman, el coeficiente de contingencia y el coeficiente V de Cramer. La concordancia general entre los resultados del SCFMG y del SCDM fue del 41%. La concordancia fue del 42% en los niños que padecen espasticidad, del 40% en los niños con discinesias, del 50% en niños con ataxia, y del 28% en niños con cierta combinación de dichas afecciones. El valor general del coeficiente kappa fue de kappa=0.235 (P<0.001). Este coeficiente fue de 0.252 en los niños que padecen espasticidad, de 0.245 en los niños con discinesias, de 0.318 en niños con ataxia, y de 0.023 en niños con cierta combinación de dichas afecciones. Los valores del coeficiente kappa, excepto en el caso de los niños con el tipo mixto de la enfermedad, resultaron significativos. El uso de dos sistemas distintos de clasificación, el SCFMG y el SCDM, para determinar el grado de capacidad y de rendimiento, según se definen en la CIF, en niños con PCI constituye una herramienta de clasificación de uso fácil y rápido para determinar el grado de limitaciones para la ejecución de actividades, según la CIF, en niños con PCI. El siguiente paso en la investigación de estos niños sería explorar los otros dominios de esta clasificación, tales como las restricciones de estos niños para participar en actividades cotidianas.Notre objectif dans cette étude était d'évaluer la performance et la capacité telle qu'elles sont définies par le système de classification GMFCS des fonctions motrices (Gross Motor FunctionClassification System) et le système de classification MACS des capacités manuelles (Manual Ability Classification System) du point de vue de la limitation de l'activité selon la classification internationale ICF des fonctions motrices, du handicap et de la santé, et d'étudier la relation entre les deux systèmes de classification dans les différents sous-types d'infirmité motrice cérébrale. Cette étude prospective transversale a été réalisée sur 448 enfants âgés de 4 à 15 ans souffrant d'infirmité motrice cérébrale. Les limitations de l'activité ont été étudiées avec la classification GMFCS pour la fonction motrice globale et la classification MACS pour l'habileté manuelle. Le coefficient de corrélation de Spearman, le coefficient de contingence et le coefficient V de Cramer ont été utilisés pour évaluer la portée et la signification des associations entre GMFCS et MACS. Le taux de corrélation global entre GMFCS et MACS a été mesuré à 41%. La corrélation était de 42% chez les enfants handicapés moteur, 40% chez les enfants dyskinétiques, 50% chez les enfants ataxiques et 28% chez les enfants de type mixte. La valeur kappa globale était kappa=0.235 (P<0.001). Le coefficient kappa était de 0.252 chez les enfants handicapés moteur, 0.245 chez les enfants dyskinétiques, 0.318 chez les enfants ataxiques et 0.023 chez les enfants de type mixte. Tous les coefficients kappa, à l'exception de la valeur correspondant au type mixte, ont été jugés significatifs. L'utilisation de deux systèmes de classification différents, GMFCS et MACS, pour décrire la capacité et la performance chez les enfants atteints d'infirmité motrice cérébrale telle que définie par l'ICF fournit un outil de classification simple et rapide pour indiquer les limitations de l'activité de l'ICF chez les enfants souffrant d'infirmité motrice cérébrale. L'étape de recherche suivante sera de mettre en évidence les autres domaines, tels que les restrictions à la participation, chez ces enfants.

In departments of neurology, neurosurgery and hospice care there is a group of patients with compete motor function impairment having normal central nervous system function. Victims of spinal cord injury, cerebral palsy, cerebral stroke, loss of extremities, neuromuscular diseases, between others belong to them. Since two decades an intensive studies of use of brain waves to steer peripheral equipments has been performed. Brain Computer Interface and Brain-Machine Interface will allow in the near future for even partial restore of skills in permanently disabled patients. Recently new sets composed of games steered by brain waves have been introduced to the market. Exercises with such equipment will help to control an ability to concentrate and precise steer of the peripheral electronic equipments. The next phase will be use of the new skills to steer the wheelchairs and other computer programs with the brain signals to control own healthy organs or artificial machines.

Purpose: The purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot. Materials and Methods: Children in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments were performed before the intervention and 1 month after the intervention. Results: After the intervention, there were significant improvements in tone, dynamic spasticity, and passive range of motion (ROM) in both groups. However, the changes were greater in group A than in group B. Dimension D (standing) in Gross Motor Function Measure (GMFM)-66 was significantly improved in group A but not in group B. On the other hand, there were no significant changes in di-mension E (walking, running, jumping) in GMFM-66 in either group. Conclusion: The results of our study suggest that a serial casting application after BTX-A injection can enhance the benefits of BTX-A injection in children with cerebral palsy.

Due to a rise in the incidence of cerebral palsy, this diagnosis is increasingly encountered by orthopaedic nurses. The majority of children with cerebral palsy have difficulty with ambulation. Because ambulation is important for orthopaedic and cardiopulmonary development, as well as independence with activities of daily living, the achievement of ambulation is an important therapeutic goal for these children. Locomotor treadmill training is a relatively new method that is used to teach children how to walk and make their ambulation more efficient. This article reviews the underlying principles of locomotor treadmill training and examines related literature for children with cerebral palsy.

ABSTRACT: BACKGROUND: Children and adults with impairments such as cerebral palsy have lower participation in life situations than able-bodied people. Less is known about their subjective perception of their lives, called their quality of life. During adolescence, rapid physical and psychological changes occur; although these may be more difficult for disabled than for able-bodied adolescents, little research has examined the lives of disabled adolescents. In 2003-4 a European Union funded project, SPARCLE, visited 818 children aged 8-12 years with cerebral palsy, sampled from population-based registers in nine European regions. The quality of life reported by these disabled children was similar to that of the general population but their participation was lower; levels of participation varied between countries even for children with similar severity of cerebral palsy. We are currently following up these children, now aged 13-17 years, to identify (i) to what extent contemporaneous factors (pain, impairment, psychological health and parental stress) predict their participation and quality of life, (ii) what factors modify how participation and quality of life at age 8-12 years are associated with participation and quality of life in adolescence, and (iii) whether differences between European countries in participation and quality of life can be explained by variations in environmental factors. METHODS: Trained researchers will visit families to administer questionnaires to capture the adolescents’ type and severity of impairment, socio-demographic characteristics, participation, quality of life, psychological health, pain, environmental access and parental stress. We will use multivariable models (linear, logistic or ordinal) to assess how adolescent participation, quality of life, psychological health, pain, environmental access and parental stress, vary with impairment and socio-demographic characteristics and, where possible, how these outcomes compare with general population data. For participation and quality of life, longitudinal analyses will assess to what extent these are predicted by corresponding levels in childhood and what factors modify this relationship. Structural equation modelling will be used to identify indirect relationships mediated by other factors.

Because cerebral palsy (CP) is a sufficiently common condition of childhood and adolescence, the number and needs of these children and young people with cerebral palsy are monitored by centres across the UK (Surman et al 2006) and Europe (Surveillance of Cerebral Palsy in Europe 2000). This article describes the epidemiology of CP in childhood using data derived from the Northern Ireland Cerebral Palsy Register, which is one of the longest running CP registers in Europe. The findings presented here are similar to, and representative of, the epidemiology of CP in the western world (Dolk et al 2006).

BACKGROUND: This study was performed to determine changes in Pediatric Outcomes Data Collection Instrument (PODCI) scores after single-event multilevel surgery (SEMS), and to evaluate the relationship between the improvements of PODCI scores and parental satisfaction after SEMS. METHODS: Demographic data, preoperative and postoperative PODCI, functional assessment questionnaire (FAQ) walking scales, and self-reported parental satisfaction with SEMS were obtained from 61 parents of ambulatory patients with cerebral palsy [40 male, 21 female, mean age 10 y 2 mo (SD 3 y 8 mo), mean follow-up 2 y 2 mo]. Postoperative improvements in each subscale of PODCI and FAQ were analyzed, and multiple regression analysis was performed to identify the factors that contributed significantly to postoperative parental satisfaction. Rasch analysis was performed for the PODCI subscale that was clinically relevant. RESULTS: FAQ, transfers/basic mobility, sports/physical activity, and global function subscales of PODCI significantly improved after SEMS. Age, gross motor function classification system level, and the amount of improvement in sports/physical activity subscale were found to affect parental satisfaction to SEMS significantly. However, the subscale showed insufficient item responses, and ceiling and floor effects. CONCLUSIONS: Although changes in sports/physical activity subscale were relatively small, they were found to affect parental satisfaction with SEMS significantly. These indicate that clinicians and researchers should pay attention to sports and physical activities in patients with cerebral palsy. LEVEL OF EVIDENCE: Diagnostic level I.

PURPOSE: Hip displacement is common in children with cerebral palsy (CP). The risk of hip displacement is related to gross motor function level as graded with the Gross Motor Function Classification System (GMFCS). Most clinicians agree that surgical treatment is indicated for progressive hip subluxation in patients with CP. However, it is unclear whether unilateral bony surgery and musculotenduous release is effective in cases in which the contralateral hip is well seated. The purpose of this study is to describe the fate of the original and the contralateral hip of severely involved patients with CP, GMFCS III to V, with unilateral hip subluxation or dislocation treated by unilateral femoral osteotomy with or without pelvic osteotomy along with unilateral or bilateral soft tissue release when the contralateral hip was well seated followed to skeletal maturity. METHODS: A continuous group of GMFCS III to V CP patients with unilateral hip subluxation or dislocation who underwent soft tissue release (adductor and iliopsoas) and unilateral intertrochanteric varus, rotation and shortening osteotomy with or without pelvic osteotomy are included. All patients were clinically and radiologically followed from the time of presentation until skeletal maturity. RESULTS: Twenty-seven children and adolescents with GMFCS level III, IV, and V met the inclusion criteria. Two patients (7.4%) were GMFCS III, 5 (18.5%) were GMFCS IV and 20 (74.1%) GMFCS V. The male:female ratio was almost 1 (13 boys and 14 girls). At the time of chart and radiograph review, the average age of this patient group was 20.4 years (range: 14 to 25 y). Twelve patients (44%) required subsequent bony surgical management of the contralateral hip for subluxation or dislocation after the index procedure. Initially, in all cases there was pelvic obliquity with the operative side higher, which reversed in cases in which the contralateral hip deteriorated, and did not reverse when the contralateral hip remained stable. Nine of them were treated with femoral varus osteotomy alone and 3 underwent a combination of femoral and pelvic osteotomy. Three of these 12 (25%) patients had revision of the first hip and bony correction of the contralateral hip. Age at surgery did not seem to have a significant effect on maintaining reduction or in preventing the contralateral hip to deteriorate. CONCLUSIONS: The rates of recurrence of the original hip and contralateral hip subluxation and dislocation after unilateral bony surgery in GMFCS III to V spastic patients are higher than those of other earlier series. However, in this series patients were followed until skeletal maturity. It is prudent to warn families of the possibility of long-term subluxation or dislocation of the original hip and development of the hip dysplasia requiring surgery on the contralateral side. Consideration should be given to adductor and iliopsoas release and bony surgery on the contralateral side in a GMFCS level III to V child undergoing surgery for hip displacement, even when the hip seem radiologically normal. If unilateral bony surgery is carried out, close radiological follow-up of both hips is recommended. It also seems that unilateral hip surgery alters the forces maintaining pelvic alignment, which can lead to destabilization of the contralateral hip. LEVEL OF EVIDENCE: Case series. Level IV.

Background: Hypocalcemia carries a risk of cardiac conduction incidents and death. Hypocalcemia is a frequent adverse effect of pamidronate. Objective: The objective of this study was to investigate whether pamidronate infusion lengthens the ventricular repolarization in children. Design and Methods: Thirty-four children with cerebral palsy and severe osteoporosis were treated for approximately 1 yr with pamidronate (three times per year). Calcemia and corrected QT interval (QTc) (in which the QT interval is a measure between the Q and T waves in the electrical cycle of the heart) were measured before and after each cycle of intravenous infusions. Results: Pamidronate decreased calcemia in all patients from 2.40 to 2.21 mM (P < 0.0001) and increased QTc from 390 to 403 ms (P < 0.0001), with 7.4% of postinfusion QTc becoming longer than 440 ms. QTc at baseline was significantly correlated to final QTc (P < 0.0001; r(2) = 0.27). Conclusions: Because we observed a lengthening in QTc after bisphosphonate infusion, we recommend that children treated with pamidronate should receive attention as to other possible risk factors of prolonged QT and have a preinfusion and postinfusion measurement of their QTc.