Cerebral Palsy

Reaching-to-grasp is essential for the performance of activities of daily living. Pathologies such as stroke, spinal cord injury, cerebral palsy, etc. limit individuals from being able to perform meaningful upper extremity movements, leading to a reduced quality of life. Robotic aided therapy is gaining prevalence as a rehabilitation tool because it can provide consistent and quantitative therapy. Such systems are dependent upon models to generate trajectories that dictate their movements. Time scaled polynomial techniques have been extensively used for robotic model development and trajectory generation. However, this approach is limited because it cannot support functional therapy tasks. This is largely due to the influence of cognitive complexity not completely considered with regards to the activity performed. We examine the influence of task cognitive complexity as manifested through the geometric properties of each object on the movement trajectories and kinematic dependent variables tasks through a motion analysis study using healthy subjects (N=8). We then compare the predicted results from several robotic trajectory models with the actual motion analysis data. Our results show that there are differences present, between the trajectory data and kinematic properties for each task, that are specific to the geometric properties of each object. In addition, the predicted results from the robotic trajectory models do not fully correlate with the actual movement information. This study is important as it will help provide some insight with regards to factors that need to be considered during the development of future robotic trajectory models and controllers for upper extremity functional rehabilitation tasks.

OBJECTIVE: Free radicals are important in causing neural cell injury during cerebral infarction. Although there was a randomized, placebo-controlled, double-blind study at multiple centers in Japan showing the efficacy of the free radical scavenger, edaravone, in acute cerebral infarction, to date the clinical studies are few. This study investigated the effect of edaravone on the outcome of patients with acute lacunar infarction. METHODS: We retrospectively evaluated 124 consecutive patients with first-ever acute lacunar infarctions who were admitted to our hospital within 24 hours after the onset between January 2004 and June 2007. Of these, 59 patients received both edaravone and conventional therapy (edaravone group), and the other 65 underwent conventional therapy only (non-edaravone group). There was no significant difference in patients' baseline characteristics in the two groups. The clinical outcome was assessed by the National Institutes of Health Stroke Scale (NIHSS). RESULTS: The reduction of NIHSS scale during hospitalization (1.5+/-1.0 vs. 1.0+/-1.1; p = 0.007), especially that of the motor palsy scale (1.0+/-1.0 vs. 0.5+/-1.0; p = 0.006) was significantly larger, and the percentage of patients with a favorable outcome (NIHSS at discharge < or =1) (91.5% vs. 78.5%; p = 0.044) was significantly better in the edaravone group. CONCLUSION: Edaravone improves the outcomes of patients with acute lacunar infarction, especially motor palsy, without regard to the conventional therapy performed concomitantly.

STUDY DESIGN: Retrospective review. OBJECTIVE: To evaluate the differences in intraoperative factors and postoperative results between pediatric patients with cerebral palsy (CP) treated with unit rods and those treated with custom-bent rods. SUMMARY OF BACKGROUND DATA: No prior study has directly compared unit and custom-bent rods for CP. METHODS: We retrospectively analyzed the clinical and radiographic data of 157 children with CP who underwent posterior spinal fusion. Of those 157, we treated 79 with unit rods and 78 with custom-bent rods. Minimum follow-up was 2 years. RESULTS: Intraoperatively, unit rod surgeries were associated with significantly shorter mean surgical time (339 and 379 minutes, respectively; P = 0.04), longer mean intensive care unit stay (4 vs. 3 days, respectively; P = 0.001), and longer mean hospital stay (14 vs. 13 days; P = 0.006) than custom-bent rod procedures. The mean estimated blood loss was higher for unit rods (2124 vs. 1885 mL, respectively), but not significantly so. After surgery, unit rod surgeries were associated with significantly more mean pelvic obliquity correction (74% vs. 22%, respectively; P = 0.002), more mean clinically apparent implant prominence at 2-year follow-up (12 vs. 2 instances; P = 0.03; most were proximal), and a higher mean infection rate (15% vs. 5%, respectively; P = 0.03). There were no significant differences in final major Cobb correction, curves with an apex above or below T10, implant-related reoperations, or neurologic complications. The only factor that was statistically correlated with the overall complication rate for both groups was absolute curve magnitude (P = 0.04). CONCLUSION: Compared with custom-bent rods, unit rods provided superior correction of pelvic obliquity but were associated with higher transfusion requirements, higher infection rates, more proximal fixation problems, and longer intensive care unit and hospital stays.

Liu W-Y, Hou Y-J, Wong AMK, Lin P-S, Lin Y-H, Chen C-L: Relationships between gross motor functions and health-related quality of life of Taiwanese children with cerebral palsy. OBJECTIVE:: To examine the relationships between gross motor functions and physical and psychosocial components of the health-related quality of life of children with cerebral palsy. DESIGN:: Participants comprising 90 children (53 boys, 37 girls; mean age +/- SD = 8.2 +/- 2.4 yrs) with cerebral palsy were enrolled by a cross-sectional design. Gross motor function measure was used to quantify their gross motor functions. Their health-related quality of life was determined by the Child Health Questionnaire-Parent Form 50 (traditional Chinese version), completed by their caregivers. RESULTS:: A significant moderate positive correlation (r = 0.73, P < 0.01) existed between the physical summary scores of the Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in Taiwanese children with cerebral palsy. There was no significant correlation between the psychosocial summary scores of Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in cerebral palsy (r = -0.13, P = 0.23). CONCLUSIONS:: Gross motor functions may be good predictors of the physical component of health-related quality of life, but they are poor predictors of the psychosocial component of health-related quality of life in children with cerebral palsy. In the future, more comprehensive information regarding children's comorbidities may need to be objectively gathered to provide professionals a better understanding of their health-related quality of life.

Background Although the importance of providing disabled children with assistive devices has always been highlighted, most studies in the field of assistive device research seek the participation of adult users or adult carers. Accordingly, the opinions of young users themselves seem to be overlooked. To start to address the gap, this study aimed to understand the children’s perspectives regarding device use in school and to explore the factors related to their device utilization in this setting. Methods Semi-structured interviews were adopted as the main data collection instrument. A total of 44 participants were involved, including 15 Taiwanese children with cerebral palsy, aged between 8 and 15 years, 15 mothers and 14 teachers. Results The interview results show a high frequency of device use in school which can be attributed to children’s willingness, teachers’ attitudes, mothers’ support, physical environmental factors and device-related features. Conclusions The findings not only demonstrate the significance of child-environment interaction but also provide evidence that children’s views may be different from those of adults because they are at a different developmental stage and act out different roles in their environment.

The protocol of Davis is widely used in children’s gait analysis, especially in cerebral palsy studies and its repeatability was evaluated primarily for adults. The aim of this research was to evaluate the uncertainty and repeatability of this protocol for children. 56 asymptomatic children aged 5-15 years performed the gait exam. Kinematics parameters and Gillette Gait Index (GGI) were calculated. 17 subjects performed the exam twice with markers replacement. Uncertainties on gait parameters were evaluated using repeatability study and Monte Carlo simulations. Uncertainty (2SD of test-retest differences) obtained on angles calculated by the protocol varied between +/-2 degrees and +/-3 degrees (for pelvis and hip in sagittal and frontal planes) and +/-14 degrees (for mean hip rotation). Uncertainty on GGI was +/-12 for healthy subjects. Monte Carlo simulations on 30 cerebral palsy children showed that the error on GGI could reach +/-100 and was correlated to GGI value (R(2)=0.92): 2SD=24+0.09xGGI.

Background For parents, receiving a diagnosis, typically in early childhood, that their child has cerebral palsy may conjure up high distress and anxiety. Resolution of these initial reactions may help parents to focus on the challenges and needs of their children. Aims of the study were to test whether parents of older children displayed resolution more often than parents of younger children, and whether parents of children with less severe cerebral palsy also showed more resolution. Method Resolution of reactions to diagnosis was assessed with the Reaction to Diagnosis Interview, in a clinic-based sample of 255 parents of children with cerebral palsy aged between 1.4 and 17.3 years. Physicians rated motor ability using the Gross Motor Function Classification System. Results Overall, the responses of 81.6% of the parents were predominantly indicative of resolution. Unresolved reactions were significantly more often found among parents of younger children and parents of children with more severe motor disabilities. Among parents of teenage children, resolution was more often apparent from a focus on action to better the lives of their children, whereas in parents of younger children, it was more apparent from their focus on constructive thoughts and information seeking. Conclusions Given time, the large majority of parents may resolve their reactions to the diagnosis that their child has cerebral palsy. Parents of the most severely affected children may need specific support which, given the age trends, might be aimed at different resolution processes for parents of younger and older children.

Aims: To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme. Methods: All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age. Results: A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33-36 weeks, >/=37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively (P= 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 (P= 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2. Conclusions: At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.

Aim: This study aimed to compare the long-term neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birth weight </= 1250 gm) who received supplementation with l-arginine during the first 28 days of life with controls. Methods: Surviving infants enrolled in a randomised control study of l-arginine supplementation were prospectively followed longitudinally to determine their neurodevelopmental outcomes at 36 months of adjusted age. Neurologic examination and neurodevelopmental assessments were performed by examiners who were unaware of the original treatment assignments. Results: A total of 132 children (95% of survivors) were evaluated at 36 months adjusted age. In the group given l-arginine, 5 of 61 (8.1%) had major neurodevelopmental disabilities, defined as the presence of one or more of cerebral palsy, cognitive delay (cognitive index <70), bilateral blindness or bilateral hearing loss requiring hearing aids as compared with 9 of 71 (12.6%) in the placebo group (relative risk, 0.64; 95 % confidence interval, 0.22-1.82; P= 0.40). Conclusions: There is no increase in neurodevelopmental disability in preterm infants who received l-arginine supplementation.

Compared with motor impairment in children with hemiplegic cerebral palsy (CP), less attention has been paid to sensory feedback processing deficits. This includes, especially, proprioceptive information regarding arm position. This study examined the ability of children with hemiplegic CP to use proprioceptive feedback during a goal-directed target-matching task. Eight children with hemiplegic CP and eight typically developing children performed proprioceptively guided matching of elbow position with either arm. Between groups, it was found that matching errors were significantly greater for the affected arm of children with hemiplegic CP. With respect to the side of brain injury, deficits were only seen for children with right hemisphere damage. These results provide valuable information that may assist in the development of more effective sensorimotor rehabilitation and training paradigms.