Cerebral Palsy

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.

Disorders of visual search by coordinated eye and head movements are frequently encountered in patients with brain damage. Homonymous visual field disorders, impaired elementary visual capacities (e.g. acuity, contrast sensitivity, convergent fusion, oculomotor disorders), visual neglect, Balint-Holmes syndrome or dementia (e.g. Alzheimer’s disease) are the most frequent causes of such disorders. Efficient visual search is necessary to select salient stimuli and bring them onto the fovea in order to perform an in-depth analysis. Visual search is not only an indispensible capacity for visual activities in vocational and private life but is also important for many motor and cognitive abilities such as reaching, grasping, standing, spatial perception, route navigation as well as mobility. Despite this importance no comprehensive system exists for the standardized assessment and treatment of visual search disorders in the German-speaking area. In this article, we describe the basic properties of such a system (EYEMOVE). After a short survey of the main causes of visual search disorders following brain damage, the diagnostic facilities, normative data as well as a variety of treatment techniques of this novel system are described. Selected results from on-going clinical studies highlight the practicability and effectiveness of this novel system which contributes to a better management of visual search disorders in neurovisual rehabilitation.

BACKGROUND AND AIM: Angiotensin II acts through two major receptors: AT1-R and AT2-R. It is known that the stimulation of AT1-R mediates vasoconstriction, cell proliferation and fibrosis, aldosterone release and inflammatory response but, although the stimulation of AT2-R is thought to promote vasodilation and anti-inflammatory effects, its real in-vivo functions are still unclear. The aim of this study was to investigate the effects of specific and selective AT2-R stimulation on the pathological events occurring in spontaneously hypertensive stroke-prone rats (SHRSPs). METHODS AND RESULTS: SHRSPs who were fed a high-salt diet underwent long-term treatment with vehicle or compound 21 (C21), a nonpeptide selective AT2-R agonist, at doses of 0.75, 5 and 10 mg/kg per day. The vehicle-treated rats developed brain abnormalities detectable by magnetic resonance imaging after 42.5 +/- 7.5 days, and died 43 +/- 9.5 days after the start of the dietary treatment. The highest C21 dose delayed the occurrence of brain damage (P < 0.001 vs. vehicle-treated SHRSPs) and prolonged survival (P < 0.001) without affecting blood pressure. These beneficial effects of C21 were abolished by the administration of PD123319, an AT2-R antagonist. C21 treatment preserved renal structure by preventing inflammatory cell infiltration, collagen accumulation, and the neo-expression of vimentin; it also prevented the increased plasma renin activity and accumulation of urinary acute-phase proteins observed in the vehicle-treated rats. CONCLUSION: Specific and selective AT2-R stimulation has beneficial effects on the pathological events occurring in SHRSPs. These data indicate a new avenue for the pharmacological treatment of diseases in which modulation of the renin-angiotensin system is required.

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.

Inequality in communicative resources available to non-speaking children with cerebral palsy in comparison with their ‘naturally’ speaking co-participants has material consequences for the ways in which face-to-face interaction is organized. Analyses of interaction involving non-speaking children with physical disability and speaking adults has often interpreted the patterns of interaction observed as indicative of non-speaking children’s apparent passivity in interaction. Research concerned with these children’s interactions with their peers has shown evidence of non-speaking children’s active engagement in episodes of interaction characterized by, for example, shared laughter and heightened affect. The analysis presented here utilizes the principles and practices of Conversation Analysis (CA) to examine how non-speaking children with cerebral palsy and their peers bring about and organize episodes of non-serious interaction. In so doing the analysis reveals how non-speaking children are demonstrably active in developing the interaction as non-serious, and how both children collaborate in constituting the non-speaking child as playfully naughty.

This study compared the intensity, co-activity and frequency content of the electromyography (EMG) signals recorded bilaterally from six muscles of the upper limbs in children with spastic hemiparetic cerebral palsy (SHCP) and typically developing (TD) children during a bilateral movement. It was found that children with SHCP executed the bimanual circular movement with higher intensities of mean neuromuscular activity in both arms compared to TD children. Furthermore, the movement was performed with longer phases of concentric and eccentric activity in children with SHCP, indicating more co-activation, especially in the more impaired arm. The EMG signals yielded a higher mean power frequency in all the muscles of the more impaired arm and the wrist and elbow flexors of the less impaired arm, which was interpreted as a relatively higher contribution of type II muscle fibres compared to TD children. These observations suggest that in children with SHCP bimanual coordination requires higher neuromuscular activation in the muscles of both arms. Furthermore, SHCP also seems to involve structural changes to the muscle properties, which differ between arms.