Cerebral Palsy

Use of the coping strategy positive reinterpretation was examined among parents of children with cerebral palsy (CP). Survey data (n = 66) were used to gain a general picture of positive reinterpretation use, which was then explored in greater depth using semistructured interviews (n = 13). Positive reinterpretation was positively correlated with self-efficacy and negatively correlated with depression and stress. Interviews identified two types of positive reinterpretation: focusing on the positive aspects of the situation and finding meaning (in caring for a child with CP). Positive reinterpretation appeared to be an adaptive coping strategy used to deal with emotional stresses experienced by parents.

Objective: To compare the prevalence and types of epilepsy and other central nervous system (CNS) diseases in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. Methods: All participants were screened through the nationwide Danish National Hospital Register (DNHR). The average observation time was 30.3years (range 27-30years), and mean age at follow-up was 42.7years (range 27-57years). Results: Of the 118 individuals with IA, 29 (24.6%) were registered with at least one epilepsy diagnosis against 5 (1.5%) in the comparison group (p<0.0001; OR=21.6; 95% CI 8.1-57.3). Other CNS diseases occurred with low frequency in both groups and only cerebral palsy, unspecified (p=0.02) was significantly more frequent among participants with a history of IA. Conclusions: Our study lends further support to the notion that epilepsy, but not other CNS diseases, is a common comorbid condition in IA. Low intelligence, but not gender, was a risk factor for epilepsy in IA. Copyright © 2010 Elsevier B.V. All rights reserved.

BACKGROUND: Gait in young people with cerebral palsy is inefficient and there is a lack of relevant indicators for monitoring the problem. In particular, the impact of gait kinematics on gait efficiency is not well documented. The aim of this study is to examine the relationship between gait efficiency, gait kinematics, lower limb muscle strength, and muscular spasticity in adolescents with cerebral palsy. METHODS: Ten ambulatory adolescents with spastic cerebral palsy were recruited. The energy expenditure index during gait, gait kinematics, flexion and extension knee isometric muscle strength, and quadriceps spasticity were assessed. FINDINGS: Energy expenditure index (1.5 (0.7) beats/m) was strongly correlated with the ankle and knee flexion/extension ranges of motion (r= -0.82, P<0.01 and r= -0.70, P<0.02, respectively) and also with maximal plantar flexion (r=0.74, P<0.05) during gait. Knee flexion strength was the only strength measurement correlated with energy expenditure index (r= -0.85; P<0.01). INTERPRETATION: This study suggests that ankle and knee flexion/extension ranges of motion during gait are key kinematics factors in gait efficiency in adolescents with cerebral palsy. Copyright © 2010 Elsevier Ltd. All rights reserved.

Measurements of femoral and tibial torsion obtained from radiographs or computed tomographic scans have been used to describe rotational malalignment of the lower extremities and to clarify indications for surgery. A weak relationship between anatomic torsion deformity and the resulting transverse plane gait pattern in patients with cerebral palsy has been described, but the observations have not yet been tested in an able-bodied patient population. We conducted a prospective study to investigate the correlation of femoral torsion and tibial torsion as measured by using computed tomography with transverse plane gait data for patients with rotational malalignment. Twenty-six lower limbs from 26 patients selected for surgery based on gait analysis were evaluated. Calculation of Pearson correlations showed that increase of femoral anteversion resulted in increase of pelvic range of motion. A very weak correlation between femoral torsion and hip rotation (determination coefficient, R(2)=0.22) was found in a linear regression model, whereas tibial torsion and knee rotation showed a strong correlation (determination coefficient, R(2)=0.71). The correlation between the foot progression angle and tibial torsion was higher than between the foot progression angle and femoral torsion. We conclude that there is a considerable dynamic influence of mechanisms of compensation, especially in the hip, that should be considered when evaluating the torsional profile. We therefore recommend conducting three-dimensional instrumented gait analysis for patients undergoing surgical correction of rotational malalignment. Copyright © 2010 Elsevier B.V. All rights reserved.

PURPOSE: To correlate motor function, as measured by the Jebsen-Taylor test, and sensory function, as measured by the 12-object stereognosis testing, in the hands of children with spastic hemiplegia due to cerebral palsy. METHODS: A chart review identified children with hemiplegic and triplegic cerebral palsy with stereognosis and Jebsen-Taylor testing between 1997 and 2008. Forty-one children were included in the study, including 22 girls and 19 boys, with an average age of 8.7 years (range, 6-16 years). The right side is affected in 23 children; 34 children have hemiplegic cerebral palsy, and 7 have triplegic cerebral palsy. The initial Jebsen-Taylor and stereognosis test results were recorded for each subject, as well as age, diagnosis, affected side, and prior treatment with hand therapy, botulinum toxin injection, or surgery. Descriptive statistics, chi-square analysis, paired t-tests, and correlation measurements were used for analysis of the data. RESULTS: Statistically significant inverse correlations exist between the cards, small objects, checkers, light objects, and heavy objects on the Jebsen-Taylor subtests, as correlated with the stereognosis scores in the affected hand (p </= 0.04). The stereognosis scores for the patients who were not able to complete the Jebsen-Taylor test with the affected hand were significantly lower than those who were able to complete the Jebsen-Taylor test with the affected hand (p = .04). The stereognosis scores were significantly lower for the affected side as compared with the contralateral side. The Jebsen-Taylor total test times were significantly longer for the affected side as compared with the contralateral side (p < .001). CONCLUSIONS: In children with hemiplegic and triplegic cerebral palsy, the impairment of stereognosis is correlated with impairment in motor function, and the inability to complete the Jebsen-Taylor test with the affected hand is associated with impaired stereognosis function. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV. Copyright © 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

OBJECTIVE: To analyze the comorbidities in patients with cerebral palsy (CP) from two perspectives as neurologic subtype and gross motor functions, and find their correlations. METHODS: Children with cerebral palsy treated in the rehabilitation center from January 2007 to June 2009 received the following examinations: intelligence capacity test, ophthalmologic consultation, language-speech test, brainstem auditory evoked potential and electroencephalogram. They were stratified according to both neurologic subtype and gross motor functions to detect the occurrence of comorbidities. RESULTS: Of all the 354 cases, 166 (46.89%) had mental retardation, 15 (4.24%) auditory limitations, 138 (38.98%) visual disorder, 216 (61.02%) language-speech disorder and 82 (23.16%) epilepsy. The frequency of individual comorbidities were distributed disproportionately between the different neurologic subtypes. Correlation analysis showed that there was a significant correlation between the spastic diplegia and the visual disorder (correlation coefficient = 0.26), between spastic hemiplegia and epilepsy (correlation coefficient = 0.17), between spastic quadriplegia and epilepsy and mental retardation (the correlation coefficient was 0.38 and 0.11, respectively) and between both dyskinetic and mixed children and language-speech disorder (the correlation coefficient was 0.24 and 0.27, respectively). The frequency of individual comorbidities was distributed disproportionately between the different neurologic subtypes and between the different GMFCS levels (P < 0.05), except for the frequency of visual disorders (chi(2) = 1.90, P > 0.05); and with the increase of the GMFCS levels, the burden of the comorbidities were more heavy and the incidence of the comorbidities was higher. Multi-comorbidities were relatively infrequently encountered in those with spastic hemiplegic or spastic diplegic children or patients whose GMFCS levels were I-III, while these entities occurred at a frequent level for those with spastic quadriplegic, dyskinetic, or mixed or children whose GMFCS levels were IV and V, and the differences were significant (P < 0.05). The mean GMFCS levels of children with spastic quadriplegic, dyskinetic or mixed CP were higher than level III, most of them had no ability of ambulation;while the mean GMFCS levels of spastic hemiplegic or spastic diplegic children were below level III, most of them could walk independently. CONCLUSIONS: There are correlations between the occurrence of the comorbidities such as mental retardation, auditory or visual impairments, language-speech disorders, epilepsy and the cerebral palsy subtype and the gross motor function levels. Clinicians should have a full recognition of these comorbidities, and we should have a cooperation between the different subjects to have an overall evaluation and rehabilitation and to improve the prognosis.

Purposes. To investigate the relationship between associated reactions and a) spasticity, b) contracture and c) coordination. Methods. Associated reactions were measured as magnitude of muscle activity in the affected limb during a 50% maximum voluntary contraction of muscles in the unaffected limb. Spasticity was measured as hyper-reflexia during passive muscle stretch, coordination as performance during a tracking task, and contracture as loss of range of motion. Chi-square analysis was used to examine the association between associated reactions and spasticity, and linear regression to examine the relationship between associated reactions and spasticity, coordination and contracture. Results. Twenty-three people with hemiplegic cerebral palsy aged from 15 to 47 years (mean [SD]: 29 years [9]) participated. Thirteen participants exhibited spasticity, and six participants exhibited associated reactions. Five of the six participants with associated reactions also had spasticity (chi(2) = 2.37, p = 0.12). Associated reactions were highly correlated with spasticity (r = 0.77, p = 0.001), but not with contracture (r = 0.35, p = 0.29) or coordination (r = -0.31, p = 0.30). Conclusions. Although 27% of participants exhibited associated reactions, and these were mostly small, associated reactions appear to be an expression of spasticity in hemiplegic cerebral palsy. Copyright (c) 2010 John Wiley & Sons, Ltd.

ABSTRACT: A 12 year old boy presented with an acute onset of anisocoria and blurred vision. Ocular motility was normal but his right pupil was dilated, round but sluggishly reactive to light. There was no history of trauma, eye drops’ instillation, nebulised drugs or local ointments. His past medical history was negative. A third nerve palsy was considered but the performed cerebral MRI was normal. On further anamnestic investigation the boy revealed that he had spent the morning doing gardening, and especially working on a “trumpet plant”. Datura and Brugmansia are well known toxic plant; all Datura and Brugmasia plants contain, primarily in their seeds and flowers, tropane alkaloids such as scopolamine, hyoscyamine and atropine. Systemic and local intoxications have already been described. The day after anisocoria was much less evident and completely resolved in three days. We present this case of an unusual cause of mydriasis to underline once more the importance of a well and deeply conducted medical hystory.

Aim The objective of this study was to assess the validity of a mobility questionnaire (MobQues) that was developed to measure parent-reported mobility limitations in children with cerebral palsy (CP). Method The parents of 439 children with CP (256 males and 183 females; age range 2-18y; Gross Motor Function Classification System [GMFCS] levels I-IV) completed the mobility questionnaire (MobQues). To assess content validity, we linked all meaningful concepts of the MobQues items to the International Classification of Functioning, Disability and Health (ICF). To assess construct validity, we compared the total scores of the two versions of the MobQues (MobQues47 and MobQues28) according to GMFCS level, and determined Pearson's correlation coefficient (r) with the Gross Motor Function Measure-66 (GMFM-66). Results Content validity was demonstrated by the fact that 46 of the 47 MobQues items were linked to categories in the 'Mobility' chapter of the ICF. Construct validity was demonstrated by the finding that MobQues scores decreased with increasing GMFCS levels (p<0.001). In a subgroup of 162 children, positive correlations were found between total scores and the GMFM-66 (MobQues47, r=0.75; MobQues28, r=0.67, p<0.001). Interpretation The results of this study provide evidence supporting the content and construct validity of the MobQues as a measure of mobility limitation in children with CP.