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Gravholt A, Fernandez B, Bessaguet H, Millet GY, Buizer AI, Lapole T. Motor function and gait decline in individuals with cerebral palsy during adulthood: a narrative review of potential physiological determinants. Eur J Appl Physiol 2024:10.1007/s00421-024-05550-y. [PMID: 39042142 DOI: 10.1007/s00421-024-05550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
Cerebral palsy (CP) is the most common childhood-onset disability. The evolution of gait according to severity is well known amongst children and thought to peak between 8 and 12 years of age among those walking without assistive devices. However, among adults, clinical experience as well as scientific studies report, through clinical assessments, questionnaires and interviews, increasing walking difficulties leading to an increased dependency of assistive devices in everyday ambulation. For many individuals with CP, this change will occur around 30-40 years, with the risk of losing mobility increasing with age. This narrative review aims to first provide objective evidence of motor function and gait decline in adults with CP when ageing, and then to offer mechanistic hypotheses to explain those alterations. Many studies have compared individuals with CP to the typically developing population, yet the evolution with ageing has largely been understudied. Comorbid diagnoses comprise one of the potential determinants of motor function and gait decline with ageing in people with CP, with the first manifestations happening at an early age and worsening with ageing. Similarly, ageing appears to cause alterations to the neuromuscular and cardiovascular systems at an earlier age than their typically developing (TD) peers. Future studies should, however, try to better understand how the physiological particularities of CP change with ageing that could pave the way for better strategies for maintaining function and quality of life in people with CP.
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Affiliation(s)
- Anders Gravholt
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Bruno Fernandez
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Hugo Bessaguet
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
| | - Guillaume Y Millet
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France
- Institut Universitaire de France (IUF), Paris, France
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thomas Lapole
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de La Motricité, 42023, Saint-Etienne, France.
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Ippersiel P, Dussault-Picard C, Mohammadyari SG, De Carvalho GB, Chandran VD, Pal S, Dixon PC. Muscle coactivation during gait in children with and without cerebral palsy. Gait Posture 2024; 108:110-116. [PMID: 38029482 DOI: 10.1016/j.gaitpost.2023.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/10/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Children with Cerebral Palsy (CP) walk with an uncoordinated gait compared to Typically Developing (TD) children. This behavior may reflect greater muscle co-activation in the lower limb; however, findings are inconsistent, and the determinants of this construct are unclear. RESEARCH OBJECTIVES (i) Compare lower-limb muscle co-activation during gait in children with, and without CP, and (ii) determine the extent to which muscle co-activation is influenced by electromyography normalization procedures and Gross Motor Function Classification System (GMFCS) class. METHODS An electromyography system measured muscle activity in the rectus femoris, semitendinosus, gastrocnemius, and tibialis anterior muscles during walking in 46 children (19 CP, 27 TD). Muscle co-activation was calculated for the tibialis anterior-gastrocnemius (TA-G), rectus femoris-gastrocnemius (RF-G), and rectus femoris-semitendinosus (RF-S) pairings, both using root mean squared (RMS)-averaged and dynamically normalized data, during stance and swing. Mann-Whitney U and independent t-tests examined differences in muscle co-activation by group (CP vs. TD) and GMFCS class (CP only), while mean difference 95% bootstrapped confidence intervals compared electromyography normalization procedures. RESULTS Using dynamically normalized data, the CP group had greater muscle co-activation for the TA-G and RF-G pairs during stance (p < 0.01). Using RMS-averaged data, the CP group had greater muscle co-activation for TA-G (stance and swing, p < 0.01), RF-G (stance, p < 0.05), and RF-S (swing, p < 0.01) pairings. Muscle co-activation calculated with dynamically normalized, compared to RMS-averaged data, were larger in the RF-S and RF-G (stance) pairs, but smaller during swing (RF-G). Children with CP classified as GMFCS II had greater muscle co-activation during stance in the TA-G pair (p < 0.05). SIGNIFICANCE Greater muscle co-activation observed in children with CP during stance may reflect a less robust gait strategy. Although data normalization procedures influence muscle co-activation ratios, this behavior was observed independent of normalization technique.
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Affiliation(s)
- P Ippersiel
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada.
| | - C Dussault-Picard
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada
| | - S G Mohammadyari
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada
| | - G B De Carvalho
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - V D Chandran
- Department of Rehabilitation, Hospital for Special Surgery, New York, New York, U.S.A
| | - S Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - P C Dixon
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the CHU Sainte-Justine, Montreal, Canada; Institute of Biomedical Engineering, Faculty of Medicine, University of Montreal, Canada
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Crecchi A, Tozzini A, Benedetti R, Maltinti M, Bonfiglio L. Case report: Intensive rehabilitation program delivered before and after single-event multilevel surgery in a girl with diplegic cerebral palsy. Front Neurol 2024; 14:1323697. [PMID: 38283677 PMCID: PMC10811248 DOI: 10.3389/fneur.2023.1323697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Diplegic cerebral palsy (CP) is often associated with musculoskeletal disorders that contribute to worsen walking function. The standard care in these cases is single-event multilevel surgery (SEMLS) followed by rehabilitation. Our aim was to investigate whether a rehabilitation program starting even before SEML could add a benefit with respect to standard postoperative programs considered by previous research. Methods From 2 months before to 13 months after SEMLS (except for the first month after surgery), the participant underwent a motor training focused on ROM exercises with tactile and kinaesthetic feedback. Walking performance, walking capacity, and quality-of-life were assessed before and after SEMLS at different follow-up times. Results Walking capacity improved 3 months after SEMLS (i.e., earlier than in current literature) and walking performance improved 12 months after SEMLS (instead of simply returning to baseline as previously reported), with a positive impact on quality-of-life. Conclusions This case suggests that a rehabilitation program starting even before SEMLS could add benefits over walking function and quality-of-life of children with diplegic CP compared to postoperative programs only.
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Affiliation(s)
- Alessandra Crecchi
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Alessandra Tozzini
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Roberta Benedetti
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Maltinti
- 1st Unit of Orthopaedics and Trauma, Pisa University Hospital, Pisa, Italy
| | - Luca Bonfiglio
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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Nilsson E, Hedberg Dubuc S, Ghafouri N, Schaller AS. Managing Fatigue: Experiences From a 6-week Course for Adults With Cerebral Palsy. Arch Rehabil Res Clin Transl 2023; 5:100300. [PMID: 38163030 PMCID: PMC10757170 DOI: 10.1016/j.arrct.2023.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To explore experiences of a 6-week Fatigue Management course (FMC) in adults with cerebral palsy (CP). Design A qualitative study using semi-structured interviews. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Setting The study was conducted in southeastern Sweden in an out-patient setting. Participants Adults (N=8) with CP who had participated in FMC. Interventions Not applicable. Main Outcome Measure Qualitative content analysis of the transcribed interviews led to identification of a main category, categories, and subcategories, describing the participants' experiences of FMC. Results The analysis identified 2 categories: Awareness regarding fatigue, with the 2 subcategories: A better understanding, and The feeling of not being alone; and Perceive opportunities for changes, with the 3 subcategories: Understanding the need for changes, Demanding process, and Taking steps toward change. These categories were summed up in the main category describing the participants' experiences of FMC: A challenging and eye-opening course that gave deeper self-understanding and thoughts about making changes. Conclusions Overall, the participants described positive experiences of FMC, with increased awareness regarding fatigue and insight regarding the possibilities for change. Nevertheless, there were challenges in coping with the extensive information and with the home assignments. This study gives promising results regarding the applicability of FMC for adults with CP. However, there is a need for course modifications with more targeted and differentiated content that is manageable and does not overload the participants. The modifications should include extended time, the addition of individual support, and follow-up between sessions, to increase participants' opportunities to implement new strategies and initiate behavioral change.
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Affiliation(s)
- Ellinor Nilsson
- Department of Habilitation, and Department of Biomedical and Clinical Sciences, Linköping University, Motala, Sweden
| | - Séverine Hedberg Dubuc
- Department of Habilitation, and Department of Biomedical and Clinical Sciences, Linköping University, Motala, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anne Söderlund Schaller
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Division of Nursing Science, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Mohammadyari Gharehbolagh S, Dussault-Picard C, Arvisais D, Dixon PC. Muscle co-contraction and co-activation in cerebral palsy during gait: A scoping review. Gait Posture 2023; 105:6-16. [PMID: 37453339 DOI: 10.1016/j.gaitpost.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Cerebral palsy (CP) results from an injury to a developing brain. Muscle activation patterns during walking are disrupted in individuals with CP. Indeed, excessive muscle co-contraction or co-activation (MCo/MCa) is one of the characteristics of pathological gait. Although some researchers have studied MCo/MCa in individuals with CP during gait, inconsistent results limit our understanding of this literature. Increased knowledge of MCo/MCa patterns in individuals with CP may help the development of improved gait management approaches. RESEARCH QUESTION This review aims to summarize MCo/MCa patterns while walking in individuals with CP across the existing literature and compare them with their healthy peers. METHODS This study follows the Joanna Briggs Institute (JBI) guidelines and the recommendations presented in PRISMA Extension for Scoping Reviews (PRISMA-ScR). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for scoping Reviews statement were respected. The following databases were searched: MEDLINE (Ovid), EMBASE (Ovid), CINAHL Plus with Full Text (Ebsco), SPORTDiscus with Full Text (Ebsco), and Web of Science. RESULTS Among 2545 identified studies, 21 studies remained after screening. In total, 337 participants with CP and 249 healthy participants were included. Both MCo and MCa terminologies are used for describing simultaneous muscle activation; however, when it is measured by electromyography (EMG), MCa terminology should be preferred to facilitate interpretation. A wide range of MCo/MCa patterns has been found across studies using different methodologies (e.g., gait protocol, computation methods). Finally, most of the included studies confirm that MCo/MCa is increased in individuals with CP during walking compared to controls. SIGNIFICANCE This review identified missing concepts and common limitations in the literature which could be addressed in future research such as the association between MCo/MCa and gait deviations, and the most appropriate MCo/MCa computation method.
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Affiliation(s)
- S Mohammadyari Gharehbolagh
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada.
| | - C Dussault-Picard
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
| | - D Arvisais
- Health Sciences Libraries, University of Montreal, Canada
| | - P C Dixon
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
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Sattoe JNT, Hilberink SR. Impairments and comorbidities in adults with cerebral palsy and spina bifida: a meta-analysis. Front Neurol 2023; 14:1122061. [PMID: 37533474 PMCID: PMC10390785 DOI: 10.3389/fneur.2023.1122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Aging with a childhood-onset disability, such as cerebral palsy (CP), spina bifida (SB), and muscular diseases (MD), comes along with significant impairments and comorbidities. Despite the increasing evidence an overall picture is lacking. This study aimed to review the literature about adults with CP/SB/MD and impairments and comorbidities to perform a meta-analysis. Materials and methods Embase, PubMed, Cinahl, and Google Scholar were searched (2000-2020). Search terms included adults with one of the aforementioned disabilities combined with impairments and comorbidities. If specific impairments or comorbidities were reported by at least four studies, these were included in the study. Pooled prevalence (95% Confidence Interval) of impairments/comorbidities were calculated. Results The search yielded 7,054 studies of which 95 were included in the meta-analysis (64 CP, 31 SB, 0 MD). In total estimates were calculated for 26 (CP) and 11 (SB) outcomes. In adults with CP, pain [56.4% (95%CI 48.8-63.8)], deformities [44.2% (95%CI 12.9-78.4)], intellectual disability [37.2% (95%CI 26.7-48.3)], and fatigue [36.9% (95%CI 24.6-50.1)] were most prevalent; renal disease [3.0% (95%CI 2.1-4.2)] and stroke/rheumatic diseases {4.8% (95%CI 3.4-6.5; 4.8% (95%CI 1.5-9.9)] respectively} were least prevalent. For adults with SB, bladder incontinence [60.0% (95%CI 50.5-69.2)], bowel incontinence [49.2% (95%CI 34.5-64.0)], pain [44.1% (95%CI 27.4-61.5)], and sleeping problems [30.3% (95%CI 4.7-65.8)] were most prevalent; diabetes [4.8% (95%CI 2.8-7.3)] and renal disease [8.7% (95%CI 2.0-19.9)] were least prevalent. The included studies showed large heterogeneity. Conclusions More research is needed to study health issues in adults with MD. Adults with CP or SB deal with a variety of health issues. More attention for the mental health of these adults is needed. There also is a need for accessible and adequate screening, preventive measures and clinical follow-up.
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Trevarrow MP, Bergwell HE, Groff BR, Wiesman AI, Wilson TW, Kurz MJ. Youth with Cerebral Palsy Display Abnormal Somatosensory Cortical Activity During a Haptic Exploration Task. Neuroscience 2023; 515:53-61. [PMID: 36796750 PMCID: PMC10023489 DOI: 10.1016/j.neuroscience.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
There are numerous clinical reports that youth with cerebral palsy (CP) have proprioceptive, stereognosis and tactile discrimination deficits. The growing consensus is that the altered perceptions in this population are attributable to aberrant somatosensory cortical activity seen during stimulus processing. It has been inferred from these results that youth with CP likely do not adequately process ongoing sensory feedback during motor performance. However, this conjecture has not been tested. Herein, we address this knowledge gap using magnetoencephalographic (MEG) brain imaging by applying electrical stimulation to the median nerve of youth with CP (N = 15, Age = 15.8 ± 0.83 yrs, Males = 12, MACS levels I-III) and neurotypical (NT) controls (N = 18, Age = 14.1 ± 2.4 yrs, Males = 9) while at rest (i.e., passive) and during a haptic exploration task. The results illustrated that the somatosensory cortical activity was reduced in the group with CP compared to controls during the passive and haptic conditions. Furthermore, the strength of the somatosensory cortical responses during the passive condition were positively associated with the strength of somatosensory cortical responses during the haptic condition (r = 0.75, P = 0.004). This indicates that the aberrant somatosensory cortical responses seen in youth with CP during rest are a good predictor of the extent of somatosensory cortical dysfunction during the performance of motor actions. These data provide novel evidence that aberrations in somatosensory cortical function in youth with CP likely contribute to the difficulties in sensorimotor integration and the ability to effectively plan and execute motor actions.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Hannah E Bergwell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Boman R Groff
- Department of Psychology & Neuroscience, University of Colorado, Boulder, CO, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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Auditory Stimulation Improves Gait and Posture in Cerebral Palsy: A Systematic Review with Between- and Within-Group Meta-Analysis. CHILDREN 2022; 9:children9111752. [DOI: 10.3390/children9111752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
The past decade has seen an increased interest in the implementation of auditory stimulation (AStim) for managing gait and postural deficits in people with cerebral palsy. Although existing reviews report beneficial effects of AStim on the spatiotemporal and kinematic parameters of gait, there are still numerous limitations that need to be addressed to correctly interpret these results. For instance, existing reviews have failed to characterize the effects of AStim by conducting separate between and within-group meta-analyses, these reviews have not evaluated the influence of AStim on postural outcomes, and nor have included several high-quality existing trials. In this study, we conducted between- and within-group meta-analyses to establish a state of evidence for the influence of AStim on gait and postural outcomes in people with cerebral palsy. We searched the literature according to PRISMA-P guidelines across 10 databases. Of 1414 records, 14 studies, including a total of 325 people with cerebral palsy, met the inclusion criterion. We report a significant enhancement in gait speed, stride length, cadence, and gross motor function (standing and walking) outcomes with AStim compared to conventional physiotherapy. The findings from this analysis reveal the beneficial influence of AStim on the spatiotemporal and kinematic parameters of gait and postural stability in people with cerebral palsy. Furthermore, we discuss the futurized implementation of smart wearables that can deliver person-centred AStim rehabilitation in people with cerebral palsy.
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MacCarthy M, Heyn P, Tagawa A, Carollo J. Walking speed and patient-reported outcomes in young adults with cerebral palsy. Dev Med Child Neurol 2022; 64:1281-1288. [PMID: 35366333 DOI: 10.1111/dmcn.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
AIM To examine the relationship between quantitative gait measurements and self-reported physical, psychological, cognitive, and social function status in young adults with cerebral palsy (CP). METHOD Seventy-two adults with CP (range 18-48y; median age 23y [interquartile range 21-27y]; 34 males, 38 females), in Gross Motor Function Classification System levels I to IV, who previously underwent an instrumented gait analysis (IGA) at our center as children were recruited. Participants underwent a repeated IGA. National Institutes of Health Patient-Reported Outcomes Information System (PROMIS) instruments including the PROMIS-57, Applied Cognition - General Concerns (Short Form), and Applied Cognition - Executive Function (Short Form) were administered. Data derived from current and prior IGA were compared via non-parametric correlation analysis with PROMIS subscores. RESULTS Subscores for anxiety, depression, sleep, and fatigue did not significantly correlate with any IGA data. Walking speed, adjusted for stature, correlated strongly with multiple subscores: physical function (p<0.001, rs =0.708); participation in social roles (p=0.007, rs =0.319); executive function (p=0.005, rs =0.335). Pain interference correlated with longitudinal change in adjusted walking speed (p=0.032, rs =-0.259). The Applied Cognition - General Concerns (Short Form) correlated with prior absolute walking speed, but not adjusted values. INTERPRETATION This study underscores the importance of walking speed and its association with a variety of functional domains in adults with CP. WHAT THIS PAPER ADDS Patient-Reported Outcomes Information System measures provide useful clinical data in young adults with cerebral palsy. Temporospatial gait parameters have wide-reaching functional influence in this population. Walking speed is strongly correlated with physical, social, and executive function.
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Affiliation(s)
- Matthew MacCarthy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Department of Pediatrics, University of South Carolina and Prisma Health Children's Hospital, Columbia, SC, USA
| | - Patricia Heyn
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Tagawa
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA
| | - James Carollo
- Center for Gait and Movement Analysis, Children's Hospital Colorado, Aurora, CO, USA.,Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Husain S, Wrightson JG, Johnson E, Brunton LK, Condliffe E. Walking and Fatigue in People with Cerebral Palsy: Brief Report. Dev Neurorehabil 2022; 25:501-504. [PMID: 35289718 DOI: 10.1080/17518423.2022.2053222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to examine the relationship between perceived fatigue and perceptions of walking abilities and difficulty in people with cerebral palsy (CP). Twenty individuals with CP (range 10-21y; mean age 14.8y) who usually walk in the community were recruited. Community mobility was assessed using the Functional Mobility Scale. Participants were asked about their walking ability and frequency, perceived effort during walking (using the Children's Effort Rating Table), and perceived fatigue (using the Fatigue Impact and Severity Self-Assessment). Community mobility, frequency, and perceived effort during walking were significantly related to fatigue. No relationship was found between time spent walking (maximum walking time) and fatigue. Here we demonstrate that perceived fatigue is related to walking in people with CP.
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Affiliation(s)
- Sarrah Husain
- University of Calgary Cumming School of Medicine, Department of Community Health Sciences, Calgary, AB, Canada
| | - James G Wrightson
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Erika Johnson
- University of Calgary Cumming School of Medicine, Clinical Neurosciences, Calgary, AB, Canada
| | - Laura Kristine Brunton
- School of Physical Therapy, Health Sciences Building, Western University, London, ON, Canada
| | - Elizabeth Condliffe
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Seyhan-Bıyık K, Arslan UE, Özal C, Çankaya Ö, Numanoğlu-Akbaş A, Üneş S, Tunçdemir M, Kerem-Günel M, Özcebe LH. The effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy: A parental perspective. Arch Pediatr 2022; 29:560-565. [DOI: 10.1016/j.arcped.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 06/18/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
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Mid-Term Results of Distal Femoral Extension and Shortening Osteotomy in Treating Flexed Knee Gait in Children with Cerebral Palsy. CHILDREN 2022; 9:children9101427. [PMID: 36291363 PMCID: PMC9600012 DOI: 10.3390/children9101427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 12/03/2022]
Abstract
Background: Distal femoral extension and shortening osteotomy (DFESO) seems to be an effective method for the treatment of flexed knee gait in children with cerebral palsy. Nevertheless, studies investigating the mid- and long-term outcomes after such procedures are lacking in the literature. Therefore, the purpose of this study was to assess the mid-term outcomes regarding sagittal plane kinematics of the knee after DFESO with or without concomitant patella advancement. Furthermore, an evaluation of the postoperative course and possible recurrence of flexed knee gait was planned. Methods: In a prospective observational study, 19 patients (28 limbs; mean age 11.8 years (6.7–16.0 years)) were examined using 3-D gait analysis and clinical exam before (E0) and at a mean of 38 months (E2: 24–55 months) after surgery. Fifteen patients (22 limbs) had an additional first postoperative gait analysis (E1) after a mean of 14 (10–20) months after surgery. In these patients, the postoperative changes between the short-term and mid-term gait analyses were evaluated. Results: DFESO led to a significant decrease in flexed knee gait with an improvement in sagittal plane kinematics during the stance phase. In addition, a slightly increased anterior pelvic tilt was observed at E1, and we found a tendency towards stiff knee gait with a decrease in mean knee flexion in swing at E2. Conclusions: DFESO led to a significant improvement in flexed knee gait in children with cerebral palsy. The therapeutic effect seems to be lasting on mid-term follow-up with a slight overall tendency to recurrence.
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Gorter JW, Fehlings D, Ferro MA, Gonzalez A, Green AD, Hopmans SN, McCauley D, Palisano RJ, Rosenbaum P, Speller B. Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project. J Clin Med 2022; 11:jcm11113060. [PMID: 35683448 PMCID: PMC9181041 DOI: 10.3390/jcm11113060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.
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Affiliation(s)
- Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Correspondence:
| | - Darcy Fehlings
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON M4G 1R8, Canada
| | - Mark A. Ferro
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Amanda D. Green
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Sarah N. Hopmans
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Robert J. Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Brittany Speller
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
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14
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De Pieri E, Romkes J, Wyss C, Brunner R, Viehweger E. Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking. Front Bioeng Biotechnol 2022; 10:810560. [PMID: 35480978 PMCID: PMC9036482 DOI: 10.3389/fbioe.2022.810560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/02/2022] [Indexed: 01/02/2023] Open
Abstract
Toe-walking characterizes several neuromuscular conditions and is associated with a reduction in gait stability and efficiency, as well as in life quality. The optimal choice of treatment depends on a correct understanding of the underlying pathology and on the individual biomechanics of walking. The objective of this study was to describe gait deviations occurring in a cohort of healthy adult subjects when mimicking a unilateral toe-walking pattern compared to their normal heel-to-toe gait pattern. The focus was to characterize the functional adaptations of the major lower-limb muscles which are required in order to toe walk. Musculoskeletal modeling was used to estimate the required muscle contributions to the joint sagittal moments. The support moment, defined as the sum of the sagittal extensive moments at the ankle, knee, and hip joints, was used to evaluate the overall muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Compared to a normal heel-to-toe gait pattern, toe-walking was characterized by significantly different lower-limb kinematics and kinetics. The altered kinetic demands at each joint translated into different necessary moment contributions from most muscles. In particular, an earlier and prolonged ankle plantarflexion contribution was required from the soleus and gastrocnemius during most of the stance phase. The hip extensors had to provide a higher extensive moment during loading response, while a significantly higher knee extension contribution from the vasti was necessary during mid-stance. Compensatory muscular activations are therefore functionally required at every joint level in order to toe walk. A higher support moment during toe-walking indicates an overall higher muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Higher muscular demands during gait may lead to fatigue, pain, and reduced quality of life. Toe-walking is indeed associated with significantly larger muscle forces exerted by the quadriceps to the patella and prolonged force transmission through the Achilles tendon during stance phase. Optimal treatment options should therefore account for muscular demands and potential overloads associated with specific compensatory mechanisms.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- *Correspondence: Enrico De Pieri,
| | - Jacqueline Romkes
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Wyss
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
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15
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Trevarrow MP, Reelfs A, Baker SE, Hoffman RM, Wilson TW, Kurz MJ. Spinal cord microstructural changes are connected with the aberrant sensorimotor cortical oscillatory activity in adults with cerebral palsy. Sci Rep 2022; 12:4807. [PMID: 35314729 PMCID: PMC8938462 DOI: 10.1038/s41598-022-08741-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
Previous animal models have illustrated that reduced cortical activity in the developing brain has cascading activity-dependent effects on the microstructural organization of the spinal cord. A limited number of studies have attempted to translate these findings to humans with cerebral palsy (CP). Essentially, the aberrations in sensorimotor cortical activity in those with CP could have an adverse effect on the spinal cord microstructure. To investigate this knowledge gap, we utilized magnetoencephalographic (MEG) brain imaging to quantify motor-related oscillatory activity in fourteen adults with CP and sixteen neurotypical (NT) controls. A subset of these participants also underwent cervical-thoracic spinal cord MRI. Our results showed that the strength of the peri-movement beta desynchronization and the post-movement beta rebound were each weaker in the adults with CP relative to the controls, and these weakened responses were associated with poorer task performance. Additionally, our results showed that the strength of the peri-movement beta response was associated with the total cross-sectional area of the spinal cord and the white matter cross-sectional area. Altogether these results suggest that the altered sensorimotor cortical activity seen in CP may result in activity-dependent plastic changes within the spinal cord microstructure, which could ultimately contribute to the sensorimotor deficits seen in this population.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Sarah E Baker
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA.
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16
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Noten S, Rodby-Bousquet E, Limsakul C, Tipchatyotin S, Visser F, Grootoonk A, Thorpe DE, van der Slot WMA, Selb M, Roebroeck ME, Roebroeck ME, Noten S, van den Berg-Emons RJG, van der Slot WMA, Hilberink SR, Limsakul C, Konijnenbelt M, van den Borne K, de Groot V, Grootoonk A, Selb M. An international clinical perspective on functioning and disability in adults with cerebral palsy. Disabil Health J 2022; 15:101318. [DOI: 10.1016/j.dhjo.2022.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
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17
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Götze M, Geisbüsch A, Thielen M, Döderlein L, Wolf SI, Dreher T, Putz C. Pain in Adults With Cerebral Palsy After Single-Event Multilevel Surgery. Am J Phys Med Rehabil 2022; 101:119-123. [PMID: 33657030 DOI: 10.1097/phm.0000000000001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the investigation was to assess the contribution of pain to functional, social, and health-related quality-of-life outcomes in adults with cerebral palsy. DESIGN This monocentric, prospective study included long-term data for ambulant adults with cerebral palsy and at levels I-III in the Gross Motor Function Classification System who had received orthopedic multilevel surgery in adulthood and in whom preoperative and postoperative three-dimensional gait analysis was conducted, including the Gait Profile Score. A questionnaire including the Visual Analog Scale, Oswestry Disability Index, and European Quality of Life 5 Dimensions 3 Level was analyzed. RESULTS Twenty-four adults at a mean age of 38.0 yrs were included. Sixteen patients (66.7%) indicated that they experienced pain and 10 patients (41.7%) had pain for more than 6 mos. Overall, 13 patients (54%) experienced both pain and anxiety. There was no correlation of the Gait Profile Score with pain, Gross Motor Function Classification System, and Oswestry Disability Index. The Oswestry Disability Index showed a positive correlation with the Gross Motor Function Classification System (r = 0.39, P = 0.05) and pain (r = 0.57, P = 0.004). CONCLUSIONS Pain and anxiety represent relevant comorbidities in adults with cerebral palsy. The occurrence of pain correlates with the Oswestry Disability Index and is higher than in children with cerebral palsy.
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Affiliation(s)
- Marco Götze
- From the Pediatric Orthopedics, Neuroorthopedics and Foot Surgery, Center for Orthopedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany (MG, AG, SIW, CP); Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany (MT); Orthopedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bavaria, Germany (LD); and Pediatric Orthopedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland (TD)
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18
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Trevarrow MP, Baker SE, Wilson TW, Kurz MJ. Microstructural changes in the spinal cord of adults with cerebral palsy. Dev Med Child Neurol 2021; 63:998-1003. [PMID: 33719037 PMCID: PMC8260437 DOI: 10.1111/dmcn.14860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 01/01/2023]
Abstract
AIM To quantify the microstructural differences in the cervical-thoracic spinal cord of adults with cerebral palsy (CP). METHOD Magnetic resonance imaging of the proximal spinal cord (C6-T3) was conducted on a cohort of adults with CP (n=13; mean age=31y 11mo, standard deviation [SD] 8y 7mo; range=20y 8mo-47y 6mo; eight females, five males) and population norm adult controls (n=16; mean age=31y 4mo, SD 9y 9mo; range=19y 4mo-49y 5mo; seven females, nine males). The cross-sectional area (CSA) of the spinal cord, gray and white matter, magnetization transfer ratio (MTR), and fractional anisotropy of the cuneatus and corticospinal tracts were calculated. RESULTS The total spinal cord CSA and proportion of the spinal cord gray matter CSA were significantly decreased in the adults with CP. The corticospinal tracts' MTR was lower in the adults with CP. Individuals that had reduced gray matter also tended to have reduced MTR in their corticospinal tracts (r=0.42, p=0.029) and worse hand dexterity clinical scores (r=0.53, p=0.004). INTERPRETATION These results show that there are changes in the spinal cord microstructure of adults with CP. Ultimately, these microstructural changes play a role in the extent of the hand sensorimotor deficits seen in adults with CP. What this paper adds Adults with cerebral palsy (CP) have a reduced spinal cord cross-sectional area (CSA). Spinal cord gray matter is reduced in adults with CP. Spinal cord CSA is associated with hand dexterity. Magnetization transfer ratio of corticospinal tracts was lower in adults with CP.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human NeuroscienceBoys Town National Research Hospital Boys Town NE USA
| | - Sarah E Baker
- Institute for Human NeuroscienceBoys Town National Research Hospital Boys Town NE USA
| | - Tony W Wilson
- Institute for Human NeuroscienceBoys Town National Research Hospital Boys Town NE USA
| | - Max J Kurz
- Institute for Human NeuroscienceBoys Town National Research Hospital Boys Town NE USA
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19
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Noten S, Troenosemito LAA, Limsakul C, Selb M, de Groot V, Konijnenbelt M, Driessen DMF, Hilberink SR, Roebroeck ME. Development of an ICF Core Set for adults with cerebral palsy: capturing their perspective on functioning. Dev Med Child Neurol 2021; 63:846-852. [PMID: 33634853 PMCID: PMC8248089 DOI: 10.1111/dmcn.14841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 01/27/2023]
Abstract
AIM To examine the most relevant aspects of functioning of adults with cerebral palsy (CP) from their perspective, in order to develop an International Classification of Functioning, Disability and Health (ICF) Core Set for adults with CP. METHOD We conducted six focus group discussions with adults with CP without intellectual disability and seven interviews with adults with CP with intellectual disability and caregivers, addressing all ICF components. Meaningful concepts were identified from verbatim transcripts and linked to ICF categories by two independent researchers. RESULTS In total, 31 adults with CP without intellectual disability (mean [SD] age 46y 1mo [14y 1mo]; 20 females, 11 males; Gross Motor Function Classification System [GMFCS] levels I-IV) and seven adults with CP and intellectual disability (mean [SD] age 25y 8mo [6y 8mo]; four females, three males; GMFCS levels III-V) participated. We identified 132 unique second-level categories: 47 body functions, seven body structures, 43 activities and participation, and 35 environmental factors. The most frequently mentioned categories were emotional function, pain, muscle tone function, support of family, products and technology, and health services. INTERPRETATION Adults with CP experienced problems in a broad range of body functions and activities and indicated the importance of environmental factors for functioning. The identified categories will be added to the list of candidate items to reach consensus on an ICF Core Set for adults with CP. What this paper adds Including the lived experience is crucial for fully understanding functioning of adults with cerebral palsy (CP). Adults with CP perceive environmental factors as essential elements for everyday functioning. Adults with intellectual disability should be considered as a group with specific problems.
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Affiliation(s)
- Suzie Noten
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Rijndam RehabilitationRotterdamthe Netherlands
| | - Lorenzo A A Troenosemito
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Chonnanid Limsakul
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Department of Orthopedic Surgery and Physical MedicinePrince of Songkla UniversitySongkhlaThailand
| | - Melissa Selb
- ICF Research BranchNottwilSwitzerland,Swiss Paraplegic ResearchNottwilSwitzerland
| | - Vincent de Groot
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam University Medical CenterVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | | | | | - Sander R Hilberink
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Research Centre Innovations in CareRotterdam University of Applied SciencesRotterdamthe Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Rijndam RehabilitationRotterdamthe Netherlands
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20
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Izzah AN, Irwanto I, Andriati A, Gunawan PI. Assessment Quality of Life in Children with Cerebral Palsy, Ages 2–18 Years. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i22021.166-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Cerebral palsy is non-progressive disorder that can cause limited movement and lead to postural deformity in children, which can affects all the psychosocial aspects and, thus, impacts children’s’ quality of life as well. Assessment of quality of life is important to evaluate suitable intervention measures for children with cerebral palsy. Purpose: This study aims to investigate the domains and determine the quality of life in children with cerebral palsy between ages 2 and 18. Methods: This was a descriptive study that employed a cross-sectional design approach. Primary data was obtained through a questionnaire. This study used the pediatric quality of life inventory (PedsQL)TM 3.0 cerebral palsy module. The study was conducted from November 2019 to February 2020. The data was collected at the Department of Medical Rehabilitation at the Dr. Soetomo Hospital, Peduli CP Foundation, and the Happy CP Community. This study involved 52 subjects, aged 2–18 years. Results: Almost all of the subjects (76.90%) had an impaired or poor quality of life. From the seven existing domains, only one domain received a good score: the domain of movement and balance. Conclusion: Based on the PedsQLTM 3.0 cerebral palsy module, parents reported that the quality of life in children (ages 2–18 years) having cerebral palsy was still low. Only the movement and balance domain got a good score.
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21
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Puce L, Pallecchi I, Chamari K, Marinelli L, Innocenti T, Pedrini R, Mori L, Trompetto C. Systematic Review of Fatigue in Individuals With Cerebral Palsy. Front Hum Neurosci 2021; 15:598800. [PMID: 33790748 PMCID: PMC8005578 DOI: 10.3389/fnhum.2021.598800] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
In this systematic review, we collected and analyzed literature works comparing self-reported fatigue and objectively-measured fatigue in individuals with cerebral palsy (CP) and in age-matched typically developing/typically developed (TD) controls (Healthy). The search was conducted on four electronic databases/platforms (PubMed, Web of Science, Cochrane Library, and Scopus) using the key words “cerebral palsy” combined with “fatig*,” where the asterisk was used as a wildcard. As a critical appraisal tool, the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies (2017) was used. A total of 22 studies passed the critical appraisal rating and were included in both narrative and quantitative analyses. The overall evidence quality of the findings was considered very good. Data of objectively-measured fatigue in performing maximal fatiguing tasks indicated lower fatigue levels in participants with CP, possibly due to their pathological inability to recruit highly fatigable muscle fibers. Highly trained individuals with CP and TD controls performing maximal fatiguing tasks seem to be an exception to this, as they exhibited similar levels of fatigue. In submaximal fatiguing tasks, including daily physical activities, either objectively-measured or self-reported fatigue was higher in participants with CP than in TD controls, indicating a lower ability for development of neurophysiological compensation for fatigue among participants with CP. Further studies on fatigue are needed to gain an insight into the multifold mechanisms of fatigue in individuals with CP. Understanding fatigue mechanisms could help in setting up strategies for effective intervention programs, with benefits in healthcare and improved quality of life of individuals with CP. Systematic Review Registration: [PROSPERO 2019], identifier [CRD42019143524].
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Affiliation(s)
- Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Ilaria Pallecchi
- CNR National Research Council, SPIN Institute, Department of Physics, Genoa, Italy
| | - Karim Chamari
- ASPETAR, Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Laboratory "Sport Performance Optimization", National Center of Sports Medicine and Sports Sciences Centre national de médecine et des sciences du sport (CNMSS), Institut supérieur du sport et éducation physique (ISSEP) Ksar-Said Manouba University, Den Den, Tunisia
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Tiziano Innocenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy.,Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Riccardo Pedrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Trevarrow MP, Kleinsmith J, Taylor BK, Wilson TW, Kurz MJ. The somatosensory cortical activity in individuals with cerebral palsy displays an aberrant developmental trajectory. J Physiol 2020; 599:1281-1289. [PMID: 33296078 DOI: 10.1113/jp280400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022] Open
Abstract
KEY POINTS Individuals with cerebral palsy (CP) have a reduced somatosensory cortical response Somatosensory cortical response strength decreases from adolescence to early adulthood Somatosensory cortical responses in youth with CP are similar to adult controls Individuals with CP may have aberrant maturation of the somatosensory system ABSTRACT: Numerous studies have documented tactile and proprioceptive deficits in children with cerebral palsy (CP) and linked these with weaker somatosensory cortical activity. However, whether such aberrations in somatosensory processing extend and/or progress into adulthood remains poorly understood. In the current study, we used magnetoencephalography (MEG) to investigate the primary somatosensory responses in a sample of individuals with CP (N = 42; age = 9-28 years) and a cohort of healthy controls (N = 23; age range = 11-23 years). Briefly, transient electrical stimulation was applied to the right tibial nerve, and standardized low-resolution brain electromagnetic tomography (sLORETA) was used to image the dynamic somatosensory cortical response. We found that the strength of somatosensory cortical activity within the 112-252 ms time window was significantly reduced in the individuals with CP compared with the healthy controls (HC = 286.53 ± 30.51, 95% CI [226.74, 346.32]; CP = 208.30 ± 19.66,CI [169.77, 246.83], P = 0.0126). These results corroborate previous findings of aberrant somatosensory cortical activity in individuals with CP. Our results also suggest that the somatosensory cortical activity tends to become weaker with age, with a similar rate of neurophysiological change in individuals with CP and healthy controls (P = 0.8790). Visualization of regression models fitted to the data imply that youth with CP may have somatosensory cortical activity similar to adult controls. These findings suggest that some individuals with CP exhibit an aberrant developmental trajectory of their somatosensory system.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | | | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
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23
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van der Slot WMA, Benner JL, Brunton L, Engel JM, Gallien P, Hilberink SR, Månum G, Morgan P, Opheim A, Riquelme I, Rodby-Bousquet E, Şimşek TT, Thorpe DE, van den Berg-Emons RJG, Vogtle LK, Papageorgiou G, Roebroeck ME. Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data. Ann Phys Rehabil Med 2020; 64:101359. [PMID: 32061920 DOI: 10.1016/j.rehab.2019.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population. OBJECTIVES This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference. METHODS Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted. RESULTS In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5). CONCLUSIONS This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.
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Affiliation(s)
- Wilma M A van der Slot
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura Brunton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joyce M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wi, USA
| | - Philippe Gallien
- Breizh Paralysie Cérébrale Health Network, Pôle MPR Saint-Hélier, Rennes, France
| | - Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Grethe Månum
- Department of Research, Sunnaas Rehabilitation Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Arve Opheim
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Research and Development, Habilitation & Health, Region Västra Götaland and Department of Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Gothenburg, Sweden
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University Institute of Health Sciences, University of the Balearic Islands, Palma de Mallorca, Mallorca, Spain
| | - Elisabet Rodby-Bousquet
- Center for Clinical Research, Uppsala University, Region Västmanland, Västerås and Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Tülay Tarsuslu Şimşek
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Deborah E Thorpe
- Division of Physical Therapy, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura K Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
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Epidemiology of Cerebral Palsy in Adulthood: A Systematic Review and Meta-analysis of the Most Frequently Studied Outcomes. Arch Phys Med Rehabil 2020; 101:1041-1052. [PMID: 32059945 DOI: 10.1016/j.apmr.2020.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). DATA SOURCES Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes ("cerebral palsy," "adult," and "outcome assessment") in literature published between January 2000 and December 2018. STUDY SELECTION Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. DATA EXTRACTION Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. DATA SYNTHESIS Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P<.01, respectively). The Fatigue Severity Scale score was 4.1 (95% CI, 3.8-4.4). Epilepsy (28.8% [95% CI, 20.1-38.4]) and asthma (28.3% [95% CI, 18.7-38.9]) were especially prevalent comorbidities. CONCLUSIONS The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On average, adults with CP are fatigued, and a majority experience pain, are ambulant, and have little or no difficulty with manual ability. On average, 40% are employed and 30% live independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.
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25
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Henderson G, Beerse M, Liang H, Ferreira D, Wu J. Improvement in Overground Walking After Treadmill-Based Gait Training in a Child With Agenesis of the Corpus Callosum. Phys Ther 2020; 100:157-167. [PMID: 31593234 DOI: 10.1093/ptj/pzz144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Agenesis of the corpus callosum (ACC) is a rare congenital brain defect that produces a wide variety of cognitive and motor impairments. Literature regarding the response of pediatric populations with ACC to physical rehabilitation is scarce. Treadmill-based gait training (TT) has been shown to improve walking ability in some pediatric populations but has not been investigated in children with ACC. OBJECTIVE The purpose of this study was to investigate the effect of a novel treadmill intervention paradigm on the gait parameters of a child with ACC. DESIGN A single-participant design with 2 phases was used. METHODS The settings were the participant's home and the laboratory. The participant was a 13-year-old girl who had ACC and cortical visual impairment and who ambulated independently using a reverse walker for household and short community distances. A home-based TT intervention (2 phases of 3 months of training over 6 months) was implemented, and a laboratory-based gait analysis was conducted at 4 time points: baseline, after each of the 2 training phases, and 3 months after the cessation of training. The intervention consisted of weekly bouts of TT. Phase I incorporated forward, backward, and incline walking for 15 minutes each; in phase II, this protocol was continued, but short-burst interval training for 10 minutes was added. Data collected at each laboratory visit included spatiotemporal parameters and kinematics (joint angles) during overground and treadmill walking. RESULTS After both phases of training, increased step length, decreased step width, and foot progression angle and decreased variability of most spatiotemporal parameters were observed for the participant. Further, after phase II, increased peak extension at the hip, knee, and ankle, decreased crouched gait, and improved minimum foot clearance during overground walking were observed. Most gait improvements were retained for 3 months after the cessation of the intervention. LIMITATIONS The small sample size of this study and wide variety of presentations within individuals with ACC limit the generalizability of our findings. CONCLUSIONS TT may be a safe and effective treatment paradigm for children with ACC. Future research should investigate the effect of intervention dosage on gait improvements and generalization in individuals with ACC.
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Affiliation(s)
- Gena Henderson
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia
| | - Matthew Beerse
- Department of Health and Sports Science, University of Dayton, Dayton, Ohio
| | - Huaqing Liang
- Department of Physical Therapy, University of Illinois, Chicago, Illinois
| | - Diego Ferreira
- Department of Kinesiology and Health, Georgia State University
| | - Jianhua Wu
- Department of Kinesiology and Health, Georgia State University, 125 Decatur St, Atlanta, GA 30302 (USA); and Center for Movement and Rehabilitation Research, Georgia State University
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Van Campenhout A, Huenaerts C, Poulussen L, Prinsen SD, Desloovere K. Role of femoral derotation on gait after selective dorsal rhizotomy in children with spastic cerebral palsy. Dev Med Child Neurol 2019; 61:1196-1201. [PMID: 30834521 DOI: 10.1111/dmcn.14192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the long-term outcome of selective dorsal rhizotomy (SDR) on gait and the influence of previous femoral derotation osteotomy (FDO). METHOD In a retrospective cohort study of 29 children (16 females, 13 males) with spastic diplegic cerebral palsy, 14 children received FDO before SDR, whereas 15 children with moderate or near-normal internal femoral rotation during gait received only SDR. Three-dimensional gait data were obtained pre-FDO, pre-SDR, 1 year post-SDR, and 3 to 5 years post-SDR, to study the Gait Profile Score (GPS), pelvic tilt, and knee and hip kinematics. A mixed analysis of variance with the repeated measure 'time' was performed between different time points for each group. RESULTS Children who first underwent FDO and then SDR started with a more complex gait pathology but showed fewer gait deviations 3 to 5 years post-SDR, compared to children who only underwent SDR. This was reflected by a lower GPS and pelvic tilt, as well as less knee flexion in stance. INTERPRETATION The effect of SDR on gait is only significant in the mid- to long-term if the bony lever arms are also corrected. Thus, the clinical outcome after SDR is dependent on good proximal alignment. WHAT THIS PAPER ADDS Pelvic tilt remains stable after femoral derotation osteotomy (FDO)+selective dorsal rhizotomy (SDR). But pelvic tilt deteriorates after SDR only. Hip and knee extension is better after FDO+SDR than after SDR only. Spasticity reduction (by SDR) combined with bony lever arm correction (by FDO) improves gait.
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Affiliation(s)
- Anja Van Campenhout
- Department of Orthopaedics, University Hospital Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Catherine Huenaerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
| | | | - Sandra D Prinsen
- Department of Orthopaedics, University Hospital Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospital Leuven, Leuven, Belgium
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27
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Contribution of corticospinal drive to ankle plantar flexor muscle activation during gait in adults with cerebral palsy. Exp Brain Res 2019; 237:1457-1467. [PMID: 30900000 DOI: 10.1007/s00221-019-05520-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/13/2019] [Indexed: 01/02/2023]
Abstract
Impaired plantar flexor muscle activation during push-off in late stance contributes importantly to reduced gait ability in adults with cerebral palsy (CP). Here we used low-intensity transcranial magnetic stimulation (TMS) to suppress soleus EMG activity during push-off as an estimate of corticospinal drive in CP adults and neurologically intact (NI) adults. Ten CP adults (age 34 years, SD 14.6, GMFCS I-II) and ten NI adults (age 33 years, SD 9.8) walked on a treadmill at their preferred walking speed. TMS of the leg motor cortex was elicited just prior to push-off during gait at intensities below threshold for motor-evoked potentials. Soleus EMG from steps with and without TMS were averaged and compared. Control experiments were performed while standing and in NI adults during gait at slow speed. TMS induced a suppression at a latency of about 40 ms. This suppression was similar in the two populations when differences in control EMG and gait speed were taken into account (CP 18%, NI 16%). The threshold of the suppression was higher in CP adults. The findings suggest that corticospinal drive to ankle plantar flexors at push-off is comparable in CP and NI adults. The higher threshold of the suppression in CP adults may reflect downregulation of cortical inhibition to facilitate corticospinal drive. Interventions aiming to facilitate excitability in cortical networks may contribute to maintain or even improve efficient gait in CP adults.
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