Longitudinal changes in health-related quality of life in preschool children with cerebral palsy of different levels of motor severity

Impact of mother's care burden, fatigue and child's functional level on quality of life in spastic cerebral palsy

BACKGROUND AND PURPOSE

Cerebral palsy (CP) may be considered one of the most common motor disabilities that require a lot of caregiving from mothers or caregivers; therefore, the mothers of children with CP face a lot of difficulties in their caregiving, which in turn may affect the child's quality of life (QOL). This work was conducted to evaluate the impact of the children's functional level in different types of spastic CP, mothers' care burden (CB), and fatigue on the child's QOL.

METHODS

One hundred thirty-eight children with different types of spastic CP (unilateral and bilateral) with different levels of the gross motor function classification system (GMFCS), with an age range of 6-12 years, and their mothers with ages ranged from 25 to 45 years, participated in this study. Mother CB, fatigue, and child QOL were measured and compared between different groups by using the Zarit burden Interview (ZBI), Chalder Fatigue Questionnaire (CFQ), and Pediatric Quality of Life Inventory (PedsQL) CP Module, respectively.

RESULTS

There were significant differences in all measured variables (ZBI, CFQ, GMFCS, and PedsQL) with p-value <0.001 among the different spastic groups (unilateral and bilateral CP). However, the results revealed a positive impact of the child's GMFCS, mother's CB, and fatigue level on the quality of the child's life, with a greater effect on those with quadriplegic type.

CONCLUSION

The mother's CB and fatigue should be considered in the rehabilitation of spastic CP children based on their GMFCS, as they have a negative impact on child QOL; therefore, helping the mother with her needs should not be ignored, especially in families with severely spastic CP children and low financial income.

Factors affecting the health-related quality of life of children with cerebral palsy in Indonesia: a cross-sectional study

PURPOSE

Children with cerebral palsy (CP) and their parents experience various problems that can affect their quality of life. This study examined factors affecting the quality of life of children with CP.

METHODS

A cross-sectional study was conducted in Yogyakarta, Indonesia, from January to August 2019. The participants were consecutively recruited children with CP aged 2 to 18 years and their parents. Ninety-eight children with CP and their parents, specifically their mothers, were recruited. Children's health-related quality of life (HRQoL) was measured using the Pediatrics Quality of Life Cerebral Palsy. Parental HRQoL and stress were measured using the WHOQOL-BREF and Parenting Stress Index (PSI).

RESULTS

Functional level V was the most common category for both Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) (35% and 28%, respectively). Children's mean HRQoL was medium (49.81±20.35). The mean total PSI score was high (94.93±17.02), and 64% of parents experienced severe stress. Bivariate analysis showed that GMFCS, BFMF, number of comorbidities, presence of pain, and parental stress were significantly correlated with the total score for children's HRQoL (p<.05). Multiple linear regression analysis (p<.05) demonstrated that more severe GMFCS and parental stress were associated with lower mean HRQoL scores in children.

CONCLUSION

Factors including the level of GMFCS and parental stress affected the HRQoL of children with CP. Parental stress management should be included in the comprehensive management of these children.

Functional and environmental predictors of health-related quality of life of school-age children with cerebral palsy: A cross-sectional study of caregiver perspectives

BACKGROUND

Caregivers' reports often serve as a decision-making guide in the treatment and rehabilitation of children with cerebral palsy (CP). This study identified predictors of the caregiver-reported health-related quality of life (HRQoL) of school-age children with CP.

METHODS

A cross-sectional study was conducted using the convenience sample of 108 children with CP (60 males; aged 7-18 years; mean age 12 years 8 months [SD 3 years 5 months]). Caregivers reported their child's HRQoL using KIDSCREEN-27. Standard multiple regression analyses were conducted to test if the child characteristics (gender, age, Gross Motor Function Classification System-Expanded & Revised [GMFCS-E&R], Manual Ability Classification System [MACS], intellectual disability, health problems, communication, social skills, behavioural difficulties); family characteristics (income, type, home adaptation); physical, social and attitudinal barriers; environmental features; and family-centeredness of service delivery significantly predicted HRQoL.

RESULTS

Fine manual abilities, home adaptation and the magnitude of barriers predicted physical well-being. The child's challenging behaviour, the magnitude of barriers and the barriers related to different policies predicted psychological well-being. The home adaptation level and provision of general information about the child's disability and available types of services predicted HRQoL domain related to interactions and relationships with parents. Children with behavioural difficulties and more severe limitations in communication had less social support from friends and peers. The social skills and intellectual functioning combined with the parental ratings of the child's behaviour, other people's attitudes towards the child and the lack of support predicted HRQoL in the School Environment domain. The magnitude and frequency of barriers were the strongest predictors of general HRQoL.

CONCLUSION

From the caregivers' perspective, home adaptation, supportive laws and policies and family-centred rehabilitation care that meets the family needs may promote children's HRQoL. Specific interventions addressing modifiable environmental features and continuous support to children in improving their fine motor abilities, communication and social skills and families in managing behavioural difficulties may be relevant for HRQoL of school-age children with CP.

Psychometric Evaluation of the Polish Version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD)

PURPOSE

The assessment of the quality of life is an important element of the clinical examination of the patient. The aim of this study was translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire into Polish language, and testing of reliability and validity of the CPCHILD-PL for children with cerebral palsy (CP).

MATERIAL AND METHODS

A Polish version of CPCHILD was created according to internationally accepted guidelines. Parents (n=77) of 51 boys/26 girls between 3 and 17 years with CP with Gross Motor Function Classification System I-V (GMFCS I-V) participated. To assess the reliability each domain and the total measure was tested for internal consistency and test-retest reliability. Convergent validity was evaluated by correlating the CPCHILD-PL with the CHAQ (Childhood Health Assessment Questionnaire) questionnaire.

RESULTS

Test-retest reliability assessed by Spearman correlation coefficient for the final result of CPCHILD-PL and for most of domains were above 0.90. The values of Cronbach's-α coefficient (measuring internal consistency) were high for all domains (except for domain 5: Health) and the entire CPCHILD-PL, with the range 0.88-0.96. The comparison between CPCHILD-PL and the Disability Index (DI) of the CHAQ showed a negative correlation. The higher the DI, the lower the CPCHILD result. The Spearman's rank coefficient was -0.75.

CONCLUSION

The Polish version for the CPCHILD for children with CP seems to be reliable and valid tool for assessing health-related quality of life from the caregiver perspective. It can be used in research and clinical practice for evaluation and comparison of health-related quality of life in children with CP in different countries.

Dynamic and static stability in para-athletes with cerebral palsy considering their impairment profile

BACKGROUND

Balance impairment is a common feature in people with cerebral palsy (CP), affecting the performance of daily-life and physical activities.

OBJECTIVES

To (1) explore the absolute and relative intrasession reliability of two balance tests to assess dynamic and static balance in ambulant para-athletes with CP; (2) explore the relationships between the two balance tests to determine potential application in sport classification; (3) assess the differences between CP profiles (ie, spastic diplegia, athetosis/ataxia, and spastic hemiplegia) in comparison to those with a minimum impairment; and (4) compare the outcomes of the static and dynamic balance of ambulant para-athletes with CP regarding controls.

METHODS

A group of 129 male well-trained para-footballers with CP, classified as Level I according to the Gross Motor Function Classification System, participated in the present study. Static balance was assessed using the One-Leg Stance test, performed bilaterally on a force platform, and the dynamic balance was assessed in two conditions of the Tandem Walk test (TW): walking heel-toe contact over a 5 -m straight line and performing 10 steps.

RESULTS

Moderate-to-excellent intrasession reliability (intraclass correlation coefficient = 0.60-0.98) was obtained for all the measurements and groups. However, only small to moderate correlations were found between the dynamic and the static measurements of balance for the CP group when performing the One-Leg Stance test with the unimpaired or dominant leg (0.23 < r < 0.30; P < .01). The TW performed over 10 steps revealed more sensitivity to discriminate between CP profiles. Those para-athletes with ataxia/athetosis performed worse in all the tests whereas all CP profiles performed worse than the control group (P < .01).

CONCLUSIONS

Balance performance and postural control are constrained to a higher extent in those with impaired voluntary control due to ataxia or with involuntary contractions of the muscles due to athetosis.

Calidad de vida relacionada con características sociodemográficas y clínicas en niños con parálisis cerebral

La parálisis cerebral  (PC) es la causa más frecuente de discapacidad en la infancia. El objetivo fue determinar  la calidad de vida relacionada con la salud (CVRS)  de niños y niñas entre 8 y 12 años con PC y relacionarlo con características sociodemográficas y clínicas. Estudio descriptivo correlacional; se aplicó cuestionario con información sociodemográfica y clínica y el Kidscreen 27 a una población de 100 niños con PC o a sus cuidadores principales, para el caso de aquellos con dificultades cognitivas o comunicativas. La dimensión de entorno escolar y estado de ánimo y sentimientos fueron mejor percibidas. En los niños más pequeños (8 a 9 años) se encontró una mejor percepción sobre la actividad física y la vida familiar y el tiempo libre, mientras que los niños mayores (10 a 12 años) en el dominio de apoyo social y amigos. Los niños de estrato socioeconómico alto dieron mayor  puntuación en todos los dominios de calidad de vida al igual que los niños menos comprometidos en su función motora gruesa.  El más alto nivel educativo de los cuidadores, estrato socioeconómico alto y menor severidad en el compromiso motor en los niños con PC, se relaciona con una mejor calidad de vida.

Novel insights into cerebral palsy

Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement and motor skills, and is attributed to injury to the developing brain. CP affects about 1 in 500 neonates. CP shows clinical features which evolve with age, and these may over time lead to deterioration of motor function although the lesion to the developing brain is non-progressive. The underlying causes for CP remain unclear. Based on recent research we are able to give a physiological explanation on the appearance and development of the condition. The damage to the central nervous system causes a change in collagen structure, with a higher level of deposition of collagen around the muscles, increasing throughout life. Assuming this premise is correct, the question is, will it by any treatment be possible to delay or prevent this collagen accumulation in the CP muscles, thereby giving CP patients a better prognosis in the future.

Functionality, school participation and quality of life of schoolchildren with cerebral palsy

Abstract Introduction: The quality of life (QoL) of schoolchildren with cerebral palsy (CP) should be evaluated considering the functional variability of the child with CP with an extended view on functionality in the school context and the determinants of QoL. Objective: to evaluate the school participation and the QoL of schoolchildren with CP in Recife's municipal public network, as well as to analyze the influence of GMFCS levels and motor performance on these variables in the study population. Method: This is an exploratory observational study whose evaluation model was structured based on the International Classification of Functioning, Disability and Health (CIF). Children with CP were classified in the Gross Motor Function Classification System (GMFCS) and evaluated according to Gross Motor Function Measure-88 (GMFM-88). The School Function Assessment (SFA) and the Quality of Life Questionnaire for Cerebral Palsy (CPQOL-Caregiver) were answered by teachers and mothers, respectively. Results: In the study population, the higher the GMFCS level, the lower the participation and the lower the independence in school activities, aspects that add to the QoL construct, mainly with less functionality, less emotional well-being and self-esteem, and lower family health. Conclusion: GMFCS levels and motor performance of schoolchildren with CP can affect school participation and QoL, and it is important to consider each child's individual and contextual factors. These results can help the development of functional, care, inclusion and pedagogical strategies for students with CP.

Responsiveness and minimal clinically important difference of TNO-AZL Preschool Children Quality of Life in children with cerebral palsy

PURPOSE

To examine the responsiveness and minimal clinically important difference (MCID) of the TNO-AZL (Netherlands Organization for Applied Scientific Research Academic Medical Centre) Preschool Children Quality of Life (TAPQOL) in children with cerebral palsy (CP).

METHODS

Ninety-seven children with CP (60 males, 37 females; aged 1-6 years) and their caregivers were recruited from the rehabilitation programs of Chang Gung Memorial Hospital in Taiwan for this 6-month longitudinal follow-up study. The Functional Independence Measure for Children (WeeFIM) and TAPQOL outcomes were measured at baseline and at a 6-month follow-up. Responsiveness was examined using the standardized response mean (SRM). The distribution-based and anchor-based MCID were determined. The TAPQOL outcomes include physical functioning (PF), social functioning (SF), cognitive functioning (CF), and emotional functioning (EF) domains.

RESULTS

The responsiveness of the TAPQOL for all of TAPQOL domains was marked (SRM = 1.12-1.54). The anchor-based MCIDs of TAPQOL for PF, SF, CF, EF, and total domains were 1.25, 3.28, 2.93, 2.25, and 1.73, respectively, which were similar to the distribution-based MCID values of TAPQOL, except in the PF domain. The distribution-based MCIDs of TAPQOL in various domains were 2.85-3.73 when effect size (ES) was 0.2, 7.13-9.32 when ES was 0.5, and 11.40-14.91 when ES was 0.8.

CONCLUSIONS

TAPQOL is markedly responsive to detect change in children with CP. The caregivers perceived the minimally important change in HRQOL of their children at a relatively low treatment efficacy. Researchers and clinicians can utilize TAPQOL data to determine whether changes in TAPQOL scores indicate clinically meaningful effects post-treatment and at the follow-up.

Child's quality of life and mother's burden in spastic cerebral palsy: a topographical classification perspective

Objective

To evaluate the child’s quality of life (QoL), mother’s burden, and correlation between these parameters in children with spastic cerebral palsy (CP).

Methods

Children with spastic CP (n = 120; mean age: 8.64 ± 3.45 years; range: 2–17 years) were classified into three groups of diplegia, hemiplegia, and quadriplegia based on topographical classification. The Pediatric Quality of Life Inventory and Zarit Burden Interview were used to determine the child’s QoL and the mother’s burden scores, respectively.

Results

Children’s QoL scores were lower in the quadriplegia group than in the hemiplegia and diplegia groups (except for emotional functioning). The mother’s burden was lower in the quadriplegia group than in the other groups, and it was lower in the diplegia group than in the hemiplegia group. Increases in children’s QoL scores were associated with decreases in the mothers’ burden scores.

Conclusion

Children’s QoL is associated with the mother’s burden in spastic CP, and quadriplegic children and their mothers are more affected. The burden of mothers ranked the highest in the quadriplegia group, followed by the diplegia group and the hemiplegia group. Topographical classification is a good indicator for children’s QoL and the mother’s burden in spastic CP.