Health and well being of adults with cerebral palsy

An evaluation of factors contributing to employment in adults with cerebral palsy

PURPOSE

To explore the impact of a selection of contributing factors on employment in adults with cerebral palsy (CP).

METHOD

Eighty adults with CP (39 male, median age 31, IQ > 70) were evaluated using standardized tests and questionnaires for hand function, gross motor function, pain, depressive symptoms, fatigue, social participation, performing daily activities, supportive materials, and mobility aids. Two separate analyses were performed. Firstly, differences between three subgroups were investigated: employee (n = 43), volunteer/sheltered (n = 14), and unemployed (n = 23). Secondly, multivariable regression analysis was applied to investigate the association between functional factors and employment hours.

RESULTS

Compared to employees, volunteer/sheltered workers performed significantly slower hand function tasks (p < 0.001). Participants in the employee group had primarily MACS I (55.8%) or MACS II (44.9%) scores. The employee group showed significantly (p < 0.001) higher social participation and performance in daily activities. Thirty-eight percent of the variance in working hours could be explained by social participation, daily activities, fatigue, and gross motor function.

INTERPRETATION

Employees are more likely adults with CP with better manual abilities. Sheltered/volunteer workers showed slower execution in hand function and higher limitations in fine motor skills. Social participation, performing daily activities, fatigue, and gross motor function are functional factors associated with hours of employment.

Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy

BACKGROUND

Delays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life.

METHODS

This article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3-12 months old and will track social and executive function across the first 2 years of their life, when infants are 3-7, 8-12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3-7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months.

DISCUSSION

This study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.

A synthesis of the characteristics of dance interventions engaging adults with neurodevelopmental disabilities: a scoping review

PURPOSE

Dance can encourage physical activity and promote physical, cognitive, and social development for adults who have neurodevelopmental disabilities (NDD). Dance is defined as a form of expression that may be structured, exploratory, and/or cultural. Current literature supports the benefits of participation in dance for persons with NDD, however less is known about what characteristics support participation in dance.

MATERIALS AND METHODS

A scoping review was conducted to synthesize the characteristics of dance interventions, teaching strategies, and outcome measures used to assess the efficacy of dance interventions. Searches were conducted across six databases and the results were screened according to: i) adults ≥18yrs of age with a diagnosed NDD, and ii) the program incorporated activities that fall within our definition of dance.

RESULTS

A range of dance forms and NDDs were represented across the fourteen studies reviewed. Few provided explicit details of the dance interventions, nor how instruction was adapted. All studies that measured fitness, mobility, balance, posture, and functional activity showed significant improvement. Studies that measured psychosocial and well-being focused on autistic characteristics and showed mixed results.

CONCLUSIONS

Details of interventions, instructions, measures of movement performance, and the relationship between outcomes and the interventions require further development and research.

Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy

PURPOSE

To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention.

MATERIALS AND METHODS

An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context.

RESULTS

Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living.

CONCLUSIONS

The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.

Experiences of young adults with cerebral palsy in pediatric care transitioning to adult care

AIM

To increase understanding regarding the experiences and values of young adults with cerebral palsy (CP), and their caregivers, regarding pediatric rehabilitation-related care, including perceived barriers and potential facilitators to transition to adult care.

METHOD

This was a qualitative descriptive study that used 20 semi-structured interviews (13 caregivers and seven patient-caregiver dyads).

RESULTS

We identified four major themes: (1) the value and security of long-term relationships; (2) feeling 'rudderless' navigating the logistics of transition; (3) differences in pediatric versus adult models of care; and (4) perceived lack of provider expertise and comfort in adult care settings. Young adults with CP who had not yet transitioned to adult rehabilitation care and their caregivers placed high value on provider relationships and expertise, advanced planning, communication, and coordination of care.

INTERPRETATION

Identified barriers and potential facilitators to the transition to adult rehabilitation care reflected the uncertainty that accompanies leaving an established healthcare relationship. Challenges related to the logistics of this transition, differences in models of care, and perceived lack of provider comfort and expertise in adult care settings were also noted. Our findings could be used to develop and study patient-centered and family-centered transition processes for individuals with CP to promote age-appropriate and developmentally appropriate lifespan care.

Adults with cerebral palsy and functional decline: A cross-sectional analysis of patient-reported outcomes from a novel North American registry

BACKGROUND

Adults with cerebral palsy (CP) have unique healthcare needs and risks, including high risk of functional decline. Understanding functional decline is an area of priority for CP research.

OBJECTIVE

Describe factors associated with patient-reported changes in function among adults with CP living in the community.

METHODS

Cross-sectional analysis of adult patient-reported outcomes collected by the CP Research Network (CPRN) Community Registry.

RESULTS

Participants included 263 respondents (76% female (n = 200); mean age 42 years (SD 14); 95% White (n = 249); 92% non-Hispanic (n = 241)). Many reported functional changes, most commonly a decline in gross motor function since childhood (n = 158, 60%). Prevalence of gross motor decline varied significantly by Gross Motor Function Classification System (GMFCS) level (p < 0.001), but neither hand function decline (p = 0.196) nor communication decline (p = 0.994) differed by GMFCS. All types of decline increased with increasing age, with statistically significant differences between age groups (p < 0.001 gross motor; p = 0.003 hand function; p = 0.004 communication). Those with spastic CP (n = 178) most commonly reported gross motor functional decline (n = 108/178, 60.7%). However, the prevalence of gross motor decline did not significantly differ between those with spastic CP and those without spastic CP (p = 0.789).

CONCLUSIONS

Many adults in the CPRN Community Registry reported functional decline, most commonly in gross motor function. Functional decline across domains increased with age. Further research into risk stratification and preventive and rehabilitative measures is needed to address functional decline across the lifespan.

Working Memory Training in Norwegian Children with Cerebral Palsy (CP) Show Minimal Evidence of Near and No Far Transfer Effects

In children with cerebral palsy (CP), learning disabilities are well documented, and impairments in executive functions, such as attention, inhibition, shifting and working memory, represent significant burdens on patients, their families and the society. The aim of this study was to evaluate whether Cogmed RM working memory training could improve working memory in children with CP and investigate whether increased working memory capacity would generalize to other cognitive functions. Twenty-eight children completed the training and the results were compared to a waitlist control group (n = 32). The results yielded three main findings. First, children with CP improved with practice on trained working memory tasks. Second, the intervention group showed minimal near transfer effects to non-trained working memory tasks. Third, no effects on cognitive and behavioral far transfer measures were found.

Spinal cord microstructural changes are connected with the aberrant sensorimotor cortical oscillatory activity in adults with cerebral palsy

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.

Rhythm and Reaching: The Influence of Rhythmic Auditory Cueing in a Goal-Directed Reaching Task With Adults Diagnosed With Cerebral Palsy

Improvements in functional reaching directly support improvements in independence. The addition of auditory inputs (e.g., music, rhythmic counting) may improve goal-directed reaching for individuals with cerebral palsy (CP). To effectively integrate auditory stimuli into adapted teaching and rehabilitation protocols, it is necessary to understand how auditory stimuli may enhance limb control. This study considered the influence of auditory stimuli during the planning or execution phases of goal-directed reaches. Adults (with CP = 10, without CP = 10) reached from a home switch to two targets. Three conditions were presented-no sound, sound before, and sound during-and three-dimensional movement trajectories were recorded. Reaction times were shorter for both groups in the sound before condition, while the group with CP also reached peak velocity relatively earlier in the sound before condition. The group with CP executed more consistent movements in both sound conditions. Sound presented before movement initiation improved both the planning and execution of reaching movements for adults with CP.

Quality of Life in Young Adults With Cerebral Palsy: A Longitudinal Analysis of the SPARCLE Study

Introduction: While most people with cerebral palsy (CP) will have a life expectancy similar to that of the general population, international research has primarily focused on childhood and adolescence; and knowledge about the quality of life (QoL) of young adults with CP, its trajectories, and associated factors remains scarce.

Methods: This longitudinal study included young adults with CP living in five European regions and who had previously participated in the SPARCLE cohort as children and/or adolescents. Their QoL in the psychological well-being and social relationships domains was estimated using age-appropriate validated instruments (KIDSCREEN-52 in childhood/adolescence and WHOQOL-Bref in young adulthood). We used generalized linear mixed-effect models with random intercept to estimate long-term trajectories of QoL in both domains and to investigate whether severity of impairment, pain, and seizure influenced these trajectories. We sought to identify potentially different trajectories of QoL from childhood to adulthood using a shape-based clustering method.

Results: In total, 164 young adults with CP aged 22–27 years participated in the study. Psychological well-being linearly decreased by 0.78 points (scale 0–100) per year (95% confidence interval (CI) −0.99 to −0.56) from childhood to young adulthood, whereas QoL in the social relationships domain increased (β coefficient 1.24, 95% CI 0.92–1.55). Severity of impairment was associated with reduced QoL in all life periods of the study (childhood, adolescence, and young adulthood): motor impairment with social relationships, and more nuancedly intellectual disability with psychological well-being and social relationships. At all periods, frequent pain significantly reduced psychological well-being, and seizures were associated with lower QoL in the social relationships domain. In both domains, we identified a group of individuals with CP who presented a reverse trajectory compared with the general QoL trajectory.

Conclusion: Identification of QoL trajectories and their associated factors yields improved knowledge about the experience of individuals with CP until young adulthood. Further studies are needed to better understand the determinants that have the greatest influence on the different shapes of long-term trajectories of QoL.

Microstructural changes in the spinal cord of adults with cerebral palsy

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.

Determinants of participation and quality of life of young adults with cerebral palsy: longitudinal approach and comparison with the general population - SPARCLE 3 study protocol

Background

Effective inclusion in society for young people with disabilities is increasingly seen as generating opportunities for self-development, and improving well-being. However, significant barriers remain in the vast majority of activities meaningful for young adults. Research argues that various personal (disabilities, health) and environmental (access to the resources needed, accessible environment, discrimination, lack of personal economic independence) factors contribute to limited participation. However, previous studies conducted in young people with cerebral palsy (CP) mainly investigated the transition period to adulthood, and did not fully consider the whole range of impairment severity profiles or environmental barriers. In this study, we will use the follow-up of the SPARCLE cohort and a comparison group from the general population (1) to investigate the impact of the environment on participation and quality of life of young adults with CP, (2) to determine predictors of a successful young adulthood in educational, professional, health and social fields, (3) to compare quality of life and frequency of participation in social, work and recreational activities with the general population, (4) to document on participation and quality of life in those with severe disabilities.

Methods

The SPARCLE3 study has a combined longitudinal and cross-sectional design. Young adults with CP aged 22 to 27 years in 6 European regions previously enrolled in the SPARCLE cohort or newly recruited will be invited to self-complete a comprehensive set of questionnaires exploring participation (daily life and discretionary activities), health-related quality of life, body function, personal factors (health, personal resources), and contextual factors (availability of needed environmental items, family environment, services provision) during home visits supervised by trained researchers. Proxy-reports or adapted questionnaires will be used for those with the most severe impairments. The recruitment of a large group from the general population (online survey) will enable to identify life areas where the discrepancies between young people with CP and their able-bodied peers are the most significant.

Discussion

This study will help identify to what extent disabilities and barriers in environment negatively affect participation and quality of life, and how previous valued experiences during childhood or adolescence might modulate these effects.

Leucine Supplementation Increases Muscle Strength and Volume, Reduces Inflammation, and Affects Wellbeing in Adults and Adolescents with Cerebral Palsy

BACKGROUND

Spastic cerebral palsy (CP) is characterized by muscle weakness owing, in part, to a blunted muscle protein synthetic response. This might be normalized by long-term leucine supplementation.

OBJECTIVES

The study assessed the effects of 10 wk leucine supplementation in adolescents and adults with CP.

METHODS

The study was a single-center randomized controlled trial. Twenty-four participants were randomly assigned to a control group (n = 12) or a leucine group (n = 12). l-Leucine (192 mg/kg body mass) was dissolved in water and administered daily for 10 wk. The primary outcome measures of elbow flexor muscle strength and muscle volume (measured by 3D ultrasound technique) and inflammation [C-reactive protein (CRP) concentration] were assessed before and after the 10 wk, alongside the secondary outcomes of body composition (measured by CP-specific skinfold assessment), metabolic rate (measured by indirect calorimetry), and wellbeing (measured by a self-reported daily questionnaire). Data were compared via a series of 2-factor mixed ANOVAs.

RESULTS

Twenty-one participants completed the intervention (control group: n = 11, mean ± SD age: 18.3 ± 2.8 y, body mass: 48.8 ± 11.9 kg, 45% male; leucine group: n = 10, age: 18.6 ± 1.7 y, body mass: 58.3 ± 20.2 kg, 70% male). After 10 wk, there was a 25.4% increase in strength (P = 0.019) and a 3.6% increase in muscle volume (P = 0.001) in the leucine group, with no changes in the control group. This was accompanied by a 59.1% reduction in CRP (P = 0.045) and improved perceptions of wellbeing (P = 0.006) in the leucine group. No changes in metabolism or body composition were observed in either group (P > 0.05).

CONCLUSIONS

Improvements in muscle strength and volume with leucine supplementation might provide important functional changes for adults and adolescents with CP and could be partly explained by reduced inflammation. The improved wellbeing highlights its capacity to improve the quality of daily living. This trial was registered at clinicaltrials.gov as NCT03668548.

The somatosensory cortical activity in individuals with cerebral palsy displays an aberrant developmental trajectory

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.

A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time. Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment. Setting: Research laboratory and community. Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78 ± 13.89 years, lived with SCI for 17.06 ± 14.6 years; 61.1% were female. Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control. Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life - short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST). Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P = 0.047, d_z= 0.507) and FIST scores improved (P = 0.035, d_z = 0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P = 0.05, d_z= 1.566) and Psychological (P = 0.040, d_z= 0.760) domains. Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.

The Impact of Vocational Interventions on Vocational Outcomes, Quality of Life, and Community Integration in Adults with Childhood Onset Disabilities: A Systematic Review

Purpose Despite the desire and ability to work, individuals with childhood onset disabilities are under-represented in employment. Vocational interventions alleviate some barriers to obtaining and maintaining employment for this population. The research question addressed is: What is the impact of vocational interventions on vocational outcomes, quality of life (QoL), and community integration (CI) in adults with childhood onset neurological disabilities including cerebral palsy (CP), spina bifida, and acquired brain injury (ABI)? Methods A literature search was conducted in multiple electronic databases. All experimental and observational studies with comparator group(s) were included. Two reviewers independently completed titles and abstracts screening, full text screening, data abstraction, and risk of bias assessment. Results Seventeen studies were eligible for final inclusion including three randomized-controlled trials, four non-randomized studies, and ten observational studies. Sixteen of seventeen studies included only individuals with ABI, while one study included individuals with CP. Vocational interventions from experimental studies were mainly components of multi-faceted interventions. Most observational studies were from the United States Vocational Rehabilitation Service. Conclusions Vocational interventions may be effective in improving vocational outcomes, QoL, and CI for individuals with ABI. There is limited experimental evidence on interventions that specifically target employment. Observational data suggest that receiving job placement assistance, on-the-job training and supports, counselling/guidance, maintenance, and supported employment successfully predicted employment outcomes.

Cerebral palsy prevalence, subtypes, and associated impairments: a population-based comparison study of adults and children

AIM

To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP.

METHOD

CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), and with the most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males).

RESULTS

Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01).

INTERPRETATION

Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed.

WHAT THIS PAPER ADDS

Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.

Oral health outcomes for people with cerebral palsy: a scoping review protocol

OBJECTIVE

This review aims to systematically map the literature reporting on oral health outcomes experienced by people with cerebral palsy.

INTRODUCTION

At present, there are no documented systematic reviews reporting on oral health outcomes for people of all ages with cerebral palsy. Subsequently, there are no clear guidelines, frameworks or detailed oral health recommendations for people with cerebral palsy. Considering the importance of oral health on general well-being and quality of life, it is important that it is not overlooked when focusing on patient-centered care for people with cerebral palsy.

INCLUSION CRITERIA

Studies that focus on oral health, including dental diagnosis, trauma and/or treatment, facial pain, saliva, and sleep apnea, and/or make statements regarding oral health pertaining to cerebral palsy will be considered for inclusion inthis scoping review.

METHODS

This review will be conducted in accordance with the guidelines outlined by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Articles published in any language will be considered for inclusion, with no restriction on publication date. The search databases will include the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase and Dentistry and Oral Science. A search of gray literature will also be conducted. Extracted data relevant to the scoping review will be performed by two reviewers.

Is there evidence of benefits associated with dancing in children and adults with cerebral palsy? A scoping review

Purpose: Cerebral palsy is a neurological disorder not only affecting motor functions but also cognitive and psychosocial dimension. Multispecialty therapies are needed to address these dimensions. Dance practice provides multidimensional benefits for people with various neurological disorders and may present a real potential for people with cerebral palsy. A scoping review is conducted to evaluate the impact of dance in children and adults with cerebral palsy, based on the Human Development Model-Disability Creation Process 2 and its three key concepts: personal factors, environmental factors and life habits.Materials and methods: Studies were selected based on a systematic search of published literature in the following databases PubMed, Medline, EBM Reviews, EMBASE and CINAHL. Studies addressing any concepts on the impact of dance training on motor, cognitive and psychosocial dimensions in people with cerebral palsy were included.Results: Seven studies representing 45 children and 12 adults with cerebral palsy were selected. They had heterogeneous populations, protocols and outcomes measures, but overall covered the three main concepts of the model. Dance may have both motor and social benefits although the evidence remains weak.Conclusions: Dance appears to be a promising activity for people with cerebral palsy. Recommendations are proposed for future studies.Implications for rehabilitationCerebral palsy affects motor and cognitive functions and has social repercussions.Dance can be a promising activity for people with a cerebral palsy.Dance may have both motor and social benefits although the evidence remains weak.

Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial

BACKGROUND

Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises.

OBJECTIVE

The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP.

METHODS

The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel.

RESULTS

The trial has not started and is pending local institutional review board approval.

CONCLUSIONS

Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03744884; https://clinicaltrials.gov/ct2/show/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/11470.

From childhood to adulthood: health care use in individuals with cerebral palsy

AIM

To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status.

METHOD

In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed.

RESULTS

The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition.

INTERPRETATION

Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies.

WHAT THIS PAPER ADDS

Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC (n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service (n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month (p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month (p < .001), and state expenditures by US$839/month (p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees' age.

Utilization of Physical Therapy Services During Transition for Young People With Cerebral Palsy: A Call for Improved Care Into Adulthood

BACKGROUND

Many young adults with cerebral palsy (CP) face limited participation in activities, including employment and independent living. Physical therapy during the transition period can help to support participation through promotion of self-care, ambulation, and functional mobility. Thus, ensuring appropriate access to physical therapy services for young people who can benefit from them before, during, and after transition is imperative.

OBJECTIVE

The objective of this study was to identify factors contributing to the utilization of physical therapy services for youth with CP both during and after secondary school.

DESIGN

The design was a deidentified secondary analysis of the National Longitudinal Transition Study 2 (NLTS2).

METHODS

Multivariate regression models were run to examine demographic and disability characteristics influencing utilization of physical therapy services for youth with CP both during and after secondary school.

RESULTS

The total weighted population sample included 35,290 young people with CP. When all youth were in secondary school, 59.4% of the youth utilized physical therapy services; however, once all youth were out of school, only 33.7% of them were reported to have utilized physical therapy since leaving secondary school. For young people with difficulties accessing general disability support services, demographic characteristics, including sex, race, income, and parent education status, influenced use of physical therapy services in addition to disability characteristics.

LIMITATIONS

This population sample included only young people in special education with Individual Education Plans (IEPs) and may not generalize to young people with CP in general education settings.

CONCLUSIONS

Frequency of physical therapy services decreases drastically once young adults with CP leave secondary school. Future work should examine this trend in more depth to identify therapy intervention strategies to optimize participation in young adult life for persons with CP.

Accelerated functional losses in ageing congenital Minamata disease patients

Severe methylmercury poisoning occurred in Minamata and neighboring communities in Japan during the 1950s and 1960s. A considerable number of children were born with conditions resembling cerebral palsy, later known as congenital Minamata disease. Although surviving patients are now in their 50s or 60s, few assessments of functional capacities in daily living have been performed. We assessed the changes in Activities of Daily Living (ADL) status of 11 patients over a 10-year period. For assessment of ADL, we applied the Barthel Index (BI) and the Functional Independence Measure (FIM). We obtained the patients' current and previous status information by interview of their caregivers or from medical records and then compared them using the Wilcoxon signed-rank test. Both ADL measures, including the status related with cognition, had significantly declined during the 10 years. The same was true for the overall BI score (p = 0.01). Similarly, all functions of the FIM scores declined (i.e., self-care, sphincter control, mobility, locomotion, communication, and social cognition), and for FIM physical and cognition subscores as well as FIM total score, the declines were statistically significant. The present study indicates that the ADL status of congenital Minamata disease patients, now in their 50s or 60s, has substantially declined during the last 10 years; a decline that was much steeper in comparison with expectation in subjects of similar ages, but in agreement with accelerated ageing also reported in subjects with cerebral palsy, past polio infection, or epilepsy. While already incapacitated due to the prenatal methylmercury poisoning, their accelerated ageing may suggest that patients with developmental neurotoxicity have less reserve capacity to compensate for normal ageing. These patients will need continuous and increasing medical and welfare support in the community.

Head Control Changes After Headpod Use in Children With Poor Head Control: A Feasibility Study

PURPOSE

To determine the feasibility of Headpod use to improve head control in children with cerebral palsy classified as Gross Motor Function Classification System level V.

METHODS

Children (3-11 years) with poor head control were video recorded before and after 3 and 6 months of Headpod use. Head control without Headpod was measured by active time children could hold head upright and number of head bobs in 5 minutes.

RESULTS

Fourteen children enrolled with 43% attrition rate. While average active time increased, average head bobs decreased and there were significant improvements in active time, but not head bobs. Active times were higher at 6 months compared with 3 months and baseline. Surveyed parents reported that the changes were apparent, supporting the large quantitative treatment effect.

CONCLUSIONS

Six months of Headpod use, 45 minutes per day, appears to be feasible, has a large effect on active head control, and merits a larger randomized controlled trial.

Quality of life as assessed by adults with cerebral palsy

Aim

We explored the quality of life of adults with cerebral palsy without an intellectual disability and the predictors of quality of life.

Background

Because cerebral palsy is a disease that manifests in childhood, much of the research into quality of life for those dealing with it focuses on children; there are few studies that evaluate the quality of life of adults with cerebral palsy. Therefore, it is important to consider their perceptions in order to improve their general wellbeing and self-determination.

Design

This was a descriptive, cross-sectional study.

Method

Quality of life was measured using the GENCAT Quality of Life Scale. Demographic and personal variables were also collected and examined. Participants comprised 75 adults (58.7 percent men, mean age = 40.84 years) with cerebral palsy who were members of the National Cerebral Palsy Association of Spain between 2014 and 2015. A linear multivariate model was examined as well.

Results

The overall mean score indicator of participants’ quality of life was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. Examining the level of qualification, we found significant differences in the factors “personal development” and “self-determination,” and those with a university education obtained higher scores than their less-educated counterparts. Having a partner was related to higher quality of life standard scores. After constructing a linear model, it was observed that maintaining sexual relationships was another factor that increased participants’ quality of life.

Conclusion

This study highlights the importance of social and romantic relationships to achieve a better quality of life in adults with cerebral palsy who do not have an intellectual disability. Social integration and sexuality education programs should be developed to improve their quality of life.

Falls Among Wheelchair and Scooter Users with Multiple Sclerosis—A Review

Falls are increasingly recognized as a threat to the safety, health and well-being of people with multiple sclerosis (MS), and emerging evidence suggests that full time wheelchair and scooter users with MS have unique fall prevention needs. This review is comprised of three parts. Part 1 summarizes findings describing influences on falls among full time wheelchair and scooter users with MS and associated clinical implications. Although further studies are needed, early findings regarding influences on fall risk operating in this specific population highlight the importance of addressing falls that occur during activities of daily living, the high frequency of falls occurring in the bathroom, and both extrinsic (e.g., wet/slippery surfaces) and intrinsic (e.g., muscle spasticity/weakness) contributors to falls. Part 2 of this review describes available evidence regarding interventions to prevent falls in full time wheelchair and scooter users with MS. Because intervention work in this area is limited to one pilot study, Part 3 presents priorities for future research and identifies the need for randomized trials evaluating fall prevention programs that address diverse fall risk factors and allow for development and attainment of individualized fall prevention goals.

Course of employment in adults with cerebral palsy over a 14-year period

AIM

To explore the course of employment in adults with cerebral palsy (CP) over 14 years, and to identify subgroups at risk for unemployment.

METHOD

Sixty-five adults with CP (33 males, 32 females; baseline age 25y 8mo, standard deviation [SD] 3y 2mo; intellectual impairment 25%; bilateral CP 65%) participated in a prospective cohort study. Self-reports of employment and work hours per week in 1996, 2000, and 2010 were documented. The course of employment (including sheltered work) and work hours per week were analysed, using generalized estimating equations (GEE).

RESULTS

Overall, employment rate was stable over time (38-45%, p=0.413), but lower than in the general population (75-86%, p<0.001). Employment rates were specifically low in adults with intellectual impairment, bilateral CP, and in adults with Gross Motor Function Classification System (GMFCS) levels IV and V. Work hours per week declined (35.0 [SD 7.9] to 31.2 [SD 10.3], p=0.033), especially among females (32.3 [SD 6.4] to 23.4 [SD 7.4], p<0.001). Similar to the general population, females often worked part-time.

INTERPRETATION

Employment was low compared with the general population, but remained stable in the long term; however, work hours per week decreased. Adults with intellectual impairment, bilateral CP, and GMFCS levels IV and V are subgroups at risk for unemployment.

Describing heterogeneity of unmet needs among adults with a developmental disability: An examination of the 2012 Canadian Survey on Disability

BACKGROUND

As a signatory to the UN Convention on the Rights of Persons with Disabilities, Canada has committed to protect the rights and dignity of persons with developmental disabilities (DD), which means that labour markets, education, and training opportunities should be inclusive and accessible.

PURPOSE

Describe the unmet employment, education and daily needs of adults with DD, with a sub analysis of persons with autism spectrum disorder (ASD) and cerebral palsy (CP) in Canada, to inform efficient and equitable policy development.

METHODS AND PROCEDURES

Secondary analysis of 2012 Canadian Survey on Disability was used to study a sample including working age (15-64 years old) individuals with self-reported DD, CP and ASD. Persons with DD reported on their met and unmet needs in term of activities of daily living, education and employment.

OUTCOMES AND RESULTS

Labour force participation is the lowest for those with DD compared to any other disability. Individuals with CP and ASD report a high level of unmet needs that differ in terms of educational, vocational and daily living supports.

CONCLUSIONS AND IMPLICATIONS

Improving labour force participation to be inclusive and accessible requires policy that considers the range of unmet needs that exist for persons with DD.

Communication changes experienced by adults with cerebral palsy as they age

PURPOSE

Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.

METHOD

Twenty adults with cerebral palsy aged 40-72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.

RESULT

Themes arising from the participants' perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.

CONCLUSION

Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

Pilot study of a targeted dance class for physical rehabilitation in children with cerebral palsy

Introduction:

This pilot study evaluates the effects of a targeted dance class utilizing classical ballet principles for rehabilitation of children with cerebral palsy on balance and upper extremity control.

Methods:

Twelve children with cerebral palsy (ages 7–15 years) with Gross Motor Function Classification scores II–IV participated in this study and were assigned to either a control group or targeted dance class group. Targeted dance class group participated in 1-h classes three times per week in a 4-week period. The Pediatric Balance Scale and the Quality of Upper Extremity Skills Test were administered before, after, and 1 month after the targeted dance class.

Results:

Improvements in the Pediatric Balance Scale were present in the targeted dance class group in before versus after and before versus 1 month follow-up comparisons (p-value = 0.0088 and p-value = 0.019, respectively). The Pediatric Balance Scale changes were not significant in the control group. The Quality of Upper Extremity Skills Test did not reach statistical differences in either group.

Conclusion:

Classical ballet as an art form involves physical training, musical accompaniment, social interactions, and emotional expression that could serve as adjunct to traditional physical therapy. This pilot study demonstrated improvements in balance control. A larger study with a more homogeneous sample is warranted.

The prevalence, location, severity, and daily impact of pain reported by youth and young adults with cerebral palsy

PURPOSE

To describe the prevalence, location, severity, and daily impact of pain reported by youth and young adults with cerebral palsy (CP). A secondary aim was to identify any significant associations between the constructs of interest.

METHOD

An observational study of 112 participants with CP to understand their experience of pain through a questionnaire. Participants were 56 males and 55 females with a mean age of 18y 9mo (SD 4y 5mo).

RESULTS

Pain was reported by 75% of males and 89% of females. Both severity and impact of pain were significantly greater in females. In addition, severity and impact of pain were significantly different between specific GMFCS levels. There were no significant differences in location of pain by gender or GMFCS level. A strong positive correlation between the severity and impact of pain was observed (rs = 0.80).

CONCLUSION

The gender differences in the severity and impact of pain and the overall and high prevalence of pain reported here provide healthcare practitioners with an increased awareness of pain distribution/characteristics among young adults with CP. Understanding the impact of pain on daily life can assist practitioners to efficiently manage pain and improve the quality of life for individuals with CP.

Femoral derotation osteotomy in adults with cerebral palsy

BACKGROUND

Internal rotation gait constitutes a complex gait disorder in bilateral spastic cerebral palsy (BSCP) including static torsional and dynamic components resulting in lever arm dysfunction. Although femoral derotation osteotomy (FDO) is a standard procedure to correct increased femoral anteversion in children, unpredictable outcome has been reported. The effect of FDO when it is done as part of single-event multilevel surgery (SEMLS) in adulthood has not been investigated.

METHODS

In this study mid-term data of 63 adults with BSCP and internal rotation gait, undergoing SEMLS including FDO were analyzed pre- and 1.7 years postoperatively by clinical examination and 3D-instrumented gait analysis. All legs were categorized as the more or less involved side to consider asymmetry. The mean hip rotation in stance preoperatively and the intraoperative derotation was correlated with the difference pre- and postoperatively.

RESULTS

The group as a whole experienced the following results postoperatively: improved mean hip rotation in stance (p=0.0001), mean foot progression angle (p=0.0001) and a significant improvement of the clinical parameter: passive internal and external hip rotation, midpoint and anteversion (p=0.0001) for both legs separately. With regard to the less and more involved side, clinical and kinematic parameters showed comparable significant changes (p=0.0001). The anteversion improved significantly in proximal compared to distal FDO (p=0.03).

CONCLUSION

This study emphasizes an overall good correction of internal rotation gait in adults with bilateral involvement after FDO. However, the results are more predictable in adults compared to studies reporting outcome after FDO in children.

Medication, rehabilitation and health care consumption in adults with cerebral palsy: a population based study

Objective:

To evaluate medication, rehabilitation and healthcare consumption in adults with CP as a function of Gross Motor Function Classification System (GMFCS) level.

Design:

Questionnaire-based cross-sectional study.

Setting:

Brittany, a French county.

Subjects:

Adults with cerebral palsy.

Interventions:

Questionnaires relating to drugs, orthotic devices, mobility aids, rehabilitation and medical input were sent to 435 members of a unique regional French network dedicated to adults with cerebral palsy. The questionnaire was completed by the participant or a helper if necessary.

Results:

Of the 282 responders, 7.8% had a GMFCS level of I, 14.2% II, 17.7% III, 29.1% IV and 31.2% V. Participants consumed a large amount of healthcare. Almost three-quarters took orally administered drugs, of which antispastic and antiepileptic drugs were among the most frequent. Nearly all patients had at least one type of rehabilitation, 87.2% had physiotherapy, 78% used at least one mobility aid and 69.5% used at least one orthotic device. The frequency of numerous inputs increased with GMFCS level. Specificities were found for each GMFCS level, e.g. participants with GMFCS level IV and V had a high level of medical input and a greater use of trunk-supporting devices, antireflux and laxative. Profiles could be established based on GMFCS levels.

Conclusions:

Adults with cerebral palsy use a large amount of drugs, mobility aids, orthotic devices, rehabilitation and medical input. Healthcare is targeted at cerebral palsy-related issues. GMFCS is a determinant of healthcare consumption and thus a useful tool for clinical practice to target care appropriately.

Pathogenesis, neuroimaging and management in children with cerebral palsy born preterm

With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern. It is now known that brain injury in children born preterm also involves neuronal-axonal disease in supratentorial and infratentorial structures. The developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature. Oligodendrocyte progenitors, which are beginning to form myelin during this time, are susceptible to attack from oxygen free radicals, glutamate, and inflammatory cytokines. Advances in imaging techniques such as diffusion tensor imaging provide a more complete picture of the location and extent of injury. Effective management of children born preterm with cerebral palsy is predicated on an understanding of sequential links from etiological antecedents to brain neuropathology as revealed with neuroimaging techniques to clinical phenotypes, toward focused interventions with measurable outcomes.

Effects of disability on pregnancy experiences among women with impaired mobility

OBJECTIVE

Little is known about how functional impairments might affect the pregnancies of women with mobility disability. We aimed to explore complications that arise during pregnancy that are specifically related to physical functional impairments of women with significant mobility disabilities.

DESIGN

Qualitative descriptive analysis.

SETTING

Telephone interviews with women from 17 USA states.

SAMPLE

22 women with significant mobility difficulties who had delivered babies within the prior 10 years; most participants were recruited through social networks.

METHODS

We conducted 2-h, in-depth telephone interviews using a semi-structured, open-ended interview protocol. We used NVIVO software to sort interview transcript texts for conventional content analyses.

MAIN OUTCOME MEASURES

Functional impairment-related complications during pregnancy.

RESULTS

The women's mean (standard deviation) age was 34.8 (5.3) years. Most were white, well-educated, and higher income; eight women had spinal cord injuries, four cerebral palsy, and 10 had other conditions; 18 used wheeled mobility aids; and 14 had cesarean deliveries (eight elective). Impairment-related complications during pregnancy included: falls; urinary tract and bladder problems; wheelchair fit and stability problems that reduced mobility and compromised safety; significant shortness of breath, sometimes requiring respiratory support; increased spasticity; bowel management difficulties; and skin integrity problems (this was rare, but many women greatly increased skin monitoring during pregnancy to prevent pressure ulcers).

CONCLUSIONS

In addition to other pregnancy-associated health risks, women with mobility disabilities appear to experience problems relating to their functional impairments. Pre-conception planning and in-depth discussions during early pregnancy could potentially assist women with mobility disabilities to anticipate and address these difficulties.

Does hip displacement influence health-related quality of life in children with cerebral palsy?

OBJECTIVE

To evaluate the association of hip lateralisation with health-related quality of life (HRQL) in children with cerebral palsy (CP) using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD(®)) questionnaire.

METHODS

We assessed n = 34 patients (mean age: 10.2 years, SD: 4.7 years; female: n = 16) with bilateral CP and Gross Motor Function Classification System (GMFCS) Level III-V using the CPCHILD(®) questionnaire. Hip lateralisation was measured by Reimer`s migration percentage (MP).

RESULTS

There was an association between both, MP and GMFCS with CPCHILD(®) total score. Stratified analyses did not suggest interaction of the association between MP and CPCHILD(®) total score by GMFCS level. After adjustment for GMFCS level, we found a significant linear decrease of CPCHILD(®) total score of -0.188 points by 1% increment in MP.

CONCLUSIONS

There was an association between MP and HRQL, which could not be explained by the GMFCS level.

The cerebral palsy transition clinic: administrative chore, clinical responsibility, or opportunity for audit and clinical research?

PURPOSE

The majority of children with orthopaedic conditions in childhood survive to adult life, and there is a need for many of them to transition to adult services. This includes children with disorders such as club foot or developmental dislocation of the hip as well as those with complex syndromic conditions, bone dysplasias or neuromuscular disorders such as cerebral palsy and myelomeningocele. In many tertiary paediatric centres, transition has become a formal process in which clinicians document and communicate the status of patients who have been under their care to ensure a smooth transfer to adult services. The purpose of this report is to support the need for clear communication when children with cerebral palsy transition to adult services and to suggest that this transition represents a significant opportunity for audit and clinical research.

METHODS

Some of the factors to be considered in developing a minimum data sheet for the transfer or transition of children with cerebral palsy to adult services are described.

CONCLUSION

Using the model of adolescents with cerebral palsy transitioning to adult services, orthopaedic surgeons can be encouraged to develop similar methodology and documentation for many other conditions for the purposes of communication, facilitation of transition, audit and clinical research.

Adolescents with cerebral palsy: transitioning to adult health care services

Data from the 2009-2010 US National Survey of Children with Special Health Care Needs were examined to determine the health, developmental and behavioral status of adolescents with cerebral palsy (CP) and to assess how well pediatric health care providers were preparing them for transition to adult health care services. Adolescents with CP had no higher rates of attention deficit hyperactivity disorder, depression, anxiety, oppositional or conduct disorders, or autism spectrum than a comparison group. However, those with CP participated less in sports, clubs, or other organized activities (P < .001). Neither group reported much help in coordinating health services or preparing for transition to adult health care services. Inadequate adult health care services have a direct and unsatisfactory impact on the adult life span. Physicians and other health care providers who include adolescents with CP in their practices should begin discussion and planning for transition to adult health care early in adolescence.

Conditions causing disability and current pregnancy among US women with chronic physical disabilities

BACKGROUND

Growing numbers of reproductive-age US women with chronic physical disabilities (CPD) are becoming pregnant. Little is known about the health conditions causing their CPD.

OBJECTIVES

To identify health conditions causing CPD among reproductive-age women and specifically among currently pregnant women.

RESEARCH DESIGN

Cross-sectional, nationally representative National Health Interview Survey data from 2006 to 2011.

SUBJECTS

A total of 6043 civilian, noninstitutionalized women aged 18-49 with CPD.

MEASURES

National Health Interview Survey asks about various movement difficulties and their underlying causes and about current pregnancy. We used responses from 8 movement difficulty and other questions to identify women with mobility difficulties caused by chronic physical health conditions.

RESULTS

Among women with CPD, 2.0% report current pregnancy, with pregnancy rates falling monotonically as CPD severity rises. Regardless of pregnancy, 20.8% report 2 causes for their CPD, and 12.7% report 3+ causes; the most common causes are arthritis, back or neck problems, and other musculoskeletal conditions. Compared with nonpregnant women, currently pregnant women report fewer causal conditions: 15.8% report 2 causes and 8.0% 3+ causes; back or neck problems are reported most frequently, followed by musculoskeletal problems and arthritis. Multivariable logistic regression analyses predicting current pregnancy controlling for age category and individual common causes of CPD found that no cause was significantly associated with higher or lower adjusted odds of pregnancy.

CONCLUSION

Almost one quarter of currently pregnant women with CPD report more than one cause for their disability. Further research will needed to examine how obstetrical needs vary for depending on the cause of a pregnant woman's disability.

Vocational rehabilitation services and employment outcomes for adults with cerebral palsy in the United States

AIM

The aim of this study was to examine the relationship between vocational rehabilitation services provided and work outcomes among people with cerebral palsy (CP), taking in to account demographic characteristics.

METHOD

From the US Department of Education Rehabilitation Service Administration Case Service Report (RSA-911) database, data from 3162 individuals with CP (1820 males [57.6%] and 1342 females [42.4% age range 16-54 y) whose cases were closed in 2009, were used in this study. A total of 1567 cases (49.6%) were closed with clients being categorized as 'successful employment' and 1595 cases (50.4%) were closed with clients being classified as unemployed.

RESULTS

Multivariate logistic regression was used to examine the relationship between services provided and work outcomes with regard to demographic characteristics. Males aged between 26 and 54 years old with higher education attainment were more likely to be employed. Individuals receiving disability benefits were less likely to be employed. After controlling for the effect of demographic and work disincentive variables, five vocational rehabilitation services significantly predicted employment outcomes (p<0.05), including (1) on-the-job training; (2) job placement assistance; (3) on-the-job support; (4) maintenance services; and (5) rehabilitation technology.

INTERPRETATION

Medical and health professionals need to be aware of vocational rehabilitation agencies as a resource for providing medical, psychological, educational, and vocational interventions for adults with CP to help them maximize their employability, to address their much needed work adjustment skills, to establish independent living, and to eventually reach their full potential in participation in society.

Gait function and decline in adults with cerebral palsy: a systematic review

PURPOSE

The aim of this systematic review was to identify, appraise and synthesize the evidence describing gait decline in adults with cerebral palsy (CP).

METHOD

Comprehensive searches were conducted in MEDLINE (1970-), EMBASE (1980-), CINAHL (1982-) and AMED (1985-) databases to June 2012. Two reviewers independently completed data extraction and analysis using a modified version of the Downs and Black quality tool.

RESULTS

From the 485 papers identified, 16 met the inclusion criteria. Most studies used samples of convenience. The reported mean ages of the study groups varied from 22 to 42.6 years. Decline in gait function was measured variably with the period of decline undefined or from an unknown reference time during childhood. Results suggest that mobility decline occurs in 25% or more of adults with CP. Those at higher risk of gait decline are those with worse initial gait ability, bilateral rather than unilateral motor impairment, older age and higher levels of pain or fatigue.

CONCLUSION

Many ambulant adults with CP experience mobility decline earlier than their nondisabled peers. More information regarding the natural history of mobility change over the lifespan in adults with CP augmented with self-efficacy qualitative data is needed to direct health advice and appropriate interventions for this group.

IMPLICATIONS FOR REHABILITATION

The literature suggests 25% or more of ambulant adults with cerebral palsy experience gait decline. Higher risk of gait decline occurs in those who are older, less independent in gait, have bilateral motor impairment and higher levels of pain or fatigue. Use of standardized gait measurement tools augmented with self-efficacy measures will aid provision of health advice and interventions.

Cerebral palsy: definition, assessment and rehabilitation

Over the last 25 years the definition and classification of cerebral palsy (CP) have evolved, as well as the approach to rehabilitation. CP is a disorder of the development of movement and posture, causing activity limitations attributed to nonprogressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. Motor control during reaching, grasping, and walking are disturbed by spasticity, dyskinesia, hyperreflexia, excessive coactivation of antagonist muscles, retained developmental reactions, and secondary musculoskeletal malformations, together with paresis and defective programing. Weakness and hypoextensibility of the muscles are due not only to inadequate recruitment of motor units, but also to changes in mechanical stresses and hormonal factors. Two methods, the General Movements Assessment and the Test of Infant Motor Performance, now permit the early detection of CP, while the development of valid and reliable outcome measures, particularly the Gross Motor Function Measure (GMFM), have made it possible to evaluate change over time and the effects of clinical interventions. The GMFM has further led to the development of predictive curves of motor function while the Gross Motor Classification System and the Manual Ability Classification System provide standardized means to classify the severity of the movement disability. With the emergence of the task-oriented approach, the focus of therapy in rehabilitation has shifted from eliminating deficits to enhancing function across all performance domains by emphasizing fitness, function, participation, and quality of life. There is growing evidence supporting selected interventions and interest for the therapy and social integration of adults with CP.

Postpartum care of a woman with cerebral palsy and deep vein thrombosis: a case study

Pregnancy can be challenging for women with cerebral palsy. Physical limitations and comorbidities can predispose them to complications during pregnancy, such as deep vein thrombosis and pulmonary embolism, making their care needs more complex. A multidisciplinary care plan, as well as clear and effective communication among different health care providers, will help ensure safe and optimal postpartum care of women with cerebral palsy and their newborns.