An update on the prevalence of cerebral palsy: a systematic review and meta-analysis

Exploring experiences of parents of young children with cerebral palsy with a standing frame program promoting hip development

PURPOSE

Children with Cerebral Palsy (CP) are at risk for hip problems, and early monitoring and intervention are recommended. This study explores the experiences of parents of young children with CP with a standing frame program (SFP) promoting hip development and identifies factors promoting or hindering the program's feasibility.

METHODS

Qualitative data were collected through 11 interviews, which were transcribed, and analyzed thematically. Quantitative data were collected through ratings of the level of agreement with statements related to the SFP.

RESULTS

For parents, balancing between their roles as parent and co-therapist, implementing the SFP involved physical and mental load. Involving the social environment, sharing care responsibilities, and integrating the SFP in different settings facilitated implementation of the program. Parents were motivated by potential benefits for their child and the opportunity for quality time.

CONCLUSIONS

Implementing the SFP is challenging for parents. For better integration of the SFP program into daily life, it is important to consider parents' needs and to collaborate with all caregivers. Future research should strengthen evidence on the SFP's impact on hip development and parental burden. Additionally, it is essential to ensure that the perspectives of burdened parents are incorporated in the program's development and evaluation.

Experiences and Therapy Needs of Parents With an Infant at High Risk for Development of Unilateral Spastic Cerebral Palsy: A Qualitative Interview Study

AIM

To understand experiences and therapy needs of parents with an infant with unilateral perinatal brain injury and at high risk for unilateral spastic cerebral palsy in the first year. Patients and Methods: Sixteen parents (from 8 children with unilateral spastic cerebral palsy, 3 without) diagnosed with unilateral perinatal brain injury participated in semistructured interviews. Data were analyzed using thematic analysis. Results: The overarching theme, "an unexpected journey," included 4 subthemes: (1) "A roller coaster start"-stressful initial experiences on a neonatal intensive care unit; (2) "Wishing for a crystal ball"-need for information on (future) development; (3) "Reaching for the stars"-value of therapist guidance in supporting infant development; (4) "Growing seeds of confidence"-increased parental confidence in their child's development and their role. Conclusion: Parents have information needs about their child's (future) neurodevelopment. Physical or occupational therapists provide information, monitor motor progress, and guide parents in supporting development and can offer needed reassurance.

A sibling study of the prenatal and perinatal risks for cerebral palsy

BACKGROUND

To evaluate the associations between prenatal and perinatal factors and CP risk using a statewide sibling-comparison design.

METHODS

We established a cohort of over 4 million singleton births in California during 2007-2015, and we identified families with outcome-discordant siblings of 1213 CP and 1544 non-CP. We estimated odds ratio (OR) and 95% confidence interval (CI) for CP according to perinatal factors including preterm birth (PTB), small for gestational age, low Apgar score, and prenatal factors including maternal pregnancy complications (perinatal infection, gestational diabetes, preeclampsia) and lifestyle-related factors (cigarette smoking, pre-pregnancy overweight).

RESULTS

The perinatal factors remained strongly associated with CP using sibling design, although the point estimates were smaller for PTB (cohort OR = 4.72, 95%CI 4.42-5.04, sibling OR = 3.49, 95%CI 2.74-4.46) and low Apgar score (cohort OR = 19.62, 95%CI 17.99-21.41, sibling OR = 8.79, 95%CI 5.49-14.08). In sibling design, the associations between maternal pregnancy complications or pre-pregnancy overweight and CP risk were attenuated to null. We observed stronger effects between maternal cigarette smoking and CP in the sibling design, however sensitivity tests indicated possible bias from carryover effects.

CONCLUSION

Adverse perinatal factors remained strongly associated with childhood CP, while uncontrolled confounding bias required considerations for pregnancy complications and CP development.

IMPACT

We conducted a population-based sibling comparison study to evaluate the associations between several prenatal and perinatal factors and cerebral palsy (CP). Preterm birth, small for gestational age, and low Apgar score at birth remained strongly associated with CP using the sibling comparison design. The associations between several maternal pregnancy complications and CP were close to null in the sibling comparison design, raising the possibility of uncontrolled confounding bias in the cohort analyses. We demonstrated that a sibling comparison design can provide valuable information to triangulate research evidence for CP etiology, but a careful implementation and interpretation of findings is warranted.

A Primary Care Approach to Visual Screening in Adults with Intellectual and Developmental Disabilities

This article explores the unique challenges faced by adults with intellectual and developmental disabilities (IDDs) and proposes ways in which primary care physicians can improve ocular health in this patient population. The existing literature does not offer specific guidelines for vision screening in adults with IDDs in the primary care setting. Effectively screening for ocular issues and making timely referrals to specialists can improve ocular health. We recommend screening visual acuity at least annually, even in the absence of visual complaints in adults with IDDs to monitor for changes in visual acuity in this unique patient population that is prone to visual challenges and is vulnerable to underdiagnosis of related conditions.

Association of Cerebral Palsy With Unanticipated Admission Following Pediatric Ambulatory Surgery

BACKGROUND

Cerebral palsy, a neurologic disorder caused by damage to the developing brain, is a leading cause of childhood disability. Due to musculoskeletal, movement, and secondary impairments, children with cerebral palsy often require surgical care. With the growing cost of surgical care, many children with cerebral palsy are scheduled for surgery in an ambulatory setting. Whether cerebral palsy increases the risk of unanticipated admission (a critical quality indicator of care) following ambulatory surgery has not been characterized. Our objective was to determine the association of cerebral palsy with unanticipated admission following pediatric ambulatory surgery.

METHODS

We used the Pediatric Health Information System (PHIS) database to evaluate a retrospective cohort of children (< 18 years) who underwent scheduled ambulatory operations between January 1, 2010 and December 31, 2022. The primary outcome was unanticipated admission. Using log-binomial regression models, we estimated the relative risk and 95% confidence intervals for unanticipated admission, comparing patients with and without cerebral palsy. To account for confounding variables, we performed a 1:1 propensity score matching without replacement.

RESULTS

A total of 1 954 108 children underwent ambulatory surgeries during the study period. Of these, 4.1% required unanticipated admission. The overall incidence of unanticipated admission was significantly higher among children with cerebral palsy than in those without (9.8% vs. 4.0%; p < 0.001). This association remained significant after multivariable adjustment (relative risk: 1.73; 95% CI: 1.59-1.87, p < 0.001).

CONCLUSION

Although cerebral palsy is not a contraindication for ambulatory surgery in children, it is significantly associated with the risk of unanticipated hospital admissions. This underscores the need for careful preoperative clinical site of care selection in this vulnerable patient population.

LEVEL OF EVIDENCE

Level II.

Movement-Based Priming: A Clinical Trial on the Effect of Cross-Training on Locomotor Abilities of Children with Unilateral Cerebral Palsy

Background: Children with unilateral cerebral palsy (UCP) frequently experience limitations in locomotor abilities, attributable to a complex interplay of factors including muscle weakness and reduced joint mobility. Movement-based priming, such as cross-training (CT), has emerged as a potential intervention to enhance motor function in children with UCP. However, evidence of its efficacy remains limited. Objective: This study aimed to investigate the effect of CT-specifically, a strengthening-based unilateral priming protocol-on muscle strength, joint mobility, and locomotor abilities in children with UCP. Methods: Thirty-six children with UCP were enrolled in a randomized controlled trial. Participants were randomized into two groups: the control group (n = 18; underwent a tailored physical rehabilitation program) and the CT group (n = 18; participated in a CT program incorporating unilateral priming exercises targeting the less-affected lower followed by the same rehabilitation program administered to the control group). Dorsiflexor strength, ankle joint mobility, and locomotor ability assessed via the 10 m walk test (10 mWT), 6 min walk test (6 MWT), and timed up-and-go test (TUG) were evaluated pre- and post-intervention. Results: Significant moderate-to-large between-group differences were observed in dorsiflexor strength (p = 0.032, partial η2 = 0.128), ankle mobility (p = 0.016, partial η2 = 0.159), and locomotor ability (10 mWT [p = 0.017, partial η2 = 0.157]; 6 MWT [p = 0.004, partial η2 = 0.222]; TUG [p = 0.047, partial η2 = 0.111]). The CT group demonstrated superior improvements concerning all outcomes. Conclusions: Unilateral priming through strengthening-based CT is a viable intervention for enhancing motor function in children with UCP, providing a promising complement to the current rehabilitation protocols.

Prevalence and Types of Strabismus in Cerebral Palsy: A Global and Historical Perspective Based on a Systematic Review and Meta-Analysis

PURPOSE

Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations.

METHODS

We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus.

RESULTS

The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels.

CONCLUSION

Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.

The effects of extracorporeal shock wave therapy in children with cerebral palsy: a systematic review

INTRODUCTION

Spastic cerebral palsy (CP) is a major cause of movement disorders in pediatric rehabilitation. Current treatments are often invasive and may lead to substantial discomfort. Extracorporeal shockwave therapy (ESWT) presents a potential alternative, offering a less invasive approach with a reduced side effect profile. However, the impact of ESWT on children with CP remains unclear. This systematic review aims to summarize the current evidence on ESWT's impact in children with spastic CP across various domains of the International Classification of Functioning, Disability, and Health for Children and Youth.

METHOD

To answer the main question, a systematic literature study is used. The studies, collected from four databases, were screened, and data on outcome measures and methodological quality were extracted. Effect sizes were calculated to facilitate study comparison.

RESULTS

In total, twelve randomized controlled trials met inclusion criteria, with PEDro scores ranging from three to eight. The combined study population included 421 children. Positive effects were observed on resistance to passive movements, passive range of motion, and gross motor skills, with effect sizes ranging from moderate (0.65) to very large (14.62).

CONCLUSION

ESWT demonstrated positive effects across multiple domains in children with spastic CP.

Factors associated with flexed knee gait in unilateral cerebral palsy

Purpose

A flexed knee gait is a common gait in children with unilateral cerebral palsy. In children without knee contracture, hamstring spasticity is commonly considered a major contributor to a flexed knee gait. We hypothesized that the popliteal angle would not correlate to a flexed knee gait.

Methods

This retrospective study included 109 children with unilateral cerebral palsy who had undergone complete 3D gait analysis. Children who had previous surgery or knee flexion contracture were excluded. Children were divided into three groups based on knee position during stance as determined by 3D gait analysis: flexion (FK, 47), hyperextension (HK, 42), and normal (NK, 20).

Results

There were no significant correlations between popliteal angle and dynamic peak knee extension in stance or at initial contact. Similarly, peak dorsiflexion during the stance phase did not correlate with dynamic peak knee extension in stance (all p > 0.05). Significant differences were observed in foot position during stance between FK and HK groups, as well as in quick stretch dorsiflexion with the knee extended between HK and NK groups.

Conclusion

A flexed knee gait in children with unilateral cerebral palsy does not always correlate with the popliteal angle or dynamic ankle position in gait. These factors may contribute but are insufficient to explain all observed differences. A flexed knee gait likely involves a complex interplay of motor control, strength, spasticity, and lever arm dynamics, indicating that interventions at a single level may not fully improve dynamic knee extension.

Upper limb training for young children with unilateral cerebral palsy using video coaching: An explorative retrospective clinical study

INTRODUCTION

Young children with unilateral cerebral palsy (CP) received a home-based training program using video coaching for parents. The primary aim of our study was to evaluate the effectiveness of unilateral training on the use of the affected arm and hand during bimanual activities and to explore factors that affect treatment response. Secondary, we evaluated whether effects were retained after an 8-week break, and if data were available, we explored the effects of a second uni- or bimanual training block. Furthermore, adherence was evaluated.

METHODS

Explorative retrospective clinical study evaluating the effectiveness of the first 8-week training block on the (Mini-) Assisting Hand Assessment ((Mini-) AHA) unit score in 81 children aged 8-36 months. Pre- and post-intervention (T0-T1) and 8-week follow-up measurements (T2) were evaluated, and factors influencing treatment response were explored, using linear mixed models (LMM). Additionally, effects of a second training block were explored in 31 of the original 81 children, contingent upon data availability, with T3-T4 measurements included. Adherence, measured as percentage of treatment duration, was explored.

RESULTS

Mini-AHA and AHA unit scores significantly improved between T0 and T1, but did not change between T1 and T2. In children aged 18 months and older, baseline AHA scores were related to change scores. In children aged <18 months, no predictors of treatment response were identified. LMM showed significant improvement between T1-T3 and T1-T4 in Mini-AHA scores in children with a second training block. Adherence rates were 85% in the first and 81% in the second block.

CONCLUSIONS

Our data suggest that upper limb training using video coaching can improve hand use in infants and toddlers with unilateral CP, with retained effects after an 8-week break and further enhancement following a second training block. Individual results differed, and controlled studies are needed to strengthen the evidence. High adherence rates suggest the program's feasibility.

CONSUMER AND COMMUNITY INVOLVEMENT STATEMENT

There was no direct consumer and community involvement in the study design.

PLAIN LANGUAGE SUMMARY

Cerebral palsy is caused by a brain injury around birth and is the most common physical disability in children, affecting their movement. Children with one side of the body affected often use that side less, making daily activities harder. Training the affected arm in the first 2 years of life is important because the brain is still very adaptable. In our study, we evaluated a home-based training program for young children with cerebral palsy, with blocks of 8 weeks of therapy using video coaching for parents. We looked at how well the first training block improved the use of the affected arm and hand. We also looked at whether the effects lasted after an 8-week break and whether a second training block further improved hand use. Lastly, we looked at how well families continued to train. We found an improvement of the use of the affected hand after the first training block. Children older than 18 months with poorer hand use at the start made more progress, while especially children younger than 18 months demonstrated further improvement after the second training block. Most parents and children were able to continue the training program using video coaching. Early upper limb home-based training with video coaching can help young children with cerebral palsy to improve the use of their affected arm and hand. Video coaching seems effective to motivate parents to continue with the program. Individual results varied. There is a need for larger studies.

Marital Cohesion and Perceived Stress in Parents of Children with Special Educational Needs: A Study of the Impact on Couple Dynamics

BACKGROUND/OBJECTIVES

The presence of a child with special educational needs (SENs) necessitates that both the child and their family engage in adaptive processes and develop resilience in response to the developmental challenges that arise following an SENs diagnosis. Furthermore, it is critical to examine the impact of such a diagnosis on parental marital cohesion. Despite the recognized importance of this issue, the effects of SENs diagnoses on marital cohesion and flexibility, and the perceived stress experienced by parents, remain underexplored in the extant literature.

METHODS

Forty-seven participants (23 parents of children diagnosed with SENs and 24 parents of typically developing children, all aged between 32 and 60 years) completed this study. The instruments used were the Family Cohesion and Flexibility Evaluation Scale (couple version) and the Perceived Stress Scale.

RESULTS

No direct relationship was found between the SENs diagnosis and marital cohesion or flexibility. Furthermore, the perceived stress did not mediate the association between these variables. Nonetheless, both groups exhibited high levels of perceived stress.

CONCLUSIONS

These results underscore the necessity for further investigation into the role of emotional support and coping strategies in alleviating the perceived stress among parents and caregivers of children with SENs. A deeper understanding of these factors is essential for the development of interventions aimed at promoting parental well-being and enhancing the quality of caregiving.

Global burden of chronic non-communicable diseases: Prenatal care and beyond, numerous challenges besiege investigation across the care continuum

Recently, the National Institutes of Health (NIH) announced possible restructuring of indirect and administrative costs for funded research. Many entities have raised concern about the impacts that such funding restructuring may have on the future progress of biomedical investigation. The NIH has historically played a key role in research on relevant chronic conditions, including spina bifida and cerebral palsy. Such research funds have not only provided occasion for basic science investigational opportunities but also have allowed for enquiry into clinical, social, and environmental factors that impact disability-specific health outcomes, including those present in some of the world's most vulnerable communities. However, the journal's editorial board is nonetheless encouraged to see the growth and change of Journal of Pediatric Rehabilitation Medicine (JPRM), as the journal evolves from a special issue format to a collections format. The collections will serve as ever-growing "homes" for the latest research on childhood-onset physical disabilities and complex care needs, with the added benefit of greater accessibility and improved user interface. Furthermore, as reflected in this issue, JPRM will continue to offer a platform for research in multidisciplinary care of childhood disability throughout the lifespan as we weather the changes of time together as a committed global community of clinicians and investigators.

A pre-operative gastrointestinal optimization protocol to improve outcomes after intrathecal baclofen pump surgery

PURPOSE

Pediatric cerebral palsy patients carry frequent medical comorbidities and disproportionately consume hospital resources after neurosurgical procedures. We implemented an institutional pre-operative gastrointestinal (GI) optimization protocol to improve outcomes and decrease resource utilization.

METHODS

All 323 intrathecal baclofen surgeries from 2000 to 2023 were categorized relative to protocol implementation on July 1, 2017. Outcomes and resource utilization were compared.

RESULTS

The protocol change resulted in significantly fewer hospital readmissions (p = 0.001) for constipation, eliminating them and GI-related emergency visits. There was a reduction of 27 hospital days for constipation-related readmission (median 1 day per patient, IQR 1, 2 days). No differences were reported between the experimental groups including demographics or GI comorbidities. Post-operative complications within 30 days were comparable between groups regarding urinary tract infections, surgical-site infections, and spinal fluid leak. There were no differences in post-operative length of stay between groups.

CONCLUSION

A GI optimization protocol can eliminate a frequent source of hospital readmissions and GI-related emergency department visits after baclofen pump surgery, even accounting for baseline GI comorbidities. Preventing readmissions and emergency visits translates to lower hospital resource utilization and improves quality of care. Future efforts are warranted to improve outcomes and care efficiency for our most complex and resource-intensive patients.

Stakeholder's perspective on brain-computer interfaces for children and young adults with cerebral palsy

Communication Brain-Computer Interfaces (cBCIs) are a promising tool for people with motor and speech impairment, in particular for children and young adults with communication impairments, for example due to cerebral palsy (CP). Here we aimed to create a solid basis for the user-centered design of cBCIs for children and young adults with severe CP by investigating the perspectives of their parents/caregivers and health care professionals on communication and cBCIs. We conducted an online survey on 1) current communication problems and usability of used aids, 2) interest in cBCIs, and 3) preference for specific types of cBCIs. A total of 19 parents/caregivers and 36 health care professionals who interacted directly with children and young adults (8-25 years old) with severe CP, corresponding to Gross Motor Function Classification System level IV or V, participated. Both groups of respondents indicated that motor impairment occurred the most frequently and had the greatest impact on communication. The currently used communication aids included mainly no/low-tech aids and high-tech aids. The majority of health care professionals and parents/caregivers reported an interest in cBCIs, with a slight preference for implanted electrodes over non-implanted ones, and no preference for either of the two proposed mental BCI control strategies. Results indicate that cBCIs should be considered for a subpopulation of children and young adults with severe CP, and that in the development of cBCIs for this group both visual stimuli and sensorimotor rhythms, as well as the use of implanted electrodes, should be considered.

Developing a Profile of Canadian Children With Cerebral Palsy Who Require Augmentative and Alternative Communication

PURPOSE

Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking.

METHOD

Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children's need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis.

RESULTS

Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations.

CONCLUSIONS

Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28229720.

Effectiveness of hand-arm bimanual intensive therapy including lower extremities in the rehabilitation of children with cerebral palsy: a systematic review protocol

INTRODUCTION

Cerebral palsy (CP) is a paediatric disorder with permanent impairment of movement and posture with a prevalence of about 2.11 in 1000 births in the world. Given the therapeutic effect of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in children with CP, a systematic review of the available literature on this topic is warranted. The objective of this study is to systematically review the effectiveness of HABIT-ILE on upper extremity, lower extremity and trunk outcomes within the domains of body functions and structures, activity and participation of the International Classification of Functioning, Disability and Health in children with CP.

METHODS AND ANALYSIS

This study will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches will be conducted in six databases: MEDLINE, PubMed, Cochrane Library, Scopus, OT seeker and Web of Science for available published literature. The grey literature sources will include WorldCat, National Technical Information Service, Agency for Healthcare Research and Quality, Open Grey, WHO and OpenDOAR. Manual searches of citations of included papers will be performed to collect all experimental studies of HABIT-ILE in children with CP. The level of evidence for included articles will be classified according to the level of evidence in the guidelines for systematic reviews on the American Occupational Therapy Association website. Based on the study design of the included articles, the risk of bias will be assessed using the revised Cochrane risk-of-bias tool, the Cochrane Risk Of Bias In Non-randomised Studies - of Interventions tool and the quality assessment tool recommended by the American Occupational Therapy Association. In order to synthesise the data, narrative synthesis will be used, along with meta-analysis, if available.

ETHICS AND DISSEMINATION

As this study only reviewed previously published articles, ethical approval was not required. The findings will be published in a peer-reviewed scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42024518179.

Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis

Background

In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP.

Methods

To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted.

Results

The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center–edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA.

Conclusions

This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.

"My child is completely underestimated": Canadian parents' perspectives on implementing an accessible language comprehension assessment for non-speaking children with cerebral palsy

PURPOSE

Reliable assessment of language comprehension is difficult for children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) was designed for children with cerebral palsy (CP) and speech and motor limitations. A Canadian English version (C-BiLLT-CAN) has been validated. However, early investigation identified feasibility challenges necessitating further exploration. This study aimed to understand parents' perceived barriers and facilitators to implementing the C-BiLLT-CAN in the Canadian clinical context.

MATERIALS AND METHODS

Seven focus groups were conducted synchronously online with 16 parents from five Canadian provinces/territories. Transcripts were analyzed using semi-deductive thematic analysis, framing results within the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Parents unanimously expressed interest in making the C-BiLLT-CAN clinically available. Facilitators and barriers were discussed under five themes. Key facilitators included the unique design, standardized nature, and potential flexibility of the C-BiLLT-CAN. Barriers involved the inability to accommodate all children, the potential for unintended assessment impacts, and clinics' readiness and willingness to prioritize implementation.

CONCLUSIONS

This study contributes new knowledge surrounding the assessment needs of parents of children with CP and speech and motor limitations. Alongside findings from a parallel clinician study, results will inform adaptations to the C-BiLLT-CAN to facilitate implementation.

Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis

BACKGROUND

In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP.

METHODS

To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted.

RESULTS

The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center-edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA.

CONCLUSIONS

This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.

Rehabilitation effect of aquatic exercise on motor function in children with cerebral palsy: Systematic review of randomized controlled trials

BACKGROUND

Cerebral palsy (CP) refers to a lasting motor impairment resulting from atypical brain development or injury. Aquatic exercise (AE) is frequently utilized as an approach for rehabilitating children with CP because of its appealing water properties.

OBJECTIVE

The aim of this study was to examine how AE influences motor skills in children affected by CP.

METHODS

Systematic searches of databases provided randomized controlled trials (RCTs) published from their inception up until May 22, 2024. The study compared the impacts of AE training with those of routine rehabilitation training (RRT). A random-effects model was employed to assess the aggregated data.

RESULTS

In total, 491 articles were retrieved, and 15 studies (n = 595 patients) were included in this study. Compared with RRT, AE improved the gross motor function of children with CP (SMD = 7.63, 95% CI 5.79-9.47, P < 0.01), especially in the lying and turning over positions (SMD = 15.66, 95% CI 13.85-17.46, P < 0.01). AE also reduced muscle tension (SMD = -0.75, 95% CI -1.03--0.47, P < 0.01).

CONCLUSIONS

AE is expected to improve motor function in children with CP. Moreover, this study emphasizes the need for future high-quality related studies to supplement the results and improve the conclusions.

Use of Computational Phenotypes for Predicting Genetic Subgroups of Cerebral Palsy

Introduction

Emerging evidence suggests that 20-30% of cases of cerebral palsy (CP) may have a genetic cause. Our group previously identified subsets of patients with CP or CP-masquerading conditions who warrant genetic testing, including those with regression or progressive neurological symptoms (CP masqueraders) and those without any known risk factors for CP (cryptogenic CP). Recognition of these subgroups in clinical settings remains challenging.

Methods

To address this challenge, we developed and evaluated a computational phenotyping approach using ICD- 9/ICD-10 billing codes to automatically identify patients with unexplained CP or CP-masquerading conditions who may benefit from genetic testing. We applied this computational phenotyping approach to a cohort of 250 participants from the Boston Children's Hospital CP Sequencing Study, aimed at identifying genetic causes in CP and CP-masquerading conditions.

Results

Manual review served as the gold standard, identifying 8% as CP masqueraders, 42% as cryptogenic CP, and 50% as non-cryptogenic CP. Computational phenotyping based on ICD-9/10 codes achieved a sensitivity of 95%, specificity of 72%, positive predictive value of 77%, and negative predictive value of 94% in identifying cases warranting genetic testing.

Conclusions

Our findings demonstrate the feasibility of using computational phenotyping to identify patients with CP or CP- masquerading conditions who warrant genetic testing. Further studies are needed to evaluate the effectiveness and real-world application of this tool in larger healthcare systems. Nonetheless, the computational phenotyping approach holds promise as a possible clinical decision support that could be integrated into electronic health record systems, enhancing clinical workflows and facilitating actionable genetic diagnoses.

From eligibility to diagnosis: candidacy and the complex journey of cerebral palsy diagnosis within primary care

BACKGROUND

Cerebral Palsy (CP) is an umbrella term for a group of permanent postural and movement conditions caused by non-progressive damage to the developing brain. Infants not identified with risk factors for CP around the time of birth are usually referred on from primary care after six months of age, essentially precluding early therapy. Candidacy, a seven-step dynamic theory, describes how individuals negotiate their eligibility for medical attention with themselves, others, and health services. This study aims to explore the CP diagnostic journey for community identified infants using the concept of candidacy.

METHODS

Data was combined from two studies: an online survey of caregivers of children with CP about their earliest concerns and diagnosis journeys (n=255), and a series of interviews to support the development of a new tool to facilitate earlier identification of infants with emerging motor difficulties (11 parents, 11 health care professionals [HCPs]). A deductive thematic analysis was used with a semantic, critical realist approach. An initial analysis was framed by the Andersen Model of Total Patient delay, and then conceptualised using Candidacy.

RESULTS

Participants had difficulties identifying whether their child needed medical attention, prompting online searches, and seeking advice from family and friends. HCP adjudications led to immediate or delayed referral, in which families continued their searches, reappearing at services until a referral was made. Once referred, families faced poor operating conditions, such as long waiting times. After learning the diagnosis criteria, participants began making requests for referral and navigated to private services if requests were denied. Participants felt that more information on infant development from a reliable source was needed to support new parents in raising their concerns to aid earlier identification.

CONCLUSION

Participants identified personal lack of infant development knowledge as being the limiting factor to earlier referral. Further research is needed to develop materials relevant for the UK and to understand General Practitioner perspectives regarding provision of such materials.

Quantitative ultrasound of submental and masticatory muscles in children with cerebral palsy

PURPOSE

Quantitative muscle ultrasound (QMUS) is potentially valuable as a diagnostic tool in central neurological disorders, as it provides information about changes in muscle architecture. This study aimed to investigate whether ultrasound images of the submental and masticatory muscles in children with spastic cerebral palsy (CP) differ from those obtained in a reference group, and whether observed ultrasound abnormalities differ between subgroups of children with different Eating and Drinking Ability Classification System (EDACS) levels to support its construct validity.

METHODS

A prospective cohort study was conducted in 25 children with spastic CP aged 3-18 years. QMUS of selected muscles was performed. Muscle thickness and echogenicity in the CP group were compared to previously collected reference values, and between different EDACS levels within the CP group.

RESULTS

Median echogenicity of all muscles was significantly higher in children with CP than in healthy controls. The temporalis muscle was significantly thinner in the CP group. There were no differences in muscle thickness or echogenicity between EDACS levels.

CONCLUSION

QMUS is able to detect abnormal architecture of submental and masticatory muscles in children with spastic CP, but the interpretation of abnormalities in relation to the severity of mastication and swallowing problems needs further investigation.

Knowledge translation strategies used to promote evidence-based interventions for children with cerebral palsy: a scoping review

BACKGROUND

Cerebral palsy (CP) is the most common childhood physical disability, imposing substantial costs on individuals and society. Early interventions that promote brain optimization and reorganization are vital for children with CP. Integrating early evidence-based practice (EBP) remains challenging but enhances functional outcomes.

METHODS

Following a scoping review methodology, databases were searched to identify studies examining the impact of knowledge translation (KT) strategies for pediatric CP interventions. Extraction included study characteristics, methodology, KT strategies, barriers, and facilitators. Numerical and inductive content analysis identified themes among KT strategies. A final stakeholder consultation to discuss the results was conducted.

RESULTS

This review included seventeen articles. Common outcomes included participant change in EBP knowledge and behaviour. Common barriers included a need for more resources, protected time, and funding. Most studies followed a multifaceted KT approach. Various KT strategies were used, primarily mentoring, workshops, case studies, and online tools.

INTERPRETATION

Results underscored the need for tailored KT strategies for implementing EBP for children with CP. Additionally, user-friendly KT tools and involving mentors to facilitate the intervention can haste EBP uptake. Successful adoption depends on challenges in healthcare settings. This study provides insights into current KT strategies for advancing best practices for children with CP.

Strength and dexterity of less affected hand of children with unilateral cerebral palsy: a comparison study with normal peers

BACKGROUND/AIM

A key aspect of hand function is dexterity, which is described as fine voluntary movements used to manipulate small objects during a specific task. The contralateral hand in children with unilateral cerebral palsy (U-CP); is commonly referred to as a "good" and "unimpaired" hand, while others have noted that it has subtle limitations. Therefore, this study aimed to assess and compare between the strength and dexterity of less-affected hand of children with U-CP and the dominant hand of normal peers.

METHODS

A sample of 120 volunteer children from both sexes and age ranged from 6 to 10 years participated in this study. Out of the 120 children, sixty were normal typically developing (TD) and sixty children with U-CP. Assessment of fine motor dexterity and grip and pinch strength were carried out by the Functional dexterity test (FDT) and Pneumatic squeeze Blub Dynamometer respectively.

RESULTS

The results showed that there was a significant lower in pinch and grip strength (p < 0.01) and significant higher FDT scores of children with U-CP compared with that of TD children (p = 0.001). Moreover, there was a significant higher functional levels in TD children compared with that of children with U-CP (p < 0.001) with no significant difference between groups in penalty distribution (p > 0.05).

CONCLUSION

Children with U-CP underperformed with their less-affected hand than the dominant hand of TD age matched peers. Future researches on bilateral hand function may be used to determine the best rehabilitation interventions.

Nutritional risk screening and nutritional assessment for children with cerebral palsy: A review of the current research status and future directions

BACKGROUND

Although the primary impairment involved in Cerebral palsy (CP) is motor function, malnutrition is also common. However, there is a lack of tool recommendations for early malnutrition risk screening in children with CP, and the means of nutritional intervention for children with CP are also limited.

METHODS

This study systematically searched the literature about clinical nutrition related content of cerebral palsy in Pubmed, MEDLINE, Embase, and the Cochrane Library in Jan 2024 and by hand searching, and we checked reference lists and citations to identify additional studies. Search terms include cerebral palsy, children, diagnosis, prediction, malnutrition, nutritional risk screening, nutritional assessment, nutritional support. Additions are marked in red in the modified version.

RESULTS

The timing of diagnosis of CP has been moving forward, and some new diagnostic tools have been developed. Nutritional status is correlated with regional economic level, but there is still a malnutrition rate of nearly 30 % in developed countries. Severe restrictions in terms of gross motor function, swallowing dysfunction, feeding difficulties, cognitive impairment, and insufficient energy intake are common risk factors for malnutrition in children with CP. Z-score should be calculated in combination with measurement indicators in the assessment of physical development of children with CP. The nutritional outcomes of children with CP can be improved by various means, including diversified a Nutrition Support Team (NST) interventions.

CONCLUSIONS

The incidence of malnutrition in children with CP is high, which needs to be paid more attention. More effective malnutrition risk screening tools need to be developed for children with CP to guide the implementation of comprehensive and personalized nutritional interventions and improve malnutrient-related outcomes.

Investigation of the relationship between gross motor maturation from 1 to 18 months and preschool gross motor performance in at-risk infants

BACKGROUND

At-risk infants are predisposed to major and minor neurodevelopmental disorders due to various biological and environmental factors.

OBJECTIVE

This study aimed to investigate the relationship between gross motor maturation from 1 to 18 months and gross motor performance in the preschool period, as well as the risk of developmental coordination disorder (DCD) in at-risk infants, referred to the Family Counselling Center of the Turkish Spastic Children's Foundation (FCCTSCF) between 2014 and 2016.

METHODS

Fifty-seven children who had their gross motor maturation assessed between 1 and 18 months at the FCCTSCF were re-evaluated in the preschool period. The Alberta Infant Motor Scale (AIMS) was used to evaluate gross motor maturation between 1 and 18 months. In contrast, the Gross Motor Function Measure-88 and the Developmental Coordination Disorder Questionnaire were used to assess gross motor performance in the preschool period.

RESULTS

Of the at-risk infants included in the study, 45.6% were evaluated as having typical development, 21% were identified as having cerebral palsy (CP), and 33.3% were determined to be at risk for DCD. Children with CP and those at risk for DCD were found to have lower percentile ranks on the past AIMS test compared to the healthy group (p = 0.001). A significant positive correlation was found between the Alberta Infant Motor Scale and the Gross Motor Function Measure-88 (p = 0.014).

CONCLUSION

In the clinical follow-up of at-risk infants, those who scored low on AIMS should be monitored for future risk of DCD and minor disorders, even if major neurological issues such as cerebral palsy are not detected.

Limited Evidence of Functional Benefit After Upper Limb Botulinum Toxin Treatment in Children With Cerebral Palsy: Systematic Review and Meta-analysis

OBJECTIVES

This systematic review and meta-analysis of randomized controlled trials aimed to summarize the reported functional effects of upper limb botulinum toxin treatment in children with spastic cerebral palsy.

DESIGN

Six databases were searched in October 2022. Two independent authors screened and extracted data on upper limb function, body function, life quality, muscle tone, spasticity, goals, pain, adverse events, and client satisfaction. A random effect model meta-analysis was performed, and RoB 2 and GRADE pro tools were used.

RESULTS

A total of 4862 publications were screened, 14 trials (621 patients) included. Pooled analyses confirm a decrease in muscle tone: mean difference Ashworth scale wrist -0.85 (95% confidence interval = -1.42 to -0.27). No significant functional gain was established: Melbourne Assessment mean difference 3.13 (95% confidence interval = -3.13 to 9.3), and Assisting Hand Assessment mean difference 3.84 (95% confidence interval = -1.86 to 9.54). Botulinum toxin groups had better goal achievement: Goal Attainment Scaling T scores mean difference 9.55 (95% confidence interval = 6.05 to 13.04) and better client satisfaction: improvement had an odds ratio of 8.44 (95% confidence interval = 1.34 to 53.08).

CONCLUSIONS

Results suggest that upper limb botulinum toxin treatment is effective to decrease muscle tone, but functional benefits are not clearly established. The discrepancy between subjective and objective results requires further investigation.

Understanding Parental Satisfaction in Caring for Children with Cerebral Palsy

INTRODUCTION

The life satisfaction of parents of children with cerebral palsy should be assessed. Parenting a child with a disability may bring more challenges and efforts, impacting overall quality of life.

AIM OF THE STUDY

the study aimed to evaluate the satisfaction with life of parents of children with cerebral palsy.

MATERIAL AND METHODS

The study was designed to assess the satisfaction with life of parents of children with cerebral palsy. To measure this outcome, we developed an original survey consisting of 29 questions inspired by the Satisfaction With Life Scale (SWLS). The study involved 43 parents or legal guardians of children diagnosed with cerebral palsy.

RESULTS

A correlation was identified between parental life satisfaction and the amount of leisure time reported by parents (p = 0.004, R = 0.46). The research indicates that parental life satisfaction does not depend on the parent's satisfaction with the level of therapy (p > 0.05) and the degree of improvement in the child's functioning (p > 0.05).

CONCLUSIONS

The level of parental life satisfaction does not depend on the level and outcome of therapy. The more leisure time the parents have, the greater their life satisfaction is. Parents of children with cerebral palsy should take care of their free time.

The Impact of Aquatic Exercise on Walking Ability, Quality of Life, and Enjoyment in Children with Cerebral Palsy: A Systematic Review

BACKGROUND/OBJECTIVES

Aquatic exercise is attracting attention as a method of rehabilitation for children with cerebral palsy (CP). The purpose of this systematic review was to evaluate whether aquatic exercise for children with CP improves their walking ability and quality of life (QOL) and is enjoyable for them.

METHODS

A literature search was conducted on 2 August 2024 using three databases: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials through Evidence-Based Medicine Reviews. Studies included in the review focused on aquatic exercise interventions for children with CP, with outcomes related to walking ability, QOL, or enjoyment. Studies that did not isolate the effects of aquatic exercise (except when combined with conventional interventions) were excluded. Two reviewers independently conducted screening and risk of bias assessments.

RESULTS

Seven studies involving 94 participants in total were included in the review. Three of these studies had a control group. All four studies reported improvements in walking ability, including walking endurance and efficiency. One of two studies showed improvement in health-related QOL (HRQOL) compared to the control group, whereas the other did not show significant differences between groups. All three studies that assessed enjoyment reported high levels of enjoyment of aquatic exercise. However, all studies were at risk of bias.

CONCLUSIONS

The reviewed studies suggest that aquatic exercise for children with CP may be enjoyable and may improve walking ability. Further research is needed to accurately assess the effects of aquatic exercise and compare it to other interventions.

Corpus callosum biometry in children born very preterm with and without cerebral palsy

BACKGROUND

Corpus callosum (CC) measurements are used as a biomarker of white matter volume in infants born very preterm (VPT; gestational age≤32 weeks). Although smaller CC measurements are found in both children born VPT and those with cerebral palsy (CP) compared to neurotypical children born at term, there is a lack of research specifically comparing CC measurements in VPT children with and without CP at different ages.

PARTICIPANTS AND METHODS

We compared five CC measurements (total length, and thickness of genu, body, isthmus, and splenium) calculated on the midsagittal plane of T1 magnetic resonance imaging (MRI) in a retrospective case-control study between VPT children with (case) and without CP (control) matched 1:1 by age at MRI at different ages (<12 months age; 5-11 years-old).

RESULTS

Seventy-four VPT children were included (median age 5.8 months [2.1-89.3], 34 females). Children with CP showed shorter length (45.3 mm [40.9-66.2] vs 50.9 mm [44.5-69]; p = 0.01), smaller isthmus thickness (1.8 mm [1.2-2.2] vs 2.2 mm [1.8-4.1]; p = 0.03), and smaller splenium thickness (3.5 [2.7-7.9] vs 5 mm [3.7-9.8]; p = 0.04) compared to children without CP. Comparison of the two groups by age at MRI, showed significantly smaller splenium thickness in both infants (<12 months age) and children (5-11 years-old) with CP than in controls.

CONCLUSION

Infants and children born VPT with CP had smaller CC measurements than those without CP, with the posterior region being the most affected. Splenium thickness in VPT infants could serve as a biomarker for white matter damage, potentially leading to CP.

A Longitudinal, Observational, and Descriptive Study About Benefits of Craniosacral Therapy in Child Neurodevelopment

INTRODUCTION

Coordination and balance are progressive motor skills that guide physical therapists in recognizing abnormal patterns during childish neurodevelopment. We aim to compare the efficacy of craniosacral therapy (CST) together with balance and coordination therapy (BCT) vs traditional BCT during neurodevelopment.

METHODS

Longitudinal, observational, and descriptive study with 111 apparently healthy children divided into 4 groups: craniosacral-balance and coordination therapy placebo (CS-BCTp), craniosacral-balance and coordination therapy (CS-BCT), balance and coordination therapy placebo (BCTp), and balance and coordination therapy (BCT).

RESULTS

Significant changes have been observed with the CS-BCT from the fourth session. Balance and coordination therapy is less effective. There are differences in the Battelle Scale at the beginning and after the 7 therapy sessions in the CS-BCT group.

CONCLUSIONS

The study shows that CST together with balance and coordination exercises can be a more effective and faster treatment to improve these motor skills, correcting and improving alterations during child neurodevelopment.

Tranexamic acid in hip and spine surgery for children with cerebral palsy - a PRISMA-compliant scoping review

Many children with cerebral palsy (CP) are frail and require major hip and/or spine surgeries associated with substantial blood loss. Tranexamic acid (TXA) is commonly used to reduce blood loss, but there is uncertainty around the optimal dose and timing of administration. There have been reviews in sub-populations and specific dosing regimens, but a broad overview of the available literature is lacking. The aim of this review was to map available evidence on TXA in hip and spine surgery for children with CP. Given the heterogeneous literature, a prospectively registered scoping review was conducted. Eligibility criteria were broad. Three screeners were involved, with the senior author consulted when disagreements were not resolved through discussion.Titles and abstracts of 14,609 records were screened, with 52 records included. Two additional records were obtained from grey literature and citation searching. Cohort studies (50.0%) were the most common. Most records (76.9%) were on spine surgery. TXA dose varied widely. Loading doses range from 5 to 100 mg/kg and intraoperative infusions from 1 to 10 mg/kg/h. Dose was not reported in 35.2% of records. Primary outcome measures included blood loss and transfusion requirements. TXA was generally reported to be safe. None of the included records reported postoperative TXA administration.While TXA is generally considered safe, there was mixed evidence on efficacy. Much of the evidence was drawn from studies in which TXA was used in patients at higher risk of bleeding or with reduced physiological reserve. There was no evidence for TXA being used postoperatively, when a large proportion of transfusions occur.

Early Diagnosis of Cerebral Palsy in Preterm Infants with MRI, General Movements and Neurological Exam

Background

The increasing clinical use of combining structural MRI (sMRI) with General Movements Assessment (GMA) or Hammersmith Infant Neurological Exam (HINE) before five months corrected age (CA) for early diagnosis of cerebral palsy (CP) lacks sufficient prognostic data for children with CP, especially those with Gross Motor Function Classification System (GMFCS) I.

Objective

Evaluate the predictive value of sMRI, GMA, and HINE individually and in combination for early CP diagnosis and assess accuracy across varying GMFCS levels in a regional cohort of preterm infants.

Methods

We performed sMRI between 39-44 weeks postmenstrual age and GMA and HINE between 12-18 weeks CA in 395 preterm infants born at ≤32 weeks' gestation across five NICUs in Greater Cincinnati. Brain abnormalities on sMRI included white matter injuries, cortical and deep gray matter lesions, or extensive cerebellar hemorrhage. Absent fidgety movements constituted abnormal GMA; abnormal HINEs were scores <56. The primary outcome was CP diagnosis at 22-26 months CA, classified by the GMFCS. We calculated sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios for individual tests and combinations.

Results

Of 338 (86%) infants with complete follow-up, 48 (14.2%) showed sMRI abnormalities, 15 (4.6%) had abnormal GMA, and 69 (20.9%) had abnormal HINE. Thirty-nine children (11.5%) developed CP at age 2, of which 28 had GMFCS level I and 11 had GMFCS >II. The combination of sMRI and GMA achieved 100% specificity but only 22% sensitivity while the combination of abnormal sMRI and HINE demonstrated sensitivity of 32% and specificity of 98% for prediction of CP. Individual or combined tests showed far higher sensitivity (78-100%) for predicting CP in children with GMFCS levels II-V.

Conclusions

The combination of sMRI with GMA or HINE demonstrated high specificity but low sensitivity for early CP diagnosis in a regional cohort of preterm infants. This approach appears effective for early detection of CP levels II-V but not for level I cases, the most prevalent type, underscoring the need for continued developmental follow-up for all very preterm infants and need for more sensitive diagnostic tools for early detection of CP.

Key Points

Questions: What is the individual and combined prognostic accuracy of sMRI, GMA, and HINE for early diagnosis of CP in preterm infants?Findings: In our prospective, regional study of preterm infants born at ≤32 weeks' gestation, we found that combining brain abnormalities on sMRI with abnormal GMA achieved 100% specificity but 22% sensitivity for diagnosing CP. Individual or combined tests showed far higher sensitivity (78-100%) for predicting CP in children with GMFCS levels II-V. Both individual and combined tests were poor predictors of GMFCS level I CP, the most common type.Meaning: While sMRI combined with GMA or HINE is effective for diagnosing CP with GMFCS levels II-V, this approach falls short for children with GMFCS level I.

Identification of Putative Biomarkers in Cerebral Palsy: A Meta-Analysis and Meta-Regression

BACKGROUND

Cerebral palsy (CP) is a neurological disorder that impairs motor abilities. Identifying maternal biomarker derangements can facilitate further evaluation for early diagnosis, potentially leading to improved clinical outcomes. This study investigates the association between maternal biomarker derangements and CP development during the antenatal period.

METHODS

A systematic search was conducted in MEDLINE, EMBASE, and Cochrane databases, following MOOSE guidelines. Data on participants exceeding biomarker thresholds (95th and 5th percentiles) were extracted for combined odds ratio estimation. Geometric mean differences, reported as multiples of the median (MoMs), were used to analyze changes in marker levels. Trimesterwise subgroup analysis and metaregression assessed the impact of variables on outcomes.

RESULTS

Five observational studies (1552 cases, 484,985 controls) revealed lower maternal pregnancy-associated plasma protein A levels were associated with CP (pooled odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.22 to 2.09; I = 0%), with a -0.04 MoM geometric mean difference. Lower maternal beta-human chorionic gonadotropin (HCG) levels in first and second trimesters indicated a pooled OR = 1.18 (95% CI = 0.85 to 1.63; I = 57%). Sensitivity analysis showed an OR = 1.40 (95% CI = 1.08 to 1.82; I = 0%), with a -0.07 MoM geometric mean difference. Metaregression identified primigravida status as negatively influencing beta-HCG levels. Elevated nuchal translucency values and CP presented a pooled OR = 1.06 (95% CI = 0.77 to 1.44; I = 0%).

CONCLUSION

Lower maternal pregnancy-associated plasma protein A levels during the first trimester and lower beta-HCG levels in the first and second trimesters are associated with CP development in children. Future research should validate the predictive utility of these biomarkers and explore novel ones through large-scale cohort studies.

The management of Pseudomonas aeruginosa respiratory infection in children with cerebral palsy: A narrative review

Children with cerebral palsy have increased respiratory morbidity and mortality. Infection with Pseudomonas aeruginosa (PA) is associated with poorer outcomes, yet there are no formal guidelines to inform treatment of respiratory infection in children with cerebral palsy. This review explores the existing literature regarding management of PA-infection in children with cerebral palsy, with the aim of synthesising clinical recommendations and identifying gaps in current understanding. Medline (Ovid), PubMed and Embase were searched using keywords. Full-text articles involving the paediatric population and antimicrobial therapy were included. There was no limit on date of publication. Four retrospective case series were identified. Respiratory microbiology, in samples collected from a range of sites along the respiratory tract, was reported in three studies. Patients who received PA-specific antibiotics clinically improved. Two studies suggest that the use of suppressive inhaled anti-pseudomonal therapy may improve respiratory morbidity in the chronic setting. There is minimal evidence to guide management of PA respiratory infection in children with cerebral palsy. Children with cerebral palsy are at risk of developing bronchiectasis, so in the absence of high-quality evidence, management should be informed by extrapolating from the non-cystic fibrosis bronchiectasis guidelines. Further research examining surveillance and management of PA-infection in this population is required given that early intervention may prevent irreversible lung damage.

Social capital of families of children with neurodevelopmental disabilities in South India

AIM

To investigate the social capital of families with children with neurodevelopmental disabilities in South India receiving a community-based early intervention (Enabling Inclusion®) program and to explore determinants and associations between social capital and program duration, socio-demographic factors, family empowerment, and caregiver burden.

METHOD

Using purposive sampling in a cross-sectional study design, 217 families (n = 71 received short Enabling Inclusion [<5 months]; n = 146 received long Enabling Inclusion [>9 months]) were recruited and completed the Short Adapted Social Capital Tool (SASCAT: cognitive, structural), measures of family empowerment, and caregiver strain. Descriptive statistics, regression, and correlations were used for analyses.

RESULTS

In 52.1% of participants, low cognitive and structural social capital was observed. Higher odds of low structural social capital were observed for mothers with primary versus secondary education (adjusted odds ratio [OR] = 0.35; 95% confidence interval [CI] 0.13-0.90; p = 0.029); and caregivers of children with cerebral palsy versus autism (OR = 4.66; 95% CI 1.02-21.21; p = 0.046). Significant associations were found between structural social capital, the child's age, and support group membership (χ2 = 6.29; 4.70; degrees of freedom [df] = 2; 1; p = 0.04; p = 0.02 respectively), as well as between cognitive social capital and other disability in the family (χ2 = 4.62, df = 1, p = 0.03).

INTERPRETATION

While program duration was not found to mediate social capital, mother's education and child's diagnosis emerged as key influential factors, warranting their consideration in interventions supporting families of children with neurodevelopmental disabilities in low- and-middle-income countries and elsewhere.

Postoperative pain management strategies following selective dorsal rhizotomy in pediatric cerebral palsy patients: a systematic review of published regimens

BACKGROUND

Surgical selective dorsal rhizotomy (SDR) in appropriate pediatric cerebral palsy patients is an effective treatment for spasticity. However, there remains heterogeneity reported in postoperative pain management with and without opioid medication in this delicate cohort. The objective of this study was to aggregate pertinent metadata by means of systematic review to summarize all relevant postoperative pain regimens in the literature.

METHODS

Searches of multiple electronic databases from inception to June 2024 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes and regimens were then summarized.

RESULTS

A total of 16 cohort studies were included in this study published between 1989 and 2024. Amongst all studies, outcomes were reported for a total of 636 with median cohort age 6.3 years, and median cohort male proportion 62% was reported. Four studies reported regimens involving systemic analgesia, 8 studies reported regimens involving epidural analgesia, and the remaining 4 studies reported regimens involving intrathecal analgesia. All studies primary pain management involved opioid medication, with 8 studies having opioid medication available as indicated, 3 studies having opioid medication as a single dose, and the remaining studies having opioid medication as a continuous agent in the immediate postoperative period. Across all studies, rates of desaturations, nausea and/or vomiting, and pruritis ranged from 0 to 55%, 25 to 82%, and 15 to 70% respectively. Eleven of the 16 studies included a comparative component, demonstrating that their regimen was at least comparable to their control regimen, if not superior.

CONCLUSIONS

Multiple variations of postoperative pain management in pediatric cerebral palsy patients following SDR have been reported in the literature, involving systemic, epidural, and intrathecal analgesia. Concerns for adverse effects with the utilization of opioid medication has led to the trend towards multimodal pain management relying more on non-opioid medication regimens in the more recent literature.

Early Biomarkers in the Prediction of Later Functional Impairment in Preterm Children With Cerebral Palsy

BACKGROUND

To identify early biomarkers that could predict later functional capabilities in preterm children with later cerebral palsy (CP).

METHODS

Data from 968 preterm children with later CP were extracted from the Canadian Cerebral Palsy Registry. One hundred eighty-two infants were born before 27 weeks of gestation, 461 infants were born between 27 and 33 weeks, and 325 infants were born between 34 and 37 weeks. Univariate and chi-square analyses were conducted to measure the association between early objective biomarkers and later mobility status defined as Gross Motor Function Classification System (GMFCS) levels IV and V as well as tube feeding dependence.

RESULTS

Univariate analysis suggested no significant association between GMFCS levels IV and V or impaired feeding status and bilateral white matter injury on magnetic resonance imaging, high-grade intraventricular hemorrhage on head ultrasound, chorioamnionitis, a birth weight of 1000 to 1500 g or <1000 g, as well as an Apgar score of ≤5 at five minutes of life. Similar results were found for gestational age <28 weeks at birth. Only a significant association between GMFCS levels IV and V and a cord or first hour of life pH of ≤7 was reported (mobility status: odds ratio [OR] 1.95, 95% confidence interval [CI] 1.09 to 3.57) and feeding status: OR 2.23, CI 0.97 to 4.65)].

CONCLUSIONS

Prediction of functional outcomes based on specific early biomarkers appears hard to obtain in children with CP born preterm in contrast to those born at term. The complications and causal pathways inherent to prematurity may contribute to making prognostication less determinant.

Precision in Progress: Unraveling the Clinimetric Properties of Beery-Buktenica Developmental Test of Visual-Motor Integration in Children With Cerebral Palsy Across Diverse Motor Severities

BACKGROUND

In the realm of pediatric cerebral palsy (CP), visual motor challenges often overshadow a child's developmental journey. This study delves into the responsiveness and crucial benchmarks, specifically the minimal clinically important difference (MCID), of the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) among children with varying motor severities.

METHOD

Eighty-eight children with CP (50 males, 38 females; aged three to 12 years) with Gross Motor Function Classification System (GMFCS) levels I to III were recruited from the rehabilitation department of Chang Gung Memorial Hospital in Taiwan. Each participant received the Beery VMI tests at baseline and at one-year follow-up. The standardized response mean (SRM) was calculated to determine the responsiveness of Beery VMI, and a distribution-based approach was used to estimate MCID.

RESULTS

The Beery VMI exhibited remarkable responsiveness across GMFCS levels I to III (SRM = 0.98-2.36). MCIDs for Beery VMI varied across severities, with ranges of 2.93 to 4.41 (0.2 S.D.), 7.31 to 11.49 (0.5 S.D.), and 11.70 to 18.38 (0.8 S.D.). Notably, in the visual perception subset, MCIDs were 3.93 to 4.03 (0.2 S.D.), 9.83 to 10.07 (0.5 S.D.), and 15.73 to 16.11 (0.8 S.D.). In the supplemental motor coordination subtest, MCIDs spanned 1.67 to 4.87 (0.2 S.D.), 4.18 to 12.17 (0.5 S.D.), and 6.68 to 19.47 (0.8 S.D.).

CONCLUSIONS

Beery VMI demonstrates robust responsiveness in children with CP. Motor-severity-tailored MCIDs offer a guide for clinicians and researchers, hinting at treatment efficacy. Particularly, lower change scores in VMI and motor coordination subtests may signal effective interventions for moderate motor disability over mild cases.

Construction and Behavioral Comparison of Two Mouse Models of Cerebral Palsy

Cerebral palsy (CP) is the most common neuromuscular disorder in children with no effective therapeutic methods. To examine CP, a large variety of methods and animal models was developed, the most popular are the hypoxic-ischemic (HI) injury and/or LPS injection in mice. In the presented work, HI and LPS were applied on the postnatal day 9 to humanized immunodeficiency mouse pups, thereupon 3 behavioral tests were performed in 8 weeks later. Both HI and LPS caused significant behavioral deficits assessed in the Rotarod test. In gait dynamics and open-field tests, HI and LPS caused significant behavioral deficits reported by some parameters, and the effect of HI was more severe. Additionally, HI and LPS produced the different effects on gait dynamics of the fore and hind paws. Thus, both HI and LPS induced the behavioral disorders in mice, but HI was more suitable for the development of humanized immunodeficiency mouse model of CP.

The state of employment in the United States among young adults with cerebral palsy

Young adults with Cerebral Palsy (CP) have lower employment rates compared to young adults in general, as they may be confronted with physical, sensory, and cognitive impairments, coupled with personal and societal barriers as they mature. These challenges are clear, but the solutions are less so. Understanding the factors that impact employment is vital. This study aimed to identify and examine variables related to employment for this population through the lens of the International Classification of Functioning, Disability, and Health (ICF) model. The Rehabilitation Services Administration (RSA-911) federal dataset was used to examine the relationship between functioning and disability within the context of personal and environmental factors as predictors of employment among young adults with CP. Following a descriptive cross-sectional design using a secondary analysis of this national dataset, binomial logistic regression was used to predict employment outcomes. Data representing those with CP who participated in vocational rehabilitation (VR) services and were between 18 and 30 years of age at the time of exit were extracted from the 2019 RSA-911 dataset (n = 2465). Just under one-third (30.4 %, n = 750) emerged as employed, while 69.6 % (n = 1715) were unemployed at exit from their VR programs in 2019. Significant predictors for employment were participation in career and other support services, having basic skills and literacy, and being of non-Hispanic/Latino ethnicity. These findings concur with the persistent low employment rates for adults with CP and reinforce the need to understand the factors that increase employability. Healthcare professionals are urged to incorporate participation in self-management activities for all transition-aged youth that will not only improve health outcomes but promote future independence and increase awareness of vocational services for this population.

Heterotopic Osteotomy for Intrathecal Baclofen Test Dose Administration in a Pediatric Patient With Spinal Fusion: A Technical Note

BACKGROUND AND IMPORTANCE

Intrathecal baclofen (ITB) pumps are used for the treatment of pediatric movement disorders that are rapidly progressive or do not respond to medical management. An ITB test dose is indicated in patients who have mixed tone, when the family remains unconvinced, or when insurance companies require it. Test doses are typically delivered by lumbar puncture; however, lumbar puncture in patients with heterotopic ossification of the lumbar vertebrae after a previous spinal fusion is not possible. To our knowledge, we present the first technical note describing a heterotopic osteotomy to access the subarachnoid space for a complex ITB test dose in a pediatric patient with a spinal fusion.

CLINICAL PRESENTATION

We present a 14-year-old woman with spastic, dystonic quadriplegic cerebral palsy, neuromuscular scoliosis, and previous T3-pelvis posterior spinal fusion. She continued to have significant dystonia and spasticity despite maximal medical management and was offered ITB therapy. A complex ITB test dose through heterotopic osteotomy was performed with excellent clinical results, and the patient will ultimately receive an ITB pump.

CONCLUSION

Heterotopic ossification following spinal fusion is not a contraindication to an ITB test dose. A heterotopic osteotomy is a feasible surgical approach to administer an ITB test dose in these pediatric patients.

Postnatal depressive symptoms in mothers of infants at high risk of cerebral palsy: the role of delayed infant communicative development

PURPOSE

Recent diagnostic advantages enable detection of cerebral palsy (CP) in infants before five months of age. Parents of children with CP often face mental health problems, but specific knowledge for infancy is needed. In this study, depressive symptoms in mothers of 16-week-old infants and associations with infant development were investigated.

MATERIALS AND METHODS

This cross-sectional study involves 56 families, 22 high-risk and 34 infants without risk of CP. High-risk-CP was identified following international clinical guidelines. We assessed infant cognitive and language development using the Bayley-III and motor development using the Alberta Infant Motor Scale. Maternal depressive symptoms were self-reported using the Edinburgh Postnatal Depression Scale.

RESULTS

Mothers of CP high-risk infants were 15.6 times more likely to experience risk of postnatal depression compared to mothers of infants without risk. Additionally, linear regression analyses showed that having an infant at high-risk of CP (β = .359, p = .006) and delayed language development (β = -0.510, p < .001) were associated with increased maternal depressive symptoms.

CONCLUSIONS

We recommend systematic screening of postnatal depressive symptoms following detection of high-risk-CP in infants. Early interventions could include a mother-infant interactional component to support caregivers in interpreting and responding to infant communicative cues.

Motor development trajectories of children with cerebral palsy in a community-based early intervention program in rural South India

BACKGROUND

Developmental trajectories are crucial for evidence-based prognostication, planning interventions, and monitoring progress in children with cerebral palsy (CP).

AIMS

To describe gross motor development patterns of children with CP in rural South India for the five Gross Motor Function Classification System (GMFCS) levels.

METHODS

Longitudinal cohort study of 302 children (176 males, 126 females) with CP aged 0 to 10 years, followed by a community-based early intervention program. GMFCS levels were 5.4 % level 1, 16.5 % level II, 22.8 % level III, 26.8 % level IV, and 28.5 % level V. Assessments were undertaken using the Gross Motor Function Measure (GMFM-66) at 6-month intervals between April 2017 and August 2020. Longitudinal analyses were performed using mixed-effects linear regression models.

OUTCOMES AND RESULTS

Five distinct motor development curves were created for ages 0 to 10 years by GMFCS levels as a function of age and GMFM-66 with a stable limit model, variation in estimated limits and rates of development.

CONCLUSIONS AND IMPLICATIONS

Motor development trajectories for CP in an LMIC differ from those reported in HICs. Consideration of how social determinants of health, environmental and personal factors impact motor development in low-resource contexts is crucial. Further work is needed to describe developmental trajectories of children for CP in LMICs.

Unplanned hospital readmission after cholecystectomy in adults with cerebral palsy

BACKGROUND

Adults with cerebral palsy (CP) are a largely understudied, growing population with unique health care requirements. We sought to establish a deeper understanding of the surgical risk in adults with CP undergoing a common general surgical procedure: cholecystectomy.

METHODS

Data were obtained from the State Inpatient Database developed for the Healthcare Cost and Utilization Project. Inclusion criteria included patients ≥ 18 years with CP and a primary ICD-9 procedure code indicating open or laparoscopic cholecystectomy. Demographics, procedure-related factors, and comorbid conditions were analyzed, and unplanned 30 and 90 day readmission rates calculated for each variable. Reasons for readmission based on ICD-9 diagnosis codes were grouped into relevant categories. Univariate analysis identified factors significantly associated with readmission rates.

RESULTS

A total of 802 patients with CP met the inclusion criteria. Unplanned 30 and 90 day readmission rates after laparoscopic cholecystectomy were 11.4% and 18.1%, respectively. Average length of stay (LOS) after laparoscopic cholecystectomy was 7.1 days. After open cholecystectomy, 30 and 90 day readmission rates were 16.9% and 30.3% with an average LOS of 14.6 days. Infection was the most common cause for 30 and 90 day readmission. Factors associated with 30 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid diabetes and malnutrition. Factors associated with 90 day readmission included type of cholecystectomy, LOS, discharge to skilled nursing facility, and comorbid heart failure, renal disease, epilepsy, and malnutrition.

CONCLUSION

Unplanned readmission rates after open and laparoscopic cholecystectomy in adult patients with CP are much higher than previously demonstrated rates in the general population. These patients frequently suffer multiple comorbid conditions that significantly complicate their surgical care. As more and more of these patients live longer into adulthood, further study is warranted to grasp the perioperative risk of simple and complex surgical procedures.

The IndieTrainer system: a small-scale trial exploring a new approach to support powered mobility skill acquisition in children

The IndieTrainer system, consisting of a mobility device and video-based gamified training modules, was developed to assist children in attaining power wheelchair (PWC) skills. The purposes of this small-scale trial were to explore the use of the IndieTrainer system to provide PWC skills training and document parental satisfaction with the IndieTrainer system. We hypothesized that PWC skills training provided using the IndieTrainer system would result in improvements in both children's understanding of how to use a PWC and their PWC skill execution, and that parental satisfaction would be high. An open-label, single-arm trial was conduct as follows: (a) Baseline testing (T0); (b) A 3-week intervention consisting of two, 60-min-PWC skills training sessions per week; (c) Post-intervention testing (T1); and (d) A single session retention trial held 4 weeks after completion of the intervention (T2). Outcome measures included the Assessment of Learning Powered mobility use (ALP), Wheelchair Skills Checklist (WSC), Canadian Occupational Performance Measure (COPM), and Client Satisfaction Questionnaire-8 (CSQ-8). 25 child/parent dyads participated. Between T0 and T1, statistically significant differences (p-value <.0001) with large effect sizes in mean ALP and WSC scores (ALP: d = 3.14; WSC: d = 3.25) and COPM performance and satisfaction scores (Performance: d = 4.66; Satisfaction: d = 3.24) were achieved. Mean T1 total CSQ-8 score was 31.52/32. At T2, all children maintained or improved their T1 ALP and WSC scores. This study provides initial support for the usability and feasibility of the IndieTrainer system. Futhermore, larger scaled studies using more rigorous research designs are indicated.

Cerebral palsy: potential risk factors and functional status among children under three years, a case-control study in northwest Iran

BACKGROUND

Cerebral palsy (CP) is one of the most common motor-postural disorders in childhood. It occurs due to impairment in the developing brain-before, during, or after birth-and has a significant burden on the public health system. This study aimed to investigate the potential risk factors and detect the associated CP-related disorders.

METHODS

This case-control study was conducted on 46 children with CP and 175 matched healthy children less than three years old who referred to the Children's Hospital, Tabriz, Iran in 2022. Then, a checklist related to the mother's medical history during current and previous pregnancies, a questionnaire related to perinatal factors of the newborn, types of CP, concurrent disorders, the Gross Motor Function Classification System (GMFCS), and Age and Stage Questionaire (ASQ) were completed. Data was analyzed using Statistical Package for the Social Sciences) SPSS(-21 software by descriptive and analytical statistics consisted of Chi-square, Independent t-test, and Binary logistic regression.

RESULTS

Finally, 35 children with CP and 122 healthy children completed the study and were analyzed. The mean (standard deviation: SD) age of children in the CP group was 15.3 (6.2) and in the healthy group was 14.4 (6.6) months (p = 0.635). Spastic CP (82.9%) was the common type, and the most common prevailing form of the involved limb was quadriplegia (54.3%). The severity of the functional disorder in 39.3% of CP cases was at levels 4 and 5 (severe form). The most prevalent comorbidities were inability to walk (31.4%), speech delay (22.9%), epilepsy (11.4), and strabismus (8.6%). Children with CP had abnormal development in gross motor (82.9%), problem-solving (68.6%), personal-social (65.7%), fine motor (60%), and communication (54.3%). Moreover, duration of pregnancy (p = 0.023), birth weight lower than 2500 g (p = 0.002), problems in the current pregnancy [adjusted odds ratio (aOR) [95% CI]: 3.06 (1.87 to 8.54); p = 0.013] and problems in previous pregnancy ([aOR (95% CI): 4.8 (1.6 to 14.2); p = 0.005) were potential risk factors.

CONCLUSION

Due to accompanying movement, vision, and speech problems, especially high developmental disorders in children with CP, necessary measures to prevent the identified risk factors are very important.

Effects of multicomponent exercise intervention on cardiometabolic risk factors in children and young adults with cerebral palsy: a multiple-baseline trial

BACKGROUND

Adults with cerebral palsy (CP) have a high risk of cardiometabolic diseases. It is unknown whether this risk is elevated in young people with CP and whether exercise can reduce this risk. Therefore, we investigated the effects of the EXErcise for Cerebral Palsy (EXECP) intervention on cardiometabolic risk in children and young adults with CP and compared this risk to typically developing children and young adults (TDs).

METHODS

Ambulatory male and female participants with spastic CP, aged 9-24 years, and age- and sex-matched TDs without musculoskeletal disorders were recruited. Participants with CP were measured at baseline, after a three-month control period manifesting normal development, and after the three-month strength, gait, and flexibility training intervention. TDs were measured at baseline and after the control period. They did not attend the intervention. Cardiometabolic risk factors included body weight, body fat percentage, and skeletal muscle mass index assessed with bioimpedance; resting systolic and diastolic blood pressure and aortic pulse wave velocity assessed with a non-invasive oscillometric device; fasting plasma high-density and low-density lipoprotein cholesterol, triglyceride, and glucose levels. Data were analyzed with independent samples t-tests and linear mixed-effects models adjusted for sex and age.

RESULTS

The study involved 18 participants with CP (13 males, 9-22 year, mean 14.2 ± 4.4) and 17 TDs (12 males, 9-22 year, mean 14.6 ± 4.3). At baseline, participants with CP had a 1.0 (95% confidence interval (CI) [-2.0, -0.0]) kg/m2 lower skeletal muscle mass index than TDs. During the control period, no statistically significant between-group differences were observed in the change of any outcome. In the CP group, body weight (β = 1.87, 95% CI [1.04, 2.70]), fat percentage (β = 1.22 [0.07, 2.37], and blood glucose (β = 0.19, 95% CI [0.01, 0.37]) increased, while diastolic blood pressure (β=-2.31, 95% CI [-4.55, -0.06]) and pulse wave velocity (β=-0.44, 95% CI [-0.73, -0.16]) decreased. In the TD group, only body weight increased (β = 0.85, 95% CI [0.01, 1.68]) statistically significantly. In the CP group, no changes were observed during the intervention.

CONCLUSIONS

Young people with and without CP do not exhibit significant differences in most cardiometabolic risk factors. EXECP intervention may attenuate some adverse development trajectories occurring without the intervention but greater volume and intensity of aerobic exercise may be needed to reduce cardiometabolic risk.

TRIAL REGISTRATION

ISRCTN69044459; Registration date 21/04/2017.