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Sabater-Gárriz Á, Montoya P, Riquelme I. Enhanced EEG power density during painful stretching in individuals with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 150:104760. [PMID: 38795555 DOI: 10.1016/j.ridd.2024.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Pain perception mechanisms in cerebral palsy remain largely unclear. AIMS This study investigates brain activity in adults with cerebral palsy during painful and non-painful stretching to elucidate their pain processing characteristics. METHODS AND PROCEDURES Twenty adults with cerebral palsy and 20 controls underwent EEG in three conditions: rest, non-painful stretching, and painful stretching. Time-frequency power density of theta, alpha, and beta waves in somatosensory and frontal cortices was analyzed, alongside baseline pressure pain thresholds. OUTCOMES AND RESULTS Cerebral palsy individuals exhibited higher theta, alpha, and beta power density in both cortices during painful stretching compared to rest, and lower during non-painful stretching. Controls showed higher power density during non-painful stretching but lower during painful stretching. Cerebral palsy individuals had higher pain sensitivity, with those more sensitive experiencing greater alpha power density. CONCLUSIONS AND IMPLICATIONS These findings confirm alterations in the cerebral processing of pain in individuals with cerebral palsy. This knowledge could enhance future approaches to the diagnosis and treatment of pain in this vulnerable population.
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Balearic ASPACE Foundation, Marratxí, Spain; Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Montoya
- Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Inmaculada Riquelme
- Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain.
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Liuzzi T, Bompard S, Raponi M, D’Arienzo F, Staccioli S, Napoli E, Diotallevi MF, Piga S, Giuliani R, Castelli E. Euterpe music therapy method for children with cerebral palsy. Front Neurol 2024; 15:1388712. [PMID: 38660092 PMCID: PMC11040093 DOI: 10.3389/fneur.2024.1388712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The main purpose of our study was to evaluate whether involvement in a personalized music therapy program (Euterpe method), could improve the condition of children with cerebral palsy and their parents, compared to a control group. It investigated whether it could positively affect children's sleep quality, temperament and quality of life, quality of family life, and parental stress. Methods A prospective single-center experimental study was conducted at "Bambino Gesù" Children's Hospital (Rome, Italy). All subjects involved attended an intensive rehabilitation program in the Neurorehabilitation Unit. In a group of patients (n = 25), a music therapy treatment was applied to evaluate the effect before and after the intervention. This group was also compared with a control group (n = 10) undergoing a standard protocol without music therapy. Results In the experimental group, the analysis shows statistically significant effects in the Disorders of initiating and maintaining sleep (p = 0.050) and the Sleep wake transition disorders (p = 0.026) factors, and the total score (p = 0.031) of Sleep Disturbances Scale for Children; the Positive emotionality scale (p = 0.013) of Italian Questionnaires of Temperament (QUIT); the Emotional Functioning (p = 0.029), Social Functioning (p = 0.012), Worry (p = 0.032), Daily Activities (p = 0.032), Total Score (p = 0.039) and Parent HRQL Summary Score (p = 0.035) dimensions of Pediatric Quality of Life for family. While in the control group, only the Attention scale of QUIT (p = 0.003) reaches statistical significance. Discussion Our study suggests that music therapy with the Euterpe Method has beneficial effects on fundamental aspects of the child's and his parents' lives, such as sleep, emotion control, and quality of family life.
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Affiliation(s)
- Tommaso Liuzzi
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Santa Cecilia Conservatory of Music, Rome, Italy
| | - Sarah Bompard
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Fiammetta D’Arienzo
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Euterpe APS Cultural Association, Rome, Italy
| | - Susanna Staccioli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Eleonora Napoli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Enrico Castelli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Kleeren L, Mailleux L, McLean B, Elliott C, Dequeker G, Van Campenhout A, de Xivry JJO, Verheyden G, Ortibus E, Klingels K, Feys H. Does somatosensory discrimination therapy alter sensorimotor upper limb function differently compared to motor therapy in children and adolescents with unilateral cerebral palsy: study protocol for a randomized controlled trial. Trials 2024; 25:147. [PMID: 38409060 PMCID: PMC10895830 DOI: 10.1186/s13063-024-07967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Besides motor impairments, up to 90% of the children and adolescents with unilateral cerebral palsy (uCP) present with somatosensory impairments in the upper limb. As somatosensory information is of utmost importance for coordinated movements and motor learning, somatosensory impairments can further compromise the effective use of the impaired upper limb in daily life activities. Yet, intervention approaches specifically designated to target these somatosensory impairments are insufficiently investigated in children and adolescents with uCP. Therefore, the aim of this randomized controlled trial (RCT) is to compare the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP, who experience somatosensory impairments in the upper limb. We will further explore potential behavioral and neurological predictors of therapy response. METHODS A parallel group, evaluator-blinded, phase-II, single-center RCT will be conducted for which 50 children and adolescents with uCP, aged 7 to 15 years, will be recruited. Participants will be randomized to receive 3 weekly sessions of 45 minutes of either somatosensory discrimination therapy or upper limb motor therapy for a period of 8 weeks. Stratification will be performed based on age, manual ability, and severity of tactile impairment at baseline. Sensorimotor upper limb function will be evaluated at baseline, immediately after the intervention and after 6 months follow-up. The primary outcome measure will be bimanual performance as measured with the Assisting Hand Assessment. Secondary outcomes include a comprehensive test battery to objectify somatosensory function and measures of bimanual coordination, unimanual motor function, and goal attainment. Brain imaging will be performed at baseline to investigate structural brain lesion characteristics and structural connectivity of the white matter tracts. DISCUSSION This protocol describes the design of an RCT comparing the effectiveness of somatosensory discrimination therapy and dose-matched motor therapy to improve sensorimotor upper limb function in children and adolescents with uCP. The results of this study may aid in the selection of the most effective upper limb therapy, specifically for children and adolescents with tactile impairments. TRIAL REGISTRATION ClinicalTrials.gov (NCT06006065). Registered on August 8, 2023.
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Affiliation(s)
- Lize Kleeren
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium.
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium.
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium.
| | - Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
| | - Belinda McLean
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Kids Rehab WA, Telethon Kids Institute, Perth, Australia
| | - Griet Dequeker
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
| | - Anja Van Campenhout
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Leuven Brain Institute, Leuven, B-3000, Belgium
- KU Leuven, Department of Movement Sciences, Research Group of Motor Control and Neuroplasticity, Leuven, B-3000, Belgium
| | - Geert Verheyden
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
| | - Els Ortibus
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
- University Hospitals Leuven, Cerebral Palsy Reference Centre, Leuven, B-3000, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, B-3000, Belgium
| | - Katrijn Klingels
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- Hasselt University, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Diepenbeek, B-3590, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, B-3001, Belgium
- KU Leuven, Child and Youth Institute, Leuven, B-3000, Belgium
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Lidbeck C, Bartonek Å, Ferrari A, Alboresi S, Örtqvist M. Signs of perceptual disorder during movement were reliably assessed in children with cerebral palsy in Sweden. Acta Paediatr 2024; 113:344-352. [PMID: 37874018 DOI: 10.1111/apa.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM The aim of this Swedish study was to evaluate the assessment of clinical signs of perceptual disorder in children with cerebral palsy (CP). METHODS Three experienced raters assessed 56 videos of 19 children from 1 to 18 years of age with bilateral spastic CP, which were recorded by colleagues at an Italian hospital. Six signs were evaluated for inter-rater reliability and criterion validity. Clinical applicability was evaluated by assessing inter-rater reliability between 47 Swedish clinicians, who examined 15 of the videos during face-to-face and online education seminars. There were 41 physiotherapists, two occupational therapists and four doctors, with 1-37 years of clinical experience and a median of 10 years. RESULTS The experienced raters demonstrated moderate to almost perfect inter-rater reliability (kappa 0.54-0.81) and criterion validity (0.54-0.87) for startle reaction, upper limbs in startle position, averted eye gaze and eye blinking. The clinicians recognised these signs with at least moderate reliability (0.56-0.88). Grimacing and posture freezing were less reliable (0.22-0.35) and valid (0.09-0.50). CONCLUSION Four of the six signs of perceptual disorder were reliably recognised by experienced raters and by clinicians after education seminars. Extended education and larger study samples are needed to recognise all the signs.
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Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Adriano Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Alboresi
- Children Rehabilitation Unit of S. M. Nuova Hospital, AUSL-IRCCS, Reggio Emilia, Italy
| | - Maria Örtqvist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Bartonek Å, Lidbeck C. Knee Flexion While Walking Exceeds Knee Flexion Contracture in Children with Spastic Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1867. [PMID: 38136069 PMCID: PMC10741394 DOI: 10.3390/children10121867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Flexed knee gait is commonly related to contractures in children with cerebral palsy (CP). Therefore, knee position while walking was compared with passive knee extension and explored with respect to functional mobility. Gait was assessed with 3D motion analysis in 30 children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) levels I-III, and in 22 typically developing (TD) children. Knee angle at initial contact (KneeAngleIC) was greater than knee flexion in stance (MinKneeFlexSt) in all groups. MinKneeFlexSt exceeded knee contractures at GMFCS levels II and III. Both KneeAngleIC and MinKneeFlexSt were greater at GMFCS II and III than at GMFCS I and the TD group. The excessive knee flexion while walking at GMFCS II and III could not be explained by knee joint contractures. Functional mobility measured with the timed-up-and-go test took longer in children at GMFCS level III compared to the other groups, assumed to be explained by the energy-requiring flexed knee gait and spatial insecurity. Discriminating between passive knee extension at the physical assessment and maximum knee extension while weight bearing may contribute to further understanding of flexed knee gait and its causes in ambulating children with spastic bilateral CP.
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Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-17176 Stockholm, Sweden;
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women’s and Children’s Health, Karolinska Institutet, SE-17176 Stockholm, Sweden;
- Motion Analysis Laboratory, Karolinska University Hospital, QA:27, Karolinska vägen 37A, SE-17176 Stockholm, Sweden
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Liang KJ, Chen HL, Huang KL, Wang TM, Shieh JY, Wang TN. Assessment for Tactile Perception in Children With Cerebral Palsy. Am J Occup Ther 2023; 77:7704205050. [PMID: 37624995 DOI: 10.5014/ajot.2023.050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Impaired tactile perception frequently accompanies motor deficits in children with cerebral palsy (CP). Assessing tactile perception precisely for children with CP remains challenging because of a lack of assessments with robust psychometric evidence or standard procedures. OBJECTIVE To develop a standardized assessment tool, the Tactile Perceptual Test (TPT), for measuring tactile perception in children with CP and to examine its psychometric properties. DESIGN Observational study design. SETTING University research laboratory and medical center. PARTICIPANTS Children with CP (n = 100) and typical development (TD; n = 50). OUTCOMES AND MEASURES The TPT includes four subtests measuring stereognosis, roughness, hardness, and heaviness. Three comparator instruments, Semmes-Weinstein monofilaments, Two-Point Discrimination, and the stereognosis subtest of the Revised Nottingham Sensory Assessment, were used for convergent validity. RESULTS Good test-retest reliability was confirmed for all of the TPT subtests. The values of minimal detectable change were acceptable. Moderate correlations between the TPT and comparator instruments were found, as expected. For known-groups validity, the significant difference was confirmed between children with CP and those with TD. CONCLUSIONS AND RELEVANCE The TPT is a reliable and valid measure for multiple subdomains of tactile perception in children with CP. This tactile assessment may help clarify tactile performance to provide appropriate, precise interventions. What This Article Adds: The TPT measures tactile perception in children with CP. It has four subdomains of tactile perception that could facilitate prioritization of tactile treatment of specific subdomains and thereby aid in the provision of appropriate interventions.
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Affiliation(s)
- Kai-Jie Liang
- Kai-Jie Liang, PhD, is Postdoctoral Researcher, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan. At the time this article was submitted, Liang was PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hao-Ling Chen
- Hao-Ling Chen, PhD, is Associate Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kuo-Lun Huang
- Kuo-Lun Huang, MS, is Occupational Therapist, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ting-Ming Wang
- Ting-Ming Wang, MD, PhD, is Professor, Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei City, Taiwan, and Physician, Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jeng-Yi Shieh
- Jeng-Yi Shieh, MD, is Physician, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tien-Ni Wang
- Tien-Ni Wang, PhD, is Professor, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan;
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Ericson A, Bartonek Å, Tedroff K, Lidbeck C. Responses to Sensory Events in Daily Life in Children with Cerebral Palsy from a Parent Reported Perspective and in a Swedish Context. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1139. [PMID: 37508634 PMCID: PMC10378633 DOI: 10.3390/children10071139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
The motor disorders of cerebral palsy (CP) are often accompanied by sensory disturbances, but knowledge of their relationship to motor functioning is sparse. This study explored responses to sensory events in relation to spastic subtype and motor functioning in children with CP. Parents of 60 children with CP (unilateral: 18, bilateral: 42) with GMFCS levels I:29, II:13, III:15 and IV:3 of mean age 12.3 years (3.7 SD) participated. The parents (n = 55) rated their children´s responses with the norm-referenced questionnaire Child Sensory Profile-2© (CSP-2©), Swedish version, incorporating nine sections and four sensory processing patterns/quadrants, and replied (n = 57) to two additional questions. On the CSP-2©, thirty (55%) of the children were reported to have responses "much more than others" (>2 SD) in one or more of the sections and/or quadrants and 22 (40%) in the section of Body Position, overrepresented by the children with bilateral CP. The additional questions revealed that a greater proportion of children at GMFCS levels III-IV compared to level I frequently were requested to sit/stand up straight (14/17 versus 6/26, p < 0.001) and were sound sensitive at a younger age (14/17 versus 10/26, p = 0.005). The findings of this study highlight the sensory aspects of motor functioning in children with spastic CP.
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Affiliation(s)
- Annika Ericson
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
| | - Cecilia Lidbeck
- Department of Women's and Children´s Health, Karolinska Institutet, S-171 76 Stockholm, Sweden
- Neuropediatric Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, S-171 76 Stockholm, Sweden
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Dukkipati SS, Walker SJ, Trevarrow MP, Busboom M, Baker SE, Kurz MJ. Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy. Front Neurol 2022; 13:930303. [PMID: 36016542 PMCID: PMC9396222 DOI: 10.3389/fneur.2022.930303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Although most neurophysiological studies of persons with cerebral palsy (CP) have been focused on supraspinal networks, recent evidence points toward the spinal cord as a central contributor to their motor impairments. However, it is unclear if alterations in the spinal pathways are also linked to deficits in the sensory processing observed clinically. This investigation aimed to begin to address this knowledge gap by evaluating the flexor carpi radialis (FCR) H-reflex in adults with CP and neurotypical (NT) controls while at rest and during an isometric wrist flexion task. The maximal H-wave (Hmax) and M-wave (Mmax) at rest were calculated and utilized to compute Hmax/Mmax ratios (H:M ratios). Secondarily, the facilitation of the H-wave was measured while producing an isometric, voluntary wrist flexion contraction (i.e., active condition). Finally, a wrist position sense test was used to quantify the level of joint position sense. These results revealed that the adults with CP had a lower H:M ratio compared with the NT controls while at rest. The adults with CP were also unable to facilitate their H-reflexes with voluntary contraction and had greater position sense errors compared with the controls. Further, these results showed that the adults with CP that had greater wrist position sense errors tended to have a lower H:M ratio at rest. Overall, these findings highlight that aberration in the spinal cord pathways of adults with CP might play a role in the sensory processing deficiencies observed in adults with CP.
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Affiliation(s)
- S. Shekar Dukkipati
- Boys Town National Research Hospital, Omaha, NE, United States
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sarah J. Walker
- Boys Town National Research Hospital, Omaha, NE, United States
| | | | - Morgan Busboom
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Sarah E. Baker
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Max J. Kurz
- Boys Town National Research Hospital, Omaha, NE, United States
- School of Medicine, Creighton University, Omaha, NE, United States
- *Correspondence: Max J. Kurz
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Marsico P, Meier L, van der Linden ML, Mercer TH, van Hedel HJA. Psychometric Properties of Lower Limb Somatosensory Function and Body Awareness Outcome Measures in Children with Upper Motor Neuron Lesions: A Systematic Review. Dev Neurorehabil 2022; 25:314-327. [PMID: 34872425 DOI: 10.1080/17518423.2021.2011976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE A systematic review of the psychometric properties and feasibility of outcome measures assessing lower limb somatosensory function and body awareness in children with upper motor neuron lesion. METHODS We followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Two raters independently judged the quality and risk of bias of each study. Data synthesis was performed, and aspects of feasibility were extracted. RESULTS Twelve studies investigated eleven somatosensory function measures quantifying four modalities and eight body awareness measures quantifying two modalities. The best evidence synthesis was very low to low for somatosensory function modalities and low for body awareness modalities. Few feasibility aspects were reported (e.g., the percentage or minimum age of participants able to perform the tests). CONCLUSION Current evidence on the psychometric characteristics of somatosensory function and body awareness outcome measures are relatively sparse. Further research on psychometric properties and practical application is needed.
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Affiliation(s)
- Petra Marsico
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Queen Margaret University, Edinburgh, Scotland
| | - Lea Meier
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Hubertus J A van Hedel
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Queen Margaret University, Edinburgh, Scotland
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Santana CAS, Dos Santos MM, de Campos AC. Interrelationships of Touch and Proprioception with Motor Impairments in Individuals with Cerebral Palsy: A Systematic Review. Percept Mot Skills 2022; 129:570-590. [PMID: 35452588 DOI: 10.1177/00315125221093904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Considering that somatosensory impairments may impact motor performance in individuals with cerebral palsy (CP), a better understanding of these relations is relevant to planning interventions. To synthesize research evidence to date on the interrelationships between the somatosensory functions of touch and proprioception with motor functions in persons with CP, we systematically searched Embase, CINAHL, PsycINFO, and Medline databases for studies relating these variables that were published in English from the inception of these databases to November 2020. We targeted the following content categories in our literature search: (a) cerebral palsy; (b) sensory functions; (c) tactile functions; (d) proprioception functions; and (e) motor functions. The selection, data extraction, and methodological quality assessment of these studies were performed in duplicate. We retrieved and analyzed information regarding the studies' methodological approaches and synthesized results. The 11 studies that met our inclusion criteria showed that, in individuals with CP, impairments in tactile discrimination, proprioception, and stereognosis are related to motor functions in terms of overall manual ability, grip strength, postural control and locomotion. Thus, clinical practitioners should attend to somatosensory aspects of motor impairment in individuals with CP. More research is needed to clarify the direction of these associations.
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Affiliation(s)
- Camila A S Santana
- Department of Physical Therapy, 67828Federal University of São Carlos, Brazil
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11
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Chen D, Huang M, Yin Y, Gui D, Gu Y, Zhuang T, Chen C, Huo K. Risk factors of cerebral palsy in children: a systematic review and meta-analysis. Transl Pediatr 2022; 11:556-564. [PMID: 35558974 PMCID: PMC9085939 DOI: 10.21037/tp-22-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to explore the main risk factors for cerebral palsy in children by meta-analysis of the literature on the risk factors of cerebral palsy. METHODS We performed a literature search of the PubMed, EMBASE, Medline, and CENTRAL databases using the following search terms: ("cerebrl plsy" or "cerebrl plsis" or "infantile cerebral palsy") and ("risk factors"). Case-control or cohort studies of children with cerebral palsy and healthy children were included for meta-analysis. The Newcastle-Ottawa Scale (NOS) of case-control studies was used to evaluate the quality of the included studies. The Chi-square test was used to test the heterogeneity of the literature. This study used subgroup analysis and sensitivity analysis to identify sources of heterogeneity. If subgroup analyses and sensitivity analyses could not identify the source of heterogeneity, no pooling between study results was performed, and only individual study results were described. In this study, Egger's test was used to test for publication bias. The random-effects model was used when heterogeneity existed, and the fixed-effect model was applied when heterogeneity did not exist. RESULTS A total of 1,836 related articles were retrieved. After screening, 13 articles were included in the analysis, involving a total of 2,489 children with cerebral palsy and 4,782 children without cerebral palsy. None of the included articles achieved a NOS score of 9, four articles scored 8, eight articles scored 7, and one article scored 6. Meta-analysis showed that maternal hypertension during pregnancy, premature rupture of membranes, premature delivery and emergency cesarean section were risk factors for cerebral palsy in children, and there was no heterogeneity among the literatures and no publication bias. CONCLUSIONS This study identified gestational hypertension, preterm birth, premature rupture of membranes, and emergency cesarean section as risk factors for cerebral palsy in children through meta-analysis, providing a reference for risk monitoring and clinical intervention.
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Affiliation(s)
- Dandan Chen
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Meiyuan Huang
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Yangyan Yin
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Dongmei Gui
- Department of Pediatrics, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yuniao Gu
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Taiping Zhuang
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Caihua Chen
- Department of Neonatology, Hainan Women and Children's Medical Center, Haikou, China
| | - Kaiming Huo
- Department of Pediatrics, The Second Affiliated Hospital of Hainan Medical College, Haikou, China
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Brun C, Traverse É, Granger É, Mercier C. Somatosensory deficits and neural correlates in cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:1382-1393. [PMID: 34145582 PMCID: PMC9290873 DOI: 10.1111/dmcn.14963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
AIM To synthetize studies assessing somatosensory deficits and alterations in cerebral responses evoked by somatosensory stimulation in individuals with cerebral palsy (CP) compared to typically developing individuals. METHOD A scoping review of the literature was performed in the MEDLINE, Embase, PsycInfo, CINAHL, Evidence-Based Medicine Reviews, and Web of Science databases (last search carried out on 6th and 7th August 2020) with a combination of keywords related to CP and somatosensory functions. Somatosensory deficits were measured with clinical tests and alterations in cerebral responses were measured with functional magnetic resonance imaging, electroencephalography, and magnetoencephalography. RESULTS Forty-eight articles were included. Overall, 1463 participants with CP (mean [SD] age 13y 1mo [4y 11mo], range 1-55y; 416 males, 319 females, sex not identified for the remaining participants) and 1478 controls (mean [SD] age 13y 1mo [5y 8mo], range 1-42y; 362 males, 334 females, sex not identified for the remaining participants) were included in the scoping review. For tactile function, most studies reported registration (8 out of 13) or perception (21 out of 21) deficits in participants with CP. For proprioception, most studies also reported registration (6 out of 8) or perception (10 out of 15) deficits. Pain function has not been studied as much, but most studies reported registration (2 out of 3) or perception (3 out of 3) alterations. Neuroimaging findings (18 studies) showed alterations in the somatotopy, morphology, latency, or amplitude of cortical responses evoked by somatosensory stimuli. INTERPRETATION Despite the heterogeneity in the methods employed, most studies reported somatosensory deficits. The focus has been mainly on tactile and proprioceptive function, whereas pain has received little attention. Future research should rigorously define the methods employed and include a sample that is more representative of the population with CP. What this paper adds Most of the papers reviewed found tactile registration and perception deficits in the upper limbs. Proprioceptive deficits were generally observed in cerebral palsy but results were heterogeneous. Pain has received little attention compared to tactile and proprioceptive functions. Neuroimaging studies supported behavioral observations. Alterations were observed for both the most and least affected limb.
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Affiliation(s)
- Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada
| | - Élodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
| | - Élyse Granger
- Centre IntégréUniversitaire de Santé et de Services Sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
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Palomo-Carrión R, Bravo-Esteban E, Ando-La Fuente S, López-Muñoz P, Martínez-Galán I, Romay-Barrero H. Efficacy of the use of unaffected hand containment in unimanual intensive therapy to increase visuomotor coordination in children with hemiplegia: a randomized controlled pilot study. Ther Adv Chronic Dis 2021; 12:20406223211001280. [PMID: 33815736 PMCID: PMC7989117 DOI: 10.1177/20406223211001280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The capacity of children with hemiplegia to be engaged in anticipatory action planning is affected. There is no balance among spatial, proprioceptive and visual information, thus altering the affected upper limb visuomotor coordination. The objective of the present study was to assess the improvement in visuomotor coordination after the application of a unimanual intensive therapy program, with the use of unaffected hand containment compared with not using unaffected hand containment. Methods: A simple blind randomized clinical trial was realized. A total of 16 subjects with congenital infantile hemiplegia participated in the study with an age mean of 5.54 years old (SD:1.55). Two intensive protocols for 5 weeks of modified constraint-induced movement therapy (mCIMT) or unimanual therapy without containment (UTWC) were executed 5 days per week (2 h/day). Affected upper limb visuomotor coordination (reaction time, task total time, active range, dynamic grasp) was measured before–after intensive therapy using a specific circuit with different slopes (10°/15°). Results: Statistically significant inter-group differences were found after the intervention, with clinically relevant results for the mCIMT group not seen in UTWC, in the following variables: reaction time 10°slope (p = 0.003, d = 2.44), reaction time 15°slope (p = 0.002, d = 2.15) as well as for the task total time 10°slope (p = 0.002, d = 2.25), active reach 10°slope (p = 0.002, d = 2.7), active reach 15°slope (p = 0.003, d = 2.29) and dynamic grasp 10°/15°slopes (p = <0.001, d = 2.69). There were not statistically significant inter-group differences in the total task time with 15°slope (p = 0.074, d = 1.27). Conclusions: The use of unaffected hand containment in mCIMT would allow improvements in the affected upper limb’s visuomotor coordination. Thus, it would favor clinical practice to make decisions on therapeutic approaches to increase the affected upper limb functionality and action planning in children diagnosed with infantile hemiplegia (4–8 years old).
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Affiliation(s)
- Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain GIFTO. Physiotherapy Research Group of Toledo
| | - Elisabeth Bravo-Esteban
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Avda. Carlos III. s/n. Toledo, 45071, Spain GIFTO. Physiotherapy Research Group of Toledo
| | | | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain GIFTO. Physiotherapy Research Group of Toledo
| | - Inés Martínez-Galán
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
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McLean B, Taylor S, Valentine J, Carey L, Thornton A, Elliott C. Somatosensory discrimination impairment in children with hemiplegic cerebral palsy as measured by the sense_assess© kids. Aust Occup Ther J 2021; 68:317-326. [PMID: 33738799 DOI: 10.1111/1440-1630.12729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To characterise somatosensory discrimination impairment of the upper-limb across domains of tactile discrimination, limb position sense and haptic object recognition using the sense_assess© kids and examine associations with upper-limb motor performance in children with hemiplegic cerebral palsy (CP). METHODS The sense_assess© kids was administered at one timepoint to 28 children, aged 6-15.5 years (M = 10.1, SD = 2.4), with hemiplegic CP (right hemiplegia n = 15) and Manual Ability Classification System Levels I (n = 11) and II (n = 17). Unimanual motor performance was quantified using the Box and Block Test. RESULTS Tactile discrimination was impaired in 18, limb position sense in 20, and haptic object recognition was impaired in 21 of 28 children. Over 80% (23/28) of children had impaired somatosensory discrimination in one or more domains. Low to moderate correlations were observed between each measure of somatosensory discrimination and motor performance. Manual ability classification was associated with limb position sense and haptic object recognition. A moderate inverse correlation (r = -.57, p < .01) exists between the number of somatosensory domains impaired and motor performance. CONCLUSION The frequency of somatosensory impairment in the upper limb of children in our sample was high and associated with manual ability, suggesting a need for routine assessment of somatosensation in this population.
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Affiliation(s)
- Belinda McLean
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Susan Taylor
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Occupational Therapy Department, Child and Adolescent Health Service, Perth, WA, Australia
| | - Jane Valentine
- Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia.,Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia
| | - Ashleigh Thornton
- Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia.,Division of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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Lidbeck C, Bartonek Å. Motor function at increasing postural demands in children with bilateral cerebral palsy. Eur J Phys Rehabil Med 2021; 57:731-737. [PMID: 33393279 DOI: 10.23736/s1973-9087.20.06662-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Among children with cerebral palsy (CP) some choose to be mobile by crawling or walking on their knees despite some bipedal walking ability. This motor behaviour raises questions and we wanted to enhance understanding of the child's choice of mobility. AIM To explore gross motor abilities in positions with various postural demands focusing on floor mobility among children with CP. DESIGN A cross-sectional observational study was performed at the neuropediatric outpatient department at Karolinska University Hospital. POPULATION Thirty-six children with bilateral CP, median age 11.2 years, functioning at Gross Motor Function Classification System (GMFCS) level I-IV. METHODS Motor skills using the Gross Motor Function Measure (GMFM-88), and lower leg muscles strength in hip flexors, knee extensors, ankle dorsiflexors and plantarflexors with a hand-held dynamometer were assessed. A Kruskal-Wallis Test with post hoc Bonferroni corrections were used to compare GMFM percentage (%) scores and muscle strength between the GMFCS levels. RESULTS GMFM-88 (%) scores in Walking (E) and Standing (D) dimensions were significantly higher at GMFCS levels I and II, compared to levels III and IV. In Crawling & Kneeling (C) level I achieved higher score than levels III and IV, and in Sitting (B) than level IV. Muscle strength values in the plantarflexors were significantly higher at GMFCS level I compared to level II. CONCLUSIONS As expected the children at GMFCS III performed less than those at GMFCS II at high postural demands in GMFM dimensions including standing and walking. Identical GMFM-scores in dimension C confirm similar motor function in items including kneeling and knee walking. Since lower limb muscle strength was similar, the difference in postural behaviour between the groups at high level motor activities may be associated with sensorimotor disturbances along with the children's motor disorder. CLINICAL REHABILITATION IMPACT The GMFM-88, in particular dimension C, including kneeling and walking items can be used as an identification of preference of floor mobility in children with CP. Awareness and understanding of how postural positions affect movement is of importance for prognosis, and physiotherapy.
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Affiliation(s)
- Cecilia Lidbeck
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden -
| | - Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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