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Ghandour M, Klotz M, Horsch A. Research trends in the orthopedic surgical management of cerebral palsy: a cross-analytical study of publications in the past decade. Front Neurol 2023; 14:1200893. [PMID: 37681012 PMCID: PMC10482432 DOI: 10.3389/fneur.2023.1200893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Little is known about the trends in orthopedic surgical management of cerebral palsy (CP). In this cross-analytical study we examined alterations in research publications in this field in the past 10 years through four databases. Thus, we divided publications into old (2012-2017) and recent (2018-2022). To determine if the focus of research in this field has changed, we compared both periods based on publication's (authors' number, journal, country, design), patients' (number, gender, age, CP type), and surgery-related (indication, number, category, type) characteristics. Publications showed a positive trend over the past 10 years with a peak in 2020. The number of publications was similar between old and recent ones (47.58% vs. 52.42%). Most research outputs were from the United States and Germany. Differences were noted between recent and old publications regarding journals (p = 0.0001), journal category (p = 0.023), authors' number (p = 0.006), and patients' age (p = 0.02). The impact factor was also different (p = 0.0001). However, no differences were noted regarding other characteristics (p > 0.05). The research output regarding surgical orthopedic management in CP has increased in the past decade with no difference between 2012-2017 and 2018-2022. Except for the number of authors, journal name, and patients' age, no significant differences were noted between both periods.
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Affiliation(s)
- Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Marienkrankenhaus Soest, Orthopedics and Trauma Surgery, Soest, Germany
| | - Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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2
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Levine J, Mavrommatis S, Vang S, Anderson S. A Case Series Evaluating Postoperative Complications of Foot and Ankle Surgeries in Adult Patients With Neuromuscular Disease. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148165. [PMID: 36654886 PMCID: PMC9841855 DOI: 10.1177/24730114221148165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Patients with neuromuscular diseases such as cerebral palsy (CP) are living longer because of advances in medicine, yielding a larger number of adult patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery to these patients because of concern for postoperative complications. A paucity of literature exists that describes complications in patients undergoing foot and ankle surgery for neuromuscular diseases. The primary study outcome was to identify the postoperative complication rates associated with foot and ankle surgery in adult patients with neuromuscular disease. Methods The charts of patients with neuromuscular diseases who had foot and ankle surgery by the senior author at a single institution from March 2010 to March 2020 were reviewed. Patient charts were reviewed for demographic data, medical history and diagnoses, and surgical treatment information. Only patients' index procedures with the senior author were evaluated for surgical data. Patient charts were assessed to determine the presence or absence of a postoperative complication following an index procedure. Results In a cohort of 42 patients, females comprised 60% of the patient cohort. The average age was 35 (range, 20-69) years old. CP was the most common neuromuscular diagnosis at 52% (22 of 42) patients. Eighteen percent (11 of 60) of the index surgeries had 1 or more complication with a total of 13 complications. The overall wound complication rate was 10% (6 of 60), infection rate was 8% (5 of 60), and the nonunion rate following arthrodesis was 10% (2 of 21). Conclusion We conclude that foot and ankle surgery in this complex population can be done safely, with postoperative complication rates similar to the average population. Although these patients may present with unique challenges, surgeons should not forgo surgery out of concern for postoperative complications. Level of Evidence Level IV, retrospective cohort study at a single institution.
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Affiliation(s)
- Joshua Levine
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA,Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA
| | - Sophia Mavrommatis
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA,Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA
| | - Sandy Vang
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA,Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA
| | - Sarah Anderson
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA,Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA,Sarah Anderson, MD, Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, St Paul, MN 55101, USA.
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Hurd CL, Barnes M, Diot CM, Condliffe EG, Alazem H, Pritchard L, Zwicker JD, McCormick A, Watt MJ, Andersen J, Kirton A, Yang JF. Parent-therapist partnership to ELEVATE gross motor function in children with perinatal stroke: protocol for a mixed methods randomized controlled trial. BMC Pediatr 2022; 22:480. [PMID: 35948896 PMCID: PMC9364526 DOI: 10.1186/s12887-022-03525-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing evidence for early, active rehabilitation to enhance motor function following early brain injury. This is clear for interventions targeting the upper extremity, whereas passive treatment approaches for the lower extremity persist. The purpose of this trial is to evaluate the effectiveness of early, intensive rehabilitation targeting the lower extremity and delivered in a parent-therapist partnership model for children with perinatal stroke. Methods We describe a protocol for a waitlist-control, single-blind, mixed methods effectiveness randomized controlled trial, with an embedded qualitative study using interpretative description. Participants are children with perinatal stroke aged eight months to three years with signs of hemiparesis. Participants will be randomly allocated to an immediate ELEVATE (Engaging the Lower Extremity Via Active Therapy Early) intervention group, or a waitlist-control group, who will receive usual care for six months. The ELEVATE intervention involves one hour of training four days per week for 12 weeks, with a pediatric therapist and a parent or guardian each delivering two sessions per week. The intervention targets the affected lower extremity by progressively challenging the child while standing and walking. The primary outcome measure is the Gross Motor Function Measure-66. Secondary outcomes include the Pediatric Quality of Life Inventory™, Young Children's Participation and Environment Measure, and an instrumented measure of spasticity. A cost-effectiveness analysis and qualitative component will explore benefit to costs ratios and parents’ perspectives of early, intensive rehabilitation, and their role as a partner in the rehabilitation, respectively. Discussion This study has the potential to change current rehabilitation for young children with perinatal stroke if the ELEVATE intervention is effective. The parent interviews will provide further insight into benefits and challenges of a partnership model of rehabilitation. The mixed methods design will enable optimization for transfer of this collaborative approach into physical therapy practice. Trial registration ClinicalTrials.gov NCT03672864. Registered 17 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03525-6.
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Affiliation(s)
- Caitlin L Hurd
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Michelle Barnes
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | | | - Elizabeth G Condliffe
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Hana Alazem
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Jennifer D Zwicker
- School of Public Policy and Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Man-Joe Watt
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, and Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Pediatrics and Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jaynie F Yang
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
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Allart E, Sturbois-Nachef N, Salga M, Rosselin C, Gatin L, Genêt F. Neuro-Orthopedic Surgery for Equinovarus Foot Deformity in Adults: A Narrative Review. J Foot Ankle Surg 2022; 61:648-656. [PMID: 34953669 DOI: 10.1053/j.jfas.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023]
Abstract
Neuro-orthopedic surgery is an alternative to the conservative treatment of spastic equinovarus foot (SEF) in adults. The objective of the present narrative review was to summarize current practice with regard to patient assessment, the choice of treatment, the various neuro-orthopedic procedures, and the latter's outcomes. We searched literature databases (MEDLINE, EMBASE, Cochrane) for original articles or opinion papers on surgical treatment of spastic equinovarus foot in adults. Neuro-orthopedic approaches require a careful analysis of the patient's and/or his/her caregiver needs and thus relevant treatment goals. Surgical planning requires detailed knowledge of impairments involved in the spastic equinovarus foot deformity based on a careful clinical examination and additional information from diagnostic nerve blocks and/or a quantitative gait analysis. Procedures mainly target nerves (neurotomy) and tendons (lengthening, transfer, tenotomy). These procedures reduce impairments (spasticity, range of motion, and foot position), improve gait and walking function, but their impact on participation and personalized treatment goals remains to be demonstrated. Neuro-orthopedic surgery is an effective treatment option for spastic equinovarus foot in adults. However, practice is still very heterogeneous and there is no consensus on the medical strategies to be applied before, during and after surgery (particularly the type of anesthesia, the need for immobilization, rehabilitation procedures).
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Affiliation(s)
- Etienne Allart
- CHU Lille, Neurorehabilitation Unit, Lille, France; Univ. Lille, INSERM UMR1172-Lille Neuroscience and Cognition, Lille, France.
| | - Nadine Sturbois-Nachef
- CHU Lille, Department of Orthopedic Surgery, Lille, France; Univ. Lille, EA 7369-URePSSS, Lille, France
| | - Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
| | | | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France; Department of Orthopedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
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Hurd C, Livingstone D, Brunton K, Smith A, Gorassini M, Watt MJ, Andersen J, Kirton A, Yang JF. Early, Intensive, Lower Extremity Rehabilitation Shows Preliminary Efficacy After Perinatal Stroke: Results of a Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:360-370. [PMID: 35427191 PMCID: PMC9127938 DOI: 10.1177/15459683221090931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. Objective To determine the feasibility and potential efficacy of ELEVATE—Engaging the Lower Extremity Via Active Therapy Early—on gross motor function. Methods We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. Results Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registration This study was registered at ClinicalTrials.gov (NCT01773369).
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Affiliation(s)
- Caitlin Hurd
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Donna Livingstone
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Kelly Brunton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Allison Smith
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Monica Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Man-Joe Watt
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - John Andersen
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Adam Kirton
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jaynie F. Yang
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Boyer ER, Novaczyk ZB, Novacheck TF, Symons FJ, Burkitt CC. Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy. PAEDIATRIC AND NEONATAL PAIN 2022; 4:44-52. [PMID: 35546914 PMCID: PMC8975226 DOI: 10.1002/pne2.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/28/2021] [Accepted: 12/05/2021] [Indexed: 12/29/2022]
Abstract
While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.
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Affiliation(s)
- Elizabeth R. Boyer
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | - Frank J. Symons
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Chantel C. Burkitt
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
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Hashemi M, Sturbois-Nachef N, Keenan MA, Winston P. Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709969. [PMID: 36188802 PMCID: PMC9397894 DOI: 10.3389/fresc.2021.709969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature. Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity. Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention. Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals. Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.
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Affiliation(s)
- Mahdis Hashemi
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Orthopédic and Traumatologic Département, University Hospital of Lille, Lille, France
| | - Marry Ann Keenan
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Neuro-Orthopaedics, MossRehab Hospital, Elkins Park, PA, United States
- Orthopaedic Surgery (Ret), University of Pennsylvania, Philadelphia, PA, United States
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
- Department of Physical Medicine and Rehabilitation, University of British Colombia, Vancouver, BC, Canada
- *Correspondence: Paul Winston orcid.org/0000-0002-8403-6988
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Willerslev-Olsen M, Lorentzen J, Røhder K, Ritterband-Rosenbaum A, Justiniano M, Guzzetta A, Lando AV, Jensen AMB, Greisen G, Ejlersen S, Pedersen LZ, Andersen B, Lipthay Behrend P, Nielsen JB. COpenhagen Neuroplastic TRaining Against Contractures in Toddlers (CONTRACT): protocol of an open-label randomised clinical trial with blinded assessment for prevention of contractures in infants with high risk of cerebral palsy. BMJ Open 2021; 11:e044674. [PMID: 34230015 PMCID: PMC8261878 DOI: 10.1136/bmjopen-2020-044674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Contractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2-3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care. METHODS AND ANALYSIS A two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9-17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respectively. ETHICS AND DISSEMINATION Full approval from the local ethics committee, Danish Committee System on Health Research Ethics, Region H (H-19041562). Experimental procedures conform with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT04250454. EXPECTED RECRUITMENT PERIOD 1 January 2021-1 January 2025.
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Affiliation(s)
- Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Katrine Røhder
- Department of Psychology, Unversity of Copenhagen, Copenhagen, Denmark
| | - Anina Ritterband-Rosenbaum
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Mikkel Justiniano
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Andrea Guzzetta
- Department of Neurology, Stella Maris Institute, Pisa, Italy
| | | | | | - Gorm Greisen
- Neonatatal Department, Rigshospitalet, Kobenhavn, Denmark
| | - Sofie Ejlersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Britta Andersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
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Kuo CC, Huang HP, Wang TM, Hong SW, Hung LW, Kuo KN, Lu TW. Tendon release reduced joint stiffness with unaltered leg stiffness during gait in spastic diplegic cerebral palsy. PLoS One 2021; 16:e0245616. [PMID: 33449939 PMCID: PMC7810324 DOI: 10.1371/journal.pone.0245616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Biomechanical deviations at individual joints are often identified by gait analysis of patients with cerebral palsy (CP). Analysis of the control of joint and leg stiffness of the locomotor system during gait in children with spastic diplegic CP has been used to reveal their control strategy, but the differences between before and after surgery remain unknown. The current study aimed to bridge the gap by comparing the leg stiffness—both skeletal and muscular components—and associated joint stiffness during gait in 12 healthy controls and 12 children with spastic diplegic CP before and after tendon release surgery (TRS). Each subject walked at a self-selected pace on a 10-meter walkway while their kinematic and forceplate data were measured to calculate the stiffness-related variables during loading response, mid-stance, terminal stance, and pre-swing. The CP group altered the stiffness of the lower limb joints and decreased the demand on the muscular components while maintaining an unaltered leg stiffness during stance phase after the TRS. The TRS surgery improved the joint and leg stiffness control during gait, although residual deficits and associated deviations still remained. It is suggested that the stiffness-related variables be included in future clinical gait analysis for a more complete assessment of gait in children with CP.
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Affiliation(s)
- Chien-Chung Kuo
- Department of Orthopedics, China Medical University Hospital, Taiwan, R.O.C
- Department of Orthopedics, School of Medicine, China Medical University, Taiwan, R.O.C
| | - Hsing-Po Huang
- Department of Biomedical Engineering, National Taiwan University, Taiwan, R.O.C
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, R.O.C
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, R.O.C
| | - Shih-Wun Hong
- Department of Physical Therapy, Tzu Chi University, Taiwan, R.O.C
| | - Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taiwan, R.O.C
| | - Ken N. Kuo
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan, R.O.C
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taiwan, R.O.C
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taiwan, R.O.C
- * E-mail:
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10
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Laffont I. 2019 Sidney Licht lecture: Spasticity and related neuro-orthopedic deformities: A core topic in physical and rehabilitation medicine. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations. J Arthroplasty 2020; 35:3383-3392. [PMID: 32873450 DOI: 10.1016/j.arth.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
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Abstract
Orthopedic conditions are common in adults with cerebral palsy (CP). Although CP is argued to be a nonprogressive condition of the brain, the musculoskeletal components tend to worsen and deteriorate over time leading to chronic pain, function limitation, and a decline in mobility. Orthopedic care of adults with CP has not been well documented in the literature. This article describes the common orthopedic conditions in adults with CP and discusses who should perform orthopedic surgery on adults.
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Affiliation(s)
- Megan R Lomax
- Texas Children's Hospital, 6701 Fannin Street, Suite 660, Houston, TX 77030, USA
| | - M Wade Shrader
- Nemours A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19807, USA.
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Marigi EM, Statz JM, Sperling JW, Sanchez-Sotelo J, Cofield RH, Morrey ME. Shoulder arthroplasty in patients with cerebral palsy: a matched cohort study to patients with osteoarthritis. J Shoulder Elbow Surg 2020; 29:483-490. [PMID: 31563508 DOI: 10.1016/j.jse.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cerebral palsy (CP) often experience shoulder impairment via spasticity, muscle contractures, and joint instability. Currently, few studies investigate shoulder arthroplasty (SA) in patients with CP. This study reviewed the outcomes of both anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) in patients with CP. METHODS Over a 30-year-period, 5 patients undergoing SA (2 TSA, 3 RSA) with a diagnosis of CP were identified. The cohort included 4 male patients with a mean age of 50.4 years (range, 44-58 years). CP patients were matched 1:2 based on age, sex, body mass index, and year of surgery with a group of patients undergoing SA for osteoarthritis (OA). RESULTS Survival from implant revision for both TSA and RSA in CP was 100% at both 2 and 5 years postoperatively. Clinical complications were only observed in 2 patients after TSA, with 1 patient requiring revision at 14 years postoperatively. Collectively, there was no difference in the rate of complications and implant survival between patients with CP vs. OA. Prior to the surgical procedure, all CP patients had severe or moderate pain, with no moderate or severe pain postoperatively. Notable postoperative increases from preoperative baselines were noted in forward elevation (57°-106°), abduction (48°-84°), and external rotation (30°-64°). RSA had significantly improved postoperative abduction compared to TSA (97° vs. 64°, P < .01). CONCLUSIONS SA is a safe, durable procedure in patients with CP to clinically improve pain, function, and satisfaction. RSA was associated with better function and fewer complications than TSA.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Abstract
INTRODUCTION Cerebral palsy (CP) is a neurodevelopmental condition with a wide range of presentations that usually lead to muscle imbalance culminating with precocious knee and hip arthrosis, often leading to total hip (THA) and knee arthroplasty (TKA). This study sought to determine the following: (1) the inherent differences of in-hospital characteristics and comorbidities between CP and non-CP patients undergoing total joint arthroplasty (TJA) and (2) do patients with CP have an increased risk of perioperative complications after TJA? METHODS The Nationwide Inpatient Sample database from 2005 to 2014 was queried in this retrospective cohort study to compare patient demographics and comorbidities, hospital characteristics, perioperative complications, and length of stay in patients with CP undergoing TJA compared with their non-CP counterparts. Statistical analyses were performed using the Rao-Scott chi-square test and analysis of variance. All analyses took into account the sampling procedure and weighting. RESULTS A total of 2,062 and 2,193 patients with CP underwent THA and TKA, respectively, during the study period. Both CP groups were younger (P < 0.0001), were more likely to have Medicaid insurance (P < 0.0001), and had longer lengths of hospital stay (P < 0.0001) compared with their non-CP counterparts. Non-CP patients had significantly higher rates of obesity, coronary artery disease, diabetes, and peripheral vascular disease (P < 0.05). However, patients with CP undergoing THA had a lower Charlson Comorbidity Index (P = 0.0002), whereas those undergoing TKA had similar comorbidity profile as the non-CP group (P = 0.097). Both THA and TKA CP patients had a higher risk of overall postoperative complications (P < 0.05) and surgical complications (P < 0.05), in particular acute postoperative anemia (P < 0.05). CONCLUSION Despite being younger with fewer comorbidities, patients with CP are at an increased risk of immediate perioperative complications after TJA compared with the general osteoarthritis population. Given that these patients have satisfactory long-term outcomes after TJA, these procedures can be performed successfully for patients with CP with careful medical management and surgical planning. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Cavarsan CF, Gorassini MA, Quinlan KA. Animal models of developmental motor disorders: parallels to human motor dysfunction in cerebral palsy. J Neurophysiol 2019; 122:1238-1253. [PMID: 31411933 PMCID: PMC6766736 DOI: 10.1152/jn.00233.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disability in children. Much of the previous research on CP has focused on reducing the severity of brain injuries, whereas very few researchers have investigated the cause and amelioration of motor symptoms. This research focus has had an impact on the choice of animal models. Many of the commonly used animal models do not display a prominent CP-like motor phenotype. In general, rodent models show anatomically severe injuries in the central nervous system (CNS) in response to insults associated with CP, including hypoxia, ischemia, and neuroinflammation. Unfortunately, most rodent models do not display a prominent motor phenotype that includes the hallmarks of spasticity (muscle stiffness and hyperreflexia) and weakness. To study motor dysfunction related to developmental injuries, a larger animal model is needed, such as rabbit, pig, or nonhuman primate. In this work, we describe and compare various animal models of CP and their potential for translation to the human condition.
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Affiliation(s)
- Clarissa F Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Monica A Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Katharina A Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
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O'Connell NE, Smith KJ, Peterson MD, Ryan N, Liverani S, Anokye N, Victor C, Ryan JM. Incidence of osteoarthritis, osteoporosis and inflammatory musculoskeletal diseases in adults with cerebral palsy: A population-based cohort study. Bone 2019; 125:30-35. [PMID: 31075418 DOI: 10.1016/j.bone.2019.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND People with cerebral palsy (CP) may be at increased risk of musculoskeletal conditions due to various factors including malnutrition and abnormal levels of skeletal loading. This study aimed to compare the incidence of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases between adults with and without CP. METHODS A population based cohort study was conducted using data from the Clinical Practice Research Datalink collected between 1987 and 2015. Adults with CP were matched to adults without CP for age, sex and general practice. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases. RESULTS 1705 adults with CP were matched to 5115 adults without CP. Adults with CP had an increased risk of osteoporosis in unadjusted (Hazard Ratio (HR) 3.67, 95% Confidence Interval (CI) 2.32 to 5.80, p < 0.001) and adjusted (HR 6.19, 95% CI 3.37 to 11.39, p < 0.001) analyses. No evidence of increased risk of inflammatory musculoskeletal diseases was observed in unadjusted or adjusted analyses. For osteoarthritis no evidence of increased risk was seen in the unadjusted analysis, but evidence of an increased risk was seen when the analysis was adjusted for alcohol consumption, smoking status, and mean yearly general practice (GP) visits (HR 1.54, 95% CI 1.17 to 2.02, p < 0.001). CONCLUSIONS After accounting for potential confounding variables, we found that CP is associated with increased risk of osteoporosis and osteoarthritis. These findings provide the strongest epidemiological evidence to date for increased risk of osteoporosis and osteoarthritis in people with CP, and highlight need for clinical awareness of such conditions in this population.
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Affiliation(s)
- Neil E O'Connell
- Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom.
| | - Kimberley J Smith
- Department of Psychological Sciences, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, USA
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, United Kingdom; Department of Interventional Cardiology, Hospital Clínico San Carlos, Spain
| | - Silvia Liverani
- School of Mathematical Sciences, Queen Mary University of London, United Kingdom
| | - Nana Anokye
- Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom
| | - Christina Victor
- Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom; Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Ireland
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Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review. Ann Phys Rehabil Med 2019; 62:283-290. [DOI: 10.1016/j.rehab.2018.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/28/2018] [Accepted: 06/30/2018] [Indexed: 11/17/2022]
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Long-term results of multilevel surgery in adults with cerebral palsy. INTERNATIONAL ORTHOPAEDICS 2018; 43:255-260. [PMID: 29922840 DOI: 10.1007/s00264-018-4023-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deterioration of gait in adolescent and adult patients with cerebral palsy can be associated with multiple factors. Multilevel surgery (MLS) is one option in adults with cerebral palsy to improve gait function with encouraging short-term results. It is a question whether these improvements are maintained over time. METHODS In a retrospective consecutive cohort study, adults with bilateral spastic cerebral palsy (BSCP) treated with MLS between 1995 and 2011 were scanned for potential inclusion. Patients needed to fulfill the following inclusion criteria: age at MLS > 17, standardized three-dimensional gait analysis (3D-GA) including clinical examination at pre-operative (E0), a short-term follow-up (E1) and at least seven years (E2) after the index MLS. Twenty adults (10 women, 10 men) with a Gross Motor Function Classification Level (GMFCS) I-III and a mean age at MLS of 24.8 years were included in this study. The average long-term follow-up was 10.9 years. The Gait Profile Score (GPS) was used as primary outcome measure. RESULTS The GPS improved significantly from 13.8° before surgery to 11.2° at short-term (p = 0.007) and to 11.3° at long-term follow-up (p = 0.002). Mean GPS showed a slight deterioration between E1 and E2 due to a minority of six patients (30%) who showed a significant loss of correction. CONCLUSION Surgical treatment in adults with BSCP was feasible and effective in the long-term. Significant improvement of gait and function was maintained in the majority of patients, while some patients were prone to develop crouch gait, hip flexion contractures, or pain.
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Intrathecal Baclofen Therapy for the Control of Spasticity. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Noble JJ, Fry NR, Bingham CR, East RH, Shortland AP. A practical clinical kinematic model for the upper limbs. Proc Inst Mech Eng H 2017; 232:207-212. [PMID: 29283018 DOI: 10.1177/0954411917749617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A novel clinically practical upper limb model is introduced that has been developed through clinical use in children and adults with neurological conditions to guide surgery to the elbow and wrist. This model has a minimal marker set, minimal virtual markers, and no functional joint centres to minimise the demands on the patient and duration of data collection. The model calculates forearm supination independently from the humerus segment, eliminating any errors introduced by poor modelling of the shoulder joint centre. Supination is calculated by defining the forearm segment twice, from the distal and proximal ends: first, using the ulna and radial wrist markers as a segment defining line and second using the medial and lateral elbow markers as a segment defining line. This is comparable to the clinical measurement of supination utilising a goniometer and enables a reduced marker set, with only the elbow, wrist, and hand markers to be applied when only the wrist and forearm angles are of interest. A sensitivity analysis of the calculated elbow flexion-extension angles to the position of the glenohumeral joint centre is performed on one healthy female subject, aged 20 years, during elbow flexion and a forward reaching task. A comparison of the supination angles calculated utilising the novel technique compared to the rotation between the humeral and forearm segments is also given. All angles are compared to a published kinematic model that follows the recommendations of the International Society of Biomechanics.
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Affiliation(s)
- Jonathan J Noble
- 1 One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Nicola Rd Fry
- 1 One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Carly R Bingham
- 1 One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Rebecca H East
- 1 One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK.,2 School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Adam P Shortland
- 1 One Small Step Gait Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK.,2 School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Total Knee Arthroplasty in Patients With Cerebral Palsy: A Matched Cohort Study to Patients With Osteoarthritis. J Am Acad Orthop Surg 2017; 25:381-388. [PMID: 28379915 DOI: 10.5435/jaaos-d-16-00437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Currently, few data examine the use of total knee arthroplasty (TKA) in patients with cerebral palsy (CP). This study reviewed the outcomes of TKA in patients with CP compared with a matched cohort undergoing TKA for primary osteoarthritis. METHODS Over a 28-year period, 15 TKAs in patients with a diagnosis of CP were identified. The cohort was 53% men, with a mean age of 58 years. Patients with CP were matched 1:2 based on age, sex, body mass index, and year of surgery with a group of patients undergoing TKA for osteoarthritis. RESULTS No difference was reported in implant survival (P = 0.27) or revision surgery (P = 0.79) between groups. All patients were ambulatory postoperatively, and significant increases were noted in the Knee Society score (P < 0.0001) and functional assessment (P = 0.003). DISCUSSION TKA is a safe, durable procedure in patients with CP to improve pain and function.
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Park EY, Kim WH. Prevalence of secondary impairments of adults with cerebral palsy according to gross motor function classification system. J Phys Ther Sci 2017; 29:266-269. [PMID: 28265154 PMCID: PMC5332985 DOI: 10.1589/jpts.29.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the prevalence of secondary impairments in
adults with cerebral palsy. [Subjects and Methods] The study sample included 52 adults
with cerebral palsy who attended a convalescent or rehabilitation center for disabled
individuals or a special school for physical disabilities in South Korea. [Results] The
univariate analysis showed that the Gross Motor Functional Classification System level was
a significant predictor of spondylopathies, general pain, arthropathies, and motor ability
loss. The prevalence of these impairments at Gross Motor Functional Classification System
level I and II was low compared with the prevalence found at Gross Motor Functional
Classification System level III–V. The prevalence of secondary impairments among adults
with cerebral palsy at Gross Motor Functional Classification System level III–V was high:
loss of motor ability, 42.3%; spondylopathies, 38.4%; general pain, 32.7%; and
arthropathies, 28.8%. [Conclusion] In this study, adults with severe cerebral palsy showed
a high prevalence of motor ability loss, spondylopathies, arthropathies, and pain. It is
necessary to develop intervention programs to prevent secondary impairments in adults with
cerebral palsy.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, Republic of Korea
| | - Won-Ho Kim
- Department of Physical Therapy, Ulsan College, Republic of Korea
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Michalska A, Szerla MK, Przysło Ł, Dudek J, Ortenburger DE. Pain assessment in the course of cerebral palsy - a review of methods used in the practice of a physiotherapist, doctor and psychologist. REHABILITACJA MEDYCZNA 2017. [DOI: 10.5604/01.3001.0009.5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) is a syndrome in which movement and posture disorders are progressive, along with the stationary nature of damage to the central nervous system. Despite the heterogeneity of clinical and functional status, patients with CP are a group of patients at high-risk of the occurrence of diverse pain. The aim of this study was to review literature on the phenomenon of pain in the course of cerebral palsy. An attempt was made to present the characteristics of the phenomenon of pain, and gather tools for its evaluation. A review of Polish and English language literature, in which the issue of pain in the course of cerebral palsy was discussed (in terms of epidemiology, characteristics and evaluation methods). Research papers and reports from the past 15 years included in the databases: PubMed, Medline and websites of Polish medical publishing houses, were analyzed. The works were searched using the key words: cerebral palsy, mental retardation, pain, pain assessment scales. Patients with cerebral palsy – due to their chronic health problems and performed diagnostic-treatment and physiotherapeutic treatments – are at risk of experiencing acute and chronic pain. There is a need to improve knowledge regarding the phenomenon of pain in patients with CP. The optimal course of therapy in this group of patients requires comprehensive and multi-faceted co-operation of doctors, physiotherapists, psychologists and patients as well as their immediate caregivers. Professionals working with patients suffering from CP should be aware of the potential pain causes, possess assessment tools and have the skills and, above all, the desire to use them. cerebral palsy, pain, pain assessment Received: 18.09.2016; accepted: 22nd Jan. 2017
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Affiliation(s)
- Agata Michalska
- Instytut Fizjoterapii, Uniwersytet Jana Kochanowskiego, Kielce / Institute of Physiotherapy, Jan Kochanowski University in Kielce, Poland
| | - Małgorzata K. Szerla
- Instytut Zdrowia Publicznego, Uniwersytet Jana Kochanowskiego, Kielce / Institute of Public Health, Jan Kochanowski University in Kielce, Poland
| | - Łukasz Przysło
- Klinika Neurologii, Instytut Centrum Zdrowia Matki Polki, Łódź / Neurological Clinic of the Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Jolanta Dudek
- Instytut Fizjoterapii, Uniwersytet Jana Kochanowskiego, Kielce / Institute of Physiotherapy, Jan Kochanowski University in Kielce, Poland
| | - Dorota E. Ortenburger
- Instytut Wychowania Fizycznego Turystyki i Fizjoterapii, Akademia im. Jana Długosza, Częstochowa / Institute of Physical Education, Tourism and Physiotherapy, Jan Dlugosz University in Czestochowa, Poland
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Putz C, Döderlein L, Mertens EM, Wolf SI, Gantz S, Braatz F, Dreher T. Multilevel surgery in adults with cerebral palsy. Bone Joint J 2016; 98-B:282-8. [DOI: 10.1302/0301-620x.98b2.36122] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate. Methods This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution. Results Two objective gait variables were calculated pre- and post-operatively; the Gillette Gait Index (GGI) and the Gait Profile Score (GPS). The results were analysed in three groups according to their childhood surgical history (group 1 = no surgery, group 2 = surgery other than SEMLS, group 3 = SEMLS). Improvements in gait were shown by a significant decrease of GPS (p = 0.001). Similar results were obtained for both legs (GGI right side and left side p = 0.01). Furthermore, significant improvements were found in all subgroups although this was less marked in group 3, where patients had undergone previous SEMLS. Discussion SEMLS is an effective and safe procedure to improve gait in adults with cerebral palsy. However, a longer rehabilitation period is to be expected than found in children. SEMLS is still effective in adult patients who have undergone previous SEMLS in childhood. Take home message: Single-event multilevel surgery is a safe and effective procedure to improve gait disorders in adults with bilateral spastic cerebral palsy. Cite this article: Bone Joint J 2016;98-B:282–8.
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Affiliation(s)
- C. Putz
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - L. Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum
Aschau GmbH, Bernauerstrasse 18, 83229
Aschau i. Chiemgau, Germany
| | - E. M. Mertens
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - S. I. Wolf
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - S. Gantz
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - F. Braatz
- Private University of Applied Sciences
Göttingen, Robert Koch Strasse 40, 37075
Göttingen, Germany
| | - T. Dreher
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
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Bisneto EDNF, Rizzi N, Setani EO, Casagrande L, Fonseca J, Fortes G. Spastic wrist flexion in cerebral palsy. Pronator teres versus flexor carpi ulnaris transfer. ACTA ORTOPEDICA BRASILEIRA 2015. [PMID: 26207093 PMCID: PMC4503608 DOI: 10.1590/1413-785220152303145550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Analize data on patients submitted to transfer of the pronator teres (PT) or the flexor carpi ulnaris (FCB) to the extensor carpi radialis longus/brevis (ECRL/B) in order to correct flexed wrist deformity in patients with cerebral palsy. METHOD Patients were divided into two groups: PT group and FCU group to ECRL/B. The results were evaluated by goniometry and by the functional hand test (FHT). RESULTS Goniometry showed a statistically significant difference in favor of FCU transfer. There was no statistically significant difference regarding FHT. CONCLUSION Both transfers PT and FCU to ECRB are good options to correct wrist flexion deformity in cerebral palsy. Level of Evidence III, Non-randomized Controlled Cohort/Follow-Up Study.
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Affiliation(s)
| | - Nivea Rizzi
- Associação de Assistência à Criança Deficiente, Brazil
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Boffeli TJ, Collier RC. Surgical Treatment Guidelines for Digital Deformity Associated With Intrinsic Muscle Spasticity (Intrinsic Plus Foot) in Adults With Cerebral Palsy. J Foot Ankle Surg 2014; 54:985-93. [PMID: 25154656 DOI: 10.1053/j.jfas.2014.06.023] [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: 03/26/2014] [Indexed: 02/03/2023]
Abstract
Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility.
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Affiliation(s)
- Troy J Boffeli
- Director, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN
| | - Rachel C Collier
- Staff Surgeon, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN.
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Abstract
Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.
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Artilheiro MC, Corrêa JCF, Cimolin V, Lima MO, Galli M, de Godoy W, Lucareli PRG. Three-dimensional analysis of performance of an upper limb functional task among adults with dyskinetic cerebral palsy. Gait Posture 2014; 39:875-81. [PMID: 24373786 DOI: 10.1016/j.gaitpost.2013.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 02/02/2023]
Abstract
Patients with dyskinetic cerebral palsy (DCP) experience considerable variability in their purposeful movements due to involuntary movements that contribute to functional impairment. Movement analyses can demonstrate how the movements involved in bringing a mug to the mouth are performed by patients with DCP. Sixteen adults with DCP (29.63±4.42 years) and eleven healthy adults (24.09±3.73 years) performed six consecutive movements of bringing a mug to the mouth using their dominant arm. The mug was placed at 75% of each subject's maximum reach. Kinematic data were captured by 10 cameras and processed using biomechanical software. Fifteen reflexive markers were placed on predetermined bony landmarks on the head, trunk and upper limbs. DCP adults required more time to perform the going (bringing the mug to the mouth), adjusting (simulating taking a drink) and returning (lowering the mug back to the table) phases, and their movements were less smooth than the controls, as indicated by the index of curvature, average jerk and number of movement units. The DCP adults took a longer time to complete the task than controls as indicated by the peak velocities, mean velocities and times to peak velocity. With respect to the angular parameters, DCP adults had a smaller range of motion for shoulder and elbow flexion and forearm pronation compared with the controls. The analysis of functional tasks represents an important measure for the evaluation of dyskinetic movements and permits the quantitative characterization of upper limb impairment in adults with DCP.
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Affiliation(s)
- Mariana Cunha Artilheiro
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
| | - João Carlos Ferrari Corrêa
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
| | - Veronica Cimolin
- Department of Electronics, Informations and Bioengineering, Politecnico di Milano, Italy.
| | - Mario Oliveira Lima
- Department of Physical Therapy, Universidade do Vale do Paraiba, São José dos Campos, São Paulo, Brazil.
| | - Manuela Galli
- Department of Electronics, Informations and Bioengineering, Politecnico di Milano, Italy; IRCCS San Raffaele Pisana, Tosinvest Sanità, Roma, Italy.
| | - Wagner de Godoy
- Movement Analysis Laboratory, Albert Einstein Hospital, São Paulo, Brazil.
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil.
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Salzmann M, Berger N, Rechl H, Döderlein L. [Spastic foot deformities in children: surgical management]. DER ORTHOPADE 2014; 42:434-41. [PMID: 23636790 DOI: 10.1007/s00132-012-1991-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the neurological defects associated with cerebral palsy are not progressive, secondary musculoskeletal disorders due to growth and gravity are variable. In the clinical analysis of spastic foot deformities different mechanisms that produce a variety of deformities have to be analyzed. The goals of surgical treatment are correction of the deformity, reestablishment of stability of the foot and preservation of functionally important ranges of motion and muscle strength. The most common spastic foot deformities are equinus, planovalgus, equinovarus and calcaneus. For treatment soft tissue surgery, such as muscle lengthening and transfer together with bone surgery, such as osteotomy or arthrodesis are used and combinations of these methods are often required. Subsequently postoperative plasters are necessary followed by dynamic orthotic management.
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Affiliation(s)
- M Salzmann
- Orthopädische Kinderklinik am Behandlungszentrum Aschau, Bernauer Straße 18, 83229 Aschau, Deutschland.
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Fagher K, Lexell J. Sports-related injuries in athletes with disabilities. Scand J Med Sci Sports 2014; 24:e320-31. [DOI: 10.1111/sms.12175] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K. Fagher
- Department of Health Sciences; Lund University; Lund Sweden
| | - J. Lexell
- Department of Health Sciences; Lund University; Lund Sweden
- Department of Rehabilitation Medicine; Skåne University Hospital; Lund Sweden
- The Swedish Sports Organization for the Disabled and The Swedish Paralympic Committee; Lund Sweden
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Abstract
Transverse plane deviations are significant contributors to pathologic gait in children with cerebral palsy (CP). Due to limitations in neuromuscular control, balance, strength and coordination, transverse plane gait deviations are poorly tolerated in these children. Transverse plane malalignment results in lever arm dysfunction and can be seen with either intoeing or out-toeing. Frequent causes of transverse plane problems and lever arm dysfunction include long bone (femoral and/or tibial) torsion, pelvic rotation, and pes varus or valgus. Computerized motion analysis facilitates accurate identification of transverse plane abnormalities. This article addresses appropriate identification and treatment of transverse plane gait deviations in children with CP.
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Yang JF, Livingstone D, Brunton K, Kim D, Lopetinsky B, Roy F, Zewdie E, Patrick SK, Andersen J, Kirton A, Watt JM, Yager J, Gorassini M. Training to enhance walking in children with cerebral palsy: are we missing the window of opportunity? Semin Pediatr Neurol 2013; 20:106-15. [PMID: 23948685 DOI: 10.1016/j.spen.2013.06.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this paper is to (1) identify from the literature a potential critical period for the maturation of the corticospinal tract (CST) and (2) report pilot data on an intensive, activity-based therapy applied during this period, in children with lesions to the CST. The best estimate of the CST critical period for the legs is when the child is younger than 2 years of age. Previous interventions for walking in children with CST damage were mainly applied after this age. Our preliminary results with training children younger than 2 years showed improvements in walking that exceeded all previous reports. Further, we refined techniques for measuring motor and sensory pathways to and from the legs, so that changes can be measured at this young age. Previous activity-based therapies may have been applied too late in development. A randomized controlled trial is now underway to determine if intensive leg therapy improves the outcome of children with early stroke.
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Affiliation(s)
- Jaynie F Yang
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
BACKGROUND Hip flexion contracture (HFC) in the ambulatory child with cerebral palsy (CP) may impair function and lead to deteriorations in health-related quality of life. Furthermore, increasing HFC may lead to increasing disability. However, the association between passive range of motion and the measures of function and well-being is unclear. This study was designed to determine whether increasing HFC is associated with functional outcome. METHODS A total of 181 children, with an average age of 14.0 ± 10.2 years, were evaluated as part of a multicenter prospective data collection of patients with ambulatory CP. Measurements of HFC were recorded, and patients were evaluated using walking score from Gillette Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM), and the Pediatric Outcome Data Collection Instrument (PODCI). Patients were grouped on the basis of severity of HFC: group A, 0 to 14 degrees; group B, 15 to 29 degrees; and group C ≥ 30 degrees. Associations were examined using the Spearman correlation. RESULTS There was an inverse association between degree of HFC and FAQ walking score (P<0.01, ρ=-0.25). Similarly, there was an inverse association between the degree of HFC and GMFM parts D (P<0.001, ρ=-0.31) and E (P<0.001, ρ=-0.32). Lastly, the PODCI domains of global function, mobility, and physical function also showed an inverse association with degree of HFC (P<0.001, ρ=-0.24). CONCLUSIONS As surgeons treating children with CP, we often rely on joint measurements as an indirect measure of function. This study of children with ambulatory CP suggests that increased HFC from the physician's perspective is associated with deterioration in function from a patient and a therapist's perspective. LEVEL OF EVIDENCE Level II, prospective study.
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