Cerebral palsy in children: a clinical overview

Assessment of the clinical significance of a UGT1A1 gene variant in affecting phototherapy response and long-term outcomes in neonatal hyperbilirubinemia

OBJECTIVE

Phototherapy is the standard treatment, but its efficacy can vary among neonates, prompting interest in genetic factors, particularly UGT1A1 gene variants. This study aims to evaluate the clinical significance of the UGT1A1 gene variant in influencing phototherapy response and long-term outcomes in neonatal hyperbilirubinemia.

METHODS

This retrospective study included 104 neonates with neonatal hyperbilirubinemia, of whom 63 carried the normal UGT1A1 gene, and 41 had the homozygous UGT1A1 Gly71Arg variant. Genetic testing for the UGT1A1 gene Gly71Arg locus had been previously conducted as part of their clinical care using DNA extraction and sequencing. Parameters such as phototherapy duration, complications, and long-term outcomes were analyzed to assess the correlation between the UGT1A1 gene variant and clinical results. Furthermore, the impact of the UGT1A1 gene variant was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Neonates with the UGT1A1 gene variant showed prolonged phototherapy duration, extended time to bilirubin normalization, increased phototherapy complications, higher phototherapy intensity, and more excellent rehospitalization rates for hyperbilirubinemia. The presence of the UGT1A1 gene variant correlated with specific complications, including dehydration, hypoglycemia, and hyperbilirubinemia. Additionally, infants with the UGT1A1 gene variant had significantly higher rates of developmental delay, cerebral palsy, hearing impairment, neurodevelopmental disorders, and severe hyperbilirubinemia-related morbidities. Mean peak bilirubin levels were significantly higher in the variant compared with the normal group. ROC analysis demonstrated moderate to strong sensitivities and specificities with area under the curve (AUC) values ranging from 0.693 to 0.830.

CONCLUSION

We found that a UGT1A1 gene variant significantly affects phototherapy response and can impact long-term outcomes in neonatal hyperbilirubinemia, highlighting the potential of genetic testing for personalized risk assessment and management of hyperbilirubinemia in newborns.

Prenatal exposure to fine particulate matter composition and risk of cerebral palsy: A population-based retrospective cohort study in Ontario, Canada

BACKGROUND

Existing literature suggests an association between prenatal exposure to fine particulate air pollution (PM2.5) and cerebral palsy (CP). However, the impact of individual PM2.5 components (SO42-, NH4+, NO3-, SS, BC, dust, OM) on CP risk remains unknown.

OBJECTIVE

To examine the associations between prenatal exposure to PM2.5 components, and risk of CP among term births in Ontario, Canada.

METHODS

This was a retrospective cohort study that examined term births (gestational age ≥37 completed weeks) from April 2002 to December 2020. PM2.5 total mass and composition measures were assigned to maternal residence at birth using satellite-based estimates and ground-level monitoring data. Cohort data were compiled using health administrative databases. Single-pollutant distributed lag cox proportional hazard models, with and without additional adjustment for PM2.5 residuals, were used to investigate the associations between gestational exposures to PM2.5 total mass and its components.

RESULTS

2,193,427 mother-infant pairs were identified, of which 3907 were diagnosed with CP during the follow-up period. Increased risk of CP was found for SO42- exposure during early pregnancy in both residual-adjusted (HR: 1.052, 95 % CI: 1.009-1.097, per IQR = 0.94 μg/m3), and non-adjusted models (HR: 1.050, 95 % CI: 1.007-1.095, per IQR = 0.94 μg/m3). The concentration-response relationship between the sensitive window found for SO42- and CP risk (weeks 4-9 of gestation) showcased a supralinear pattern.

CONCLUSIONS

Prenatal exposure to SO42- may be associated with increased CP risk during the early pregnancy period. Associations between prenatal PM2.5 total mass and composition exposure and CP risk should be further investigated.

The effectiveness of non-invasive brain stimulation in enhancing lower extremity function in children with spastic cerebral palsy: Protocol for a systematic review and meta-analysis

Non-invasive brain stimulation (NIBS) techniques have emerged as a promising non-pharmacological adjunct to neurorehabilitation. Children with Cerebral Palsy (CP) exhibit altered cortical excitability, and while CP remains incurable, physiotherapy combined with other interventions is essential for managing motor dysfunction. Although some studies have examined NIBS using various stimulation parameters, there is limited evidence regarding its effects on the lower extremities and optimal administration protocols. This review aims to evaluate the effectiveness of NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for the treatment of motor function in spastic cerebral palsy, specifically in the lower extremity. A systematic search will be conducted in databases including MEDLINE, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. The search strategy will follow the PICO framework (Participants, Intervention, Comparison, Outcomes), focusing on randomized controlled trials (RCTs). Two independent reviewers will manage screening, selection, data extraction, risk of bias assessment, and grading of evidence. This review will provide key insights into the effectiveness of NIBS for lower-extremity function in children with spastic CP, guiding future research and clinical applications.

The effects of vestibular rehabilitation on preterm children with spastic hemiparetic cerebral palsy: Case report

INTRODUCTION

Cerebral Palsy (CP), a common neurodevelopmental disorder, impacts the developing brain and leads to motor, postural, and sensory impairments in children. Since sensory processing, especially vestibular input, is crucial for balance, coordination, and movement quality, this case report aimed to investigate the effects of vestibular rehabilitation on muscle tone, motor function, and development in two preterm children with spastic hemiparetic CP.

MATERIALS AND METHODS

Demographic information and birth history were recorded, and assessments were conducted at the beginning and end of the 10-week vestibular rehabilitation program. Muscle tone was evaluated using the Modified Ashworth Scale (MAS), while motor development was measured with the Denver II Developmental Screening Test (DDST II) and the Alberta Infant Motor Scale (AIMS).

RESULTS

After the 10-week vestibular rehabilitation program, both cases showed improvement on the DDST II: the first case in fine motor-adaptive, language, and gross motor areas; the second in personal-social, language, and gross motor areas. Upper extremity hypertonus scores decreased by 2 and 3 points, and lower extremity hypertonus by 5 points in each case. Additionally, total AIMS scores increased from 22 to 28 in the first case and from 16 to 23 in the second.

CONCLUSIONS

This case report suggests that vestibular rehabilitation may be beneficial in improving motor function and reducing hypertonus in preterm infants with spastic CP. These positive findings indicate that incorporating vestibular rehabilitation could enhance outcomes in the rehabilitation of children with CP.

Muscle physiology in spasticity and muscle stiffness

This paper examines the physiological changes in spastic muscles contributing to spasticity and muscle stiffness, focusing on the underlying mechanisms and their clinical implications. Spasticity, which is prevalent in neurological conditions such as multiple sclerosis, cerebral palsy, spinal cord injury, stroke, and traumatic brain injury, is characterized by disordered sensorimotor control and often results in increased muscle stiffness and resistance to movement. Recent developments in the understanding of spasticity suggest the importance of architectural changes in muscles that may contribute to increased passive resistance, potentiate reflex mechanisms, and progression to fibrosis, with hyaluronan (HA), a glycosaminoglycan, playing a pivotal in modulating the properties of the muscle extracellular matrix (ECM). The hyaluronan hypothesis of muscle stiffness postulates that the accumulation and biophysical alteration of HA in the ECM of muscle increases its viscosity, resulting in increased passive mechanical resistance. This is turn mayincrease muscle sensitivity to stretch, potentiating spasticity, and lead to cellular differentiation of myofibroblasts to fibroblasts ultimately leading to fibrosis and contracture. A deeper understanding of HA's role in ECM dynamics offers promising avenues for novel treatments aimed at mitigating stiffness and preventing long-term disability in patients with spasticity.

Cerebral Palsy and Ankyloglossia: Improved Sleep, Speech, Swallowing, and Breathing After Tongue-Tie Release: A Case Series

AIMS

To assess the impact of tongue-tie (ankyloglossia) and lip-tie release on functional outcomes in pediatric patients with cerebral palsy (CP) and explore the role of oral restrictions in hindering therapy progress.

METHODS

Four female patients with CP, aged 10 months, 3 years, 6 years, and 7 years, underwent tongue-tie release with concomitant lip-tie and/or buccal-tie release. Pre- and postprocedure assessments focused on parental reports of quality of life improvements.

RESULTS

All four patients demonstrated significant functional improvements following the release procedures. Reported improvements included better speech clarity, more effective swallowing, improved breathing, increased postural balance, reduced fascial tension, alleviation of gastrointestinal symptoms, and improved sleep patterns. These changes were observed consistently across all patients, suggesting a positive correlation between the release of oral restrictions and functional gains in children with CP.

CONCLUSIONS

Undiagnosed oral restrictions may impair mobility and development in children with CP. Addressing these restrictions may improve speech, swallowing, and other critical functions. Proper assessment of oral restrictions in children with CP or other comorbidities is essential to optimize therapeutic outcomes and enhance quality of life. This case series highlights the importance of considering oral restrictions in children with special healthcare needs and the ongoing need for further research.

Genetic testing in cerebral palsy with clinical and neuroimaging variables

AIM

To optimize genetic testing in children with cerebral palsy (CP) by using clinical and magnetic resonance imaging (MRI) variables.

METHOD

In this mixed methods study, we surveyed current approaches to genetic testing by Australian clinicians involved in the diagnosis of CP. Using an international expert panel we explored 78 variables, to determine which variables were thought to be supportive of monogenic CP. We tested the 78 variables in a retrospective cohort of 100 children with CP, of whom 21 had a genetic cause of CP.

RESULTS

Forty-five clinicians replied to the survey of current practice, 91% agreed that genetic testing has a role in CP, although 47% thought that there was inadequate guidance on which patients to test. The expert panel reached 75% agreement for 30 out of 78 variables for genetic CP, and 14 out of 78 variables against a genetic cause of CP. Retrospective testing in 100 children with CP revealed dysmorphic features (odds ratio [OR] = 7.50; 95% confidence interval [CI] 1.88-29.85) and intellectual disability (OR = 4.86; 95% CI 1.29-18.30) were more common in those with genetic CP, and MRI being compatible with the clinical picture was the feature least common in genetic CP (OR = 0.14; 95% CI 0.05-0.41).

INTERPRETATION

Genetic testing has a role in determining CP aetiology; however, there is no consensus on who should be tested. We used mixed methodology and found that dysmorphic features, intellectual disability, and 'MRI not compatible with the clinical picture' are most supportive of a genetic cause of CP.

Associations of prenatal exposure to residential greenspace and active living environments with cerebral palsy: A population-based cohort study in Ontario, Canada

Background

Prenatal exposure to environmental factors, such as greenspace and active living environments, has been associated with numerous health benefits, including improved neurodevelopmental outcomes. Although cerebral palsy (CP) is not typically linked to these exposures, emerging evidence suggests that exposure to environmental factors during pregnancy may influence brain development, making it important to explore their potential role in CP risk.

Methods

We conducted a retrospective cohort study using health administrative data from Ontario, Canada, between 1 April 2002 and 31 December 2020. We identified 1,436,411 mother-infant pairs, of which 2,883 were diagnosed with CP during the follow-up period. Exposures of interest included the Normalized Difference Vegetation Index (NDVI), Green View Index (GVI), and park proximity. The Canadian Active Living Environments index was also utilized. Cox proportional hazards models estimated hazard ratios (HRs) for CP risk associated with these environmental exposures, adjusting for potential confounders.

Results

Interquartile range (IQR) increases in NDVI (HR = 1.040; 95% confidence interval [CI]: 0.987, 1.096; per IQR = 0.1) and GVI (HR =0.989; 95% CI: 0.943, 1.038; per IQR = 10.05%) were not significantly associated with CP risk. Similar results were found for quartile increases of NDVI and GVI. Residential proximity to parks at birth was associated with a reduction in CP risk (HR = 0.946; 95% CI: 0.904, 0.990; per 0.06 increase in park proximity index), after adjusting for active living environment and air pollution.

Conclusions

Our study suggests that living closer to parks reduces the risk of CP. Further research should investigate these protective effects and consider other dimensions of greenspace quality and usability.

The Validity and Reliability of the Seated Postural Control Measure in Cerebral Palsy

PURPOSE

To establish the validity and reliability of the Turkish version of the Seated Postural Control Measure (SPCM-TR) in children with cerebral palsy (CP).

METHODS

The original version of the Seated Postural Control Measure was translated and culturally adapted according to international guidelines. The participants were 124 children with CP, with a mean age of 8.6 ± 2.6 years. The measures were administered by 2 independent physical therapists twice, 1 week apart. Convergent validity was evaluated with the sitting dimension of the Gross Motor Function Measure (GMFM), whereas construct validity was evaluated with the Gross Motor Function Classification System (GMFCS).

RESULTS AND CONCLUSIONS

Cronbach's alpha values of the alignment and function subscales and total score were 0.83, 0.89, and 0.91, respectively. Correlations between SPCM-TR total scores and GMFCS (-0.92) and GMFM (0.91) scores were very good. The intraclass correlation coefficient was excellent (0.90) for intra-rater and inter-rater reliability. The results indicate that the SPCM-TR is a valid and reliable scale in children with CP.

Case Report: Robot-assisted gait training with the wearable cyborg hybrid assistive limb 2S size in three children with cerebral palsy

Introduction

Recently, robot-assisted gait training (RAGT) has attracted attention as a rehabilitation method to efficiently improve walking function. The purpose of this case report is to examine whether there is a change in gait function after RAGT with HAL in children with cerebral palsy (CP).

Methods

Three children with CP participated in this study. Case 1 was an 8-year-old boy with Gross Motor Function Classification System (GMFCS) level II. Case 2 involved a 9-year-old girl with a class IV GMFCS. Case 3 was that of a 10-year-old boy with class IV GMFCS. RAGT was conducted once a day for 20 min for a total of 11-12 sessions. Gait was assessed before and after RAGT. We assessed using three-dimensional motion analysis and surface electromyography (sEMG). The sEMG signals were recorded from the bilateral tensor fascia lata, gluteus maximus, semitendinosus, and rectus femoris.

Results

All cases showed changes in the joint angle and muscle activity in the lower limbs before and after RAGT. In Case 1, the maximum hip extension angle increased from -10.6° to -4.1° at the terminal stance, and the average muscle activity of the gluteus maximus in the right stance phase increased from 22.4% to 30.2%. In Case 2, the maximum extension angle of the left knee joint increased from -43.0° to -26.9°. In Case 3, the maximum hip extension angle increased from -39.9° to -25.9° on the left side and from -35.1° to -18.7° on the right side; the maximum knee extension angle increased from -55.7° to -38.8° on the left side and from -52.1° to -36.9° on the right side.

Discussion

A Case 1 had significant hip flexion during gait, but RAGT with HAL emphasized hip extension motion and enabled an efficient gait. As a result, the maximum hip extension angle increased, and the activity of the gluteus maximus muscle in the stance phase increased. Cases 2 and 3 had greater hip and knee joint flexion angles, however increased knee extension angles after RAGT. The increased hip and knee joint extension angles during the stance phase increased the propulsive force propelling the walker forward.

Korean Cerebral Palsy Registry (KCPR): study rationale and protocol of a multicentre prospective cohort study

INTRODUCTION

Cerebral palsy (CP) is a leading cause of motor developmental disability in children. Generating epidemiological data on CP could enable early diagnosis, intervention and translational research. We aim to establish a Korean network and online data repository for CP called the Korean Cerebral Palsy Registry (KCPR).

METHODS AND ANALYSIS

The KCPR is a nationwide, multicentre, prospective cohort study designed to conduct a 20-year longitudinal follow-up of children with CP. Institution-based surveillance involving 42 institutions across the country will be used for the registration of children with CP aged less than 7 years to participate in KCPR. The data collection form of the KCPR will comprise diagnostic information, risk factors, extent of disability, genetic data, quality of life, socioeconomic status, functional levels according to life cycle stages and patterns of healthcare utilisation, including rehabilitation. The primary goal of KCPR is to establish a national data repository for CP in Korea, providing a platform for continuous monitoring and analysis of CP cases. Based on its role as a registry, KCPR will support various research projects to enhance the understanding and management of CP. The specific objectives of research projects using KCPR data include: (1) identifying the pathological characteristics of CP and their associated medical, social, economic and psychological needs; (2) using data from prospective tracking of CP children's function and quality of life to develop integrated service plans and policies and (3) conducting intervention cohort studies to establish guidelines for standardised rehabilitative medical services.

ETHICS AND DISSEMINATION

The study protocol was approved by the ethics committees of all 42 participating hospitals. Findings from this study will be disseminated in peer-reviewed publications.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

PROSPERO REGISTRATION NUMBER

CRD42024518179.

Split tendon transfer of the posterior tibialis for spastic equinovarus foot deformity: Does tendon routing impact post-operative ankle kinematics?

BACKGROUND

Split tendon transfer of the posterior tibialis (SPOTT) is a surgical procedure in which the split posterior tibialis tendon is transferred posterior to the fibula (PO) with insertion on the peroneus brevis tendon to rebalance the forces across the hindfoot. Routing of the split tendon through the interosseous membrane (IO) is a variation with the potential benefit of augmenting ankle dorsiflexion in swing.

RESEARCH QUESTION

Does IO routing improve ankle dorsiflexion in swing and/or varus in stance compared to PO routing?

METHODS

A retrospective chart review was completed to identify forty-two patients who underwent a SPOTT procedure for equinovarus foot deformity. 14 patients received IO routing and 28 received PO routing. Two main outcomes: maximum ankle dorsiflexion in swing and average ankle coronal angle in stance were analyzed using a mixed effects model.

RESULTS

Both the IO and PO routing significantly improved maximum dorsiflexion in swing (p = 0.018 and p = 0.001, respectively.) There was no significant difference in the maximum dorsiflexion during swing, post-operatively, between the two groups (p = 0.431). Pre-operatively, patients in the IO group exhibited significantly more average ankle varus during stance, with a median of 6.7 degrees of varus compared to a median of 1.8 degrees of varus in the PO group (p = 0.024). The IO group yielded a statistically significant reduction in average ankle varus during stance (p < 0.001) whereas there was no significant change in the PO group (p = 0.138). There was no difference between groups in proportion of patients that achieved an average ankle coronal angle during stance within one SD of normative data (between -8.7 and 0.7 degrees, p = 0.381).

SIGNIFICANCE

The SPOTT procedure utilized for correction of spastic equinovarus foot deformity, can improve ankle kinematics with routing of the tendon through the IO membrane or posterior to the fibula if performed concurrently with the appropriate tendon lengthening to address equinus contracture. More clinical studies are needed to better understand potential confounding factors.

Massage Therapy for Ankle Mobility and Spasticity in an Adult with Cerebral Palsy: A Case Report

Background

Cerebral palsy (CP) refers to a group of permanent neurologic disorders associated with injury to the brain during its development. The most common type of CP is spastic CP. Individuals with spastic CP commonly present with increased deep tendon reflexes, tremors, muscular hypertonicity, and weakness. Treatment aims to manage primary and secondary symptoms of CP and improve quality of life. Massage therapy has been shown to improve function and decrease spasticity in individuals with CP.

Objective

The objective of this study was to determine the effectiveness of massage therapy in increasing ankle mobility and decreasing spasticity in an adult with spastic CP.

Method

A student massage therapist at MacEwan University administered five massage therapy treatments over 6 weeks on a 55-year-old female with spastic diplegic CP who presented with no active ankle movement and her ankles rigid in plantarflexion. The treatment goals were to obtain some ankle mobility and decrease spasticity in the knee extensors, which negatively impacted her ability to don socks and shoes. Progress was monitored using goniometry pre- and post-treatment to assess ankle mobility, and by administering the Modified Ashworth Scale prior to the third, fourth, fifth, and final sessions to assess spasticity. Techniques included static contact, effleurage, broad compressions, petrissage, muscle stripping, Golgi tendon organ release, muscle approximation, joint mobilizations, and passive range of motion.

Results

Ankle mobility increased, and slight active ankle dorsiflexion and plan-tarflexion were possible. Spasticity in the knee extensors decreased, but the change was not clinically significant.

Conclusion

The results of this study suggest that massage therapy may improve ankle mobility and decrease spasticity in an adult with spastic CP.

Cerebral palsy: Current concepts and a glimpse into the future

ABSTRACT

Cerebral palsy (CP) is an encompassing term for a group of permanent neurologic disorders of movement and posture commonly seen in early childhood and caused by abnormal brain development early in life. The cause of CP is unclear in the majority of patients affected and can be multifactorial, occurring in various time frames such as prenatal, intrapartum, and postpartum. Because CP is a clinical diagnosis, clinicians must have a strong understanding of the clinical presentation to ensure early diagnosis and improved outcomes for patients. This article reviews CP and describes advances in diagnosis and management; it also provides an overview of new treatments that are under investigation.

Functional electrical stimulation for walking in adults with cerebral palsy: a service evaluation

Cerebral palsy (CP) is a neuromotor disorder which can lead to walking difficulties. Functional electrical stimulation (FES) is approved by The National Institute for Health and Care Excellence (NICE) for managing foot drop in upper motor neuron disorders, however there is limited evidence for its use in CP. We discuss a cohort of 26 patients with CP using FES for a 3 month period and longitudinal data for a subset of 11 patients that have used FES for at least 4 years. Patients were referred for the following common barriers to walking: reported falls (54%), foot drop (46%) and tripping (15%). After application of FES at baseline, there was a small clinically insignificant orthotic effect on walking speed (0.01 m/s on/off difference). However, orthotic effects became statistically and clinically significant at three months of continuous use (0.12 m/s on/off difference, p = 0.01) and in the subset of 11 patients this remained significant at four years (0.24 m/s on/off difference, p = 0.01). Patient reported walking satisfaction (numerical rating scale) improved when comparing no-FES versus FES at three months and at four years. FES is a safe, cost-effective treatment option and should be considered, for adults with CP who have walking difficulties.

ChMER: an exoskeleton robot with active body weight support walker based on compliant actuation for children with cerebral palsy

Introduction

Lower limb exoskeleton robots for young children with cerebral palsy (CP) are crucial to support earlier rehabilitation that is more beneficial than later. For safety reasons, pediatric exoskeletons are usually equipped with body weight support (BWS) devices to help young patients maintain balance. However, existing pediatric exoskeletons tend to use stiff joint actuation and passive BWS with limited compliance.

Method

This paper proposes a novel mobile exoskeleton robot for young children (3- ∼ 6-years-old) with CP based on intrinsically compliant actuation. A compact kinematic chain that integrates an exoskeleton, an active BWS system, and a walker is proposed. Furthermore, with the actuation design optimization of the kinematic chain, the robot can walk alone stably in passive rehabilitation and provide high compliance in active rehabilitation. The exoskeleton adopts actuation similar to the quasi-direct drive paradigm to acquire high mechanical compliance and uses a secondary planetary reducer to ensure high output torque. Assistive torque control is achieved through proprioceptive sensing instead of torque sensors. The BWS system uses a series elastic actuator to accurately generate the weight support force and significantly reduce the fluctuation of the support force compared to the passive BWS.

Results and discussion

Finally, control frameworks for passive and active rehabilitation are implemented to validate the robot performance. The experimental results demonstrate that our robot can support safe and compliant rehabilitation.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Comprehensive Review on Utilizing Human Brain Organoids to Study Neuroinflammation in Neurological Disorders

Most current information about neurological disorders and diseases is derived from direct patient and animal studies. However, patient studies in many cases do not allow replication of the early stages of the disease and, therefore, offer limited opportunities to understand disease progression. On the other hand, although the use of animal models allows us to study the mechanisms of the disease, they present significant limitations in developing drugs for humans. Recently, 3D-cultured in vitro models derived from human pluripotent stem cells have surfaced as a promising system. They offer the potential to connect findings from patient studies with those from animal models. In this comprehensive review, we discuss their application in modeling neurodevelopmental conditions such as Down Syndrome or Autism, neurodegenerative diseases such as Alzheimer's or Parkinson's, and viral diseases like Zika virus or HIV. Furthermore, we will discuss the different models used to study prenatal exposure to drugs of abuse, as well as the limitations and challenges that must be met to transform the landscape of research on human brain disorders.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A systematic review and meta-analysis of neuromuscular electrical stimulation post-botulinum toxin injection in children with cerebral palsy

The aim of our study is to investigate whether adjunct neuromuscular electrical stimulation (NMES) therapy improves functional performance outcomes in children with cerebral palsy (CP) who have received botulinum toxin (BTX) injections. We searched the PubMed, Cochrane Library, CINAHL, EMBASE, and Scopus databases for randomized controlled trials studying the effects of NMES after BTX injection in children with CP from database inception to July 3, 2024. Two independent reviewers extracted data, and risks of bias were assessed using the PEDro scale for randomized controlled trials. We included 5 randomized controlled trials in this meta-analysis. NMES treatment following BTX injection resulted in greater functional performance outcomes compared with BTX injections alone (standardized mean difference = 0.57; 95% CI = 0.22 to 0.92). However, NMES following BTX injections did not significantly improve spasticity outcomes (standardized mean difference = 0.28; 95% CI = - 0.21 to 0.76). Despite including only a small number of trials, the present analysis demonstrated that NMES is an effective adjunct to BTX injections for managing CP in children. Further research must be conducted to refine these therapies, ensure better outcomes, and alleviate the burdens faced by individuals with CP.

Effect of leg pedaling exercise from an inclined position on functional ability and strength in children with diplegia

Objectives

Children with spastic diplegic cerebral palsy (SDCP) can develop various complications that affect their daily activities and quality of life, such as impaired functional ability, trunk control, and muscle weakness. This study evaluated the effects of lower extremity pedaling exercise from an inclined position on functional ability, trunk control, and muscle strength in these children.

Methods

Thirty children diagnosed with SDCP, aged 6-9 years, were randomly assigned to two groups: a study group (Group A) and a control group (Group B). Both groups followed a designated physical therapy program for 45 min three times weekly for two consecutive months. Group A performed leg pedaling exercises for 30 min per session from an inclined position. Functional ability, trunk control, and muscle strength were assessed before and after the study using the Gross Motor Function Measure, Trunk Control Measurement Scale, and a handheld dynamometer, respectively.

Results

Both groups demonstrated statistically significant improvements in the assessed variables post-treatment (P < 0.05). Group A exhibited substantial improvements in functional ability, trunk control, and muscle strength following treatment (P < 0.05).

Conclusions

For children with SDCP, integrating leg pedaling exercises from an inclined position into their therapeutic program can improve their functional ability, trunk control, and muscle strength.

Effects of mind-body exercise in children with cerebral palsy-A systematic review and meta-analysis

BACKGROUND AND PURPOSE

An increasing number of studies have investigated the efficacy of mind-body exercise in the treatment of children with cerebral palsy (CP). However, the findings of these researches have produced inconsistent results. The objective of this study was to evaluate the effects of mind-body exercise on children with CP in order to provide more conclusive results.

MATERIALS AND METHODS

A comprehensive search was conducted in PubMed, Cochrane, Embase, Web of Science, and Ovid databases from inception to May 2024. One researcher extracted the data, including first author, study type, country, year of publication, population, age, sample size, intervention details and outcomes, accuracy was verified by a second researcher. The included studies were analyzed using Review Manager 5.4 (RevMan 5.4) and StataNow/MP 18.5 software, with publication bias examined using funnel plots, and result stability assessed through sensitivity analysis.

RESULTS

A total of six eligible studies, comprising 173 patients, were included in the meta-analysis. The results of the meta-analysis indicated that mind-body exercise can improve balance function in children with CP (SMD = 0.48, P = 0.006). There was no significant difference in the effect of mind-body exercise on walking function in children with CP (SMD = -0.23, P = 0.58).

CONCLUSION

Compared with routine care and rehabilitation, mind-body exercise may provide a safe and convenient approach to improving balance functions in children with CP, but showed no statistically significant beneficial effects on walking in children with CP.

PROSPERO REGISTRATION NUMBER

CRD42024534257.

Early Independent Wheeled Mobility in Children with Cerebral Palsy: A Norwegian Population-Based Registry Study

Background: The aim was to explore independent wheeled mobility in children with CP, and identify predictors of early independent wheeled mobility and changes over time across birth cohorts. Methods: We included data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) comprising 11,565 assessments of 1780 children born in 2002-2019. Variables included demographic data, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, wheelchair use, and independent wheeled mobility. Cox proportional hazard regression was used to identify predictors for early independent wheeled mobility. Kaplan-Meier survival curves were used to compare birth cohorts. Results: Of 769 (43%) children who used a wheelchair, 511 (67%) had independent wheeled mobility. Two thirds of the children (n = 337) achieved independent wheeled mobility before age 7. Most children with independent wheeled mobility used powered wheelchairs. Children at GMFCS levels III and IV were more likely to reach independent wheeled mobility at an early age. Children at MACS levels III-V had a lower probability of early independent wheeled mobility. The average age of achieving independent mobility decreased from 9.5 to 4.0 years between birth years 2002 and 2019. Conclusions: Two in three children were independent wheelchair users before 7 years of age, and the age of obtaining independent wheeled mobility has decreased over the last 20 years. Children with better hand function were more likely to obtain early independent wheeled mobility. Early intervention programs to promote mobility, development and participation should include powered mobility, adapted steering options, and interventions for hand function.

Multimodal fuzzy logic-based gait evaluation system for assessing children with cerebral palsy

Gait analysis is crucial for identifying functional deviations from the normal gait cycle and is essential for the individualized treatment of motor disorders such as cerebral palsy (CP). The primary contribution of this study is the introduction of a multimodal fuzzy logic system-based gait index (FLS-GIS), designed to provide numerical scores for gait patterns in both healthy children and those with CP, before and after surgery. This study examines and evaluates the surgical outcomes in children with CP who have undergone Achilles tendon lengthening. The FLS-GIS utilizes hierarchical feature fusion and fuzzy logic models to systematically evaluate and score gait patterns, focusing on spatial and temporal features across the hip, knee, and ankle joints. The two FLS types-1 (FLS-GIS-T1) and type-2 (FLS-GIS-T2) indices, respectively, were implemented to comprehensively study gait profiles. Starting with the gait parameters of all subjects, the changes in gait parameters in post-surgery children reflect significant improvements in gait dynamics, bringing walking patterns in CP children closer to those of their typically healthy peers. Both FLS-GIS-T1 and FLS-GIS-T2 demonstrated significant improvements in post-surgery evaluations compared to pre-surgery assessments, with p values < 0.05 and < 0.001, respectively, when compared to traditional indices. The proposed FLS-based index offers clinicians a robust and standardized gait evaluation tool, characterized by a fixed range of values, enabling consistent assessment across various gait conditions.

Understanding Parental Satisfaction in Caring for Children with Cerebral Palsy

INTRODUCTION

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

AIM OF THE STUDY

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Exploring the Characteristics and Utilization of General Practice Healthcare by Adults With Cerebral Palsy: A Systematic Review

BACKGROUND

Individuals with cerebral palsy (CP) experience acute and chronic health issues requiring lifespan primary care. This review aimed to investigate characteristics and utilization of general practitioner (GP) access by adults with CP. Secondary aims included exploring reasons prompting access, identifying interventions provided, and personal features affecting access.

METHODS

Using systematic review methodology, 5 databases were searched using keywords relating to adults, CP, and primary care, relating to quantitative studies (January 2000-July 2024). Data was extracted, collated, and analyzed descriptively, with additional meta-analyses to estimate proportion of GP visits.

RESULTS

Fifteen studies were included describing GP access by 6231 adults with CP. The proportion annually accessing a GP was 78% (95% CI = 69%-85%). The frequency of GP access ranged from 1.76 to 11.7 visits per year, increased with advancing age and disability severity. Comorbid intellectual disability and pain also increased GP attendance. Limited data was available reporting healthcare needs prompting GP access, and no interventions were described.

CONCLUSIONS

Advancing age, greater disability severity, comorbid intellectual disability, and pain may prompt increased GP access by adults with CP. Identification of reasons for seeking primary care, and interventions provided are required through data linkage studies to enhance lifespan care.

An automated framework for pediatric hip surveillance and severity assessment using radiographs

PURPOSE

Hip dysplasia is the second most common orthopedic condition in children with cerebral palsy (CP) and may result in disability and pain. The migration percentage (MP) is a widely used metric in hip surveillance, calculated based on an anterior-posterior pelvis radiograph. However, manual quantification of MP values using hip X-ray scans in current standard practice has challenges including being time-intensive, requiring expert knowledge, and not considering human bias. The purpose of this study is to develop a machine learning algorithm to automatically quantify MP values using a hip X-ray scan, and hence provide an assessment for severity, which then can be used for surveillance, treatment planning, and management.

METHODS

X-ray scans from 210 patients were curated, pre-processed, and manually annotated at our clinical center. Several machine learning models were trained using pre-trained weights from Inception ResNet-V2, VGG-16, and VGG-19, with different strategies (pre-processing, with and without region of interest (ROI) detection, with and without data augmentation) to find an optimal model for automatic hip landmarking. The predicted landmarks were then used by our geometric algorithm to quantify the MP value for the input hip X-ray scan.

RESULTS

The pre-trained VGG-19 model, fine-tuned with additional custom layers, outputted the lowest mean squared error values for both train and test data, when ROI cropped images were used along with data augmentation for model training. The MP value calculated by the algorithm was compared to manual ground truth labels from our orthopedic fellows using the hip screen application for benchmarking.

CONCLUSION

The results showed the feasibility of the machine learning model in automatic hip landmark detection for reliably quantifying MP value from hip X-ray scans. The algorithm could be used as an accurate and reliable tool in orthopedic care for diagnosing, severity assessment, and hence treatment and surgical planning for hip displacement.

The relationship between pneumonia and dental visits in patients with cerebral palsy: A nationwide registry-based cohort study in Taiwan

Background/purpose

In general, improving oral health can reduce the risk of pneumonia. The purpose of this retrospective cohort study was to investigate the risk of pneumonia between cerebral palsy (CP) cohort and non-CP cohort as well as the association of pneumonia with the number of dental visits in CP patients in Taiwan.

Materials and methods

We identified 10,544 patients who were diagnosed with CP between 2010 and 2019 from the Taiwan National Health Insurance Research Database. 63,264 individuals who had never been diagnosed with CP were captured and matched in a 6:1 ratio. Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between CP cohort and non-CP cohort.

Results

Our findings demonstrated that CP cohort had 2.619-fold risk for pneumonia as compared with non-CP cohort after adjustment (95 % CI = 2.574-2.813, P < 0.0001). Cox regression analysis indicated that the CP group had significantly higher incidence risk of pneumonia (log rank P < 0.0001). Higher risks of pneumonia in CP patients were associated with younger age, and lower urbanization level. Some comorbidities as well as history of pneumonia had the higher aHR for pneumonia within 180 days prior to index date. In addition, there was a positive association with the more than two dental visits for the decrease 0.887-fold incidence of pneumonia in CP-cohort as compared with no dental visit (95 % CI: 0.799-0.984).

Conclusion

Taken together, CP patients had a higher risk of pneumonia. Dental visits are beneficial for preventing the risk of pneumonia in CP patients. The patients with CP should receive regular dental checkup.

Development of a Virtual Robot Rehabilitation Training System for Children with Cerebral Palsy: An Observational Study

This paper presents the development of a robotic system for the rehabilitation and quality of life improvement of children with cerebral palsy (CP). The system consists of four modules and is based on a virtual humanoid robot that is meant to motivate and encourage children in their rehabilitation programs. The efficiency of the developed system was tested on two children with CP. The effect of using the robot is an increase in the number of exercise repetitions, as well as the time spent on therapy, developing and strengthening the child's musculature. Additionally, the children are able to produce socially acceptable gestures in the context of non-verbal communication for socialization. The main advantages of this system are its flexibility and ease of use. Besides the proposed use in CP rehabilitation, this system can be used in the rehabilitation of people recovering from surgery or injuries. Use of the proposed system significantly decreases the work load of the therapist who would be conducting the repetitive motion, allowing the therapist to see an increased number of patients. In the future, the number of different movements the robot is able to perform will be increased by way of domain-specific modelling and language.

Selective dorsal rhizotomy outcomes in mixed spasticity and dystonia cases

INTRODUCTION

This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.

METHOD

A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.

RESULTS

Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.

CONCLUSION

SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.

Association between hand grip strength and quality of life in children with cerebral palsy: a cross-sectional study

Background

Cerebral palsy (CP) covers a wide range of causes and symptoms. It is characterized by persistent motor and postural dysfunction caused by a non-progressing pathological lesion of the immature brain. Development of fine motor skills, such as the ability to manipulate objects with smaller muscles, is crucial for a child's development. It is evident that there is a lack of hand grip strength (HGS) and quality of life (QoL) data in children with CP compared to typically developed (TD) children. Understanding the relationship between these factors might help facilitate healthcare provision and provide insight into rehabilitation programs. The aim of this study is to investigate the relationship between HGS and health-related quality of life (HRQoL) in children with CP compared to TD children.

Methods

An experimental cross-sectional study was conducted and 60 children (30 CP and 30 TD) were chosen; age, gender, height, weight, body mass index, preferred hand, number of siblings, school attendance, and housing type data were collected. HGS was measured using a standard hand dynamometer, and HRQoL was measured using the KIDSCREEN-10 item questionnaire.

Results

There was a statistically significant main effect of gender on the average HGS, F (1, 56) = 24.09, p < 0.001, and the KIDSCREEN-10 sum score, F (1, 56) = 8.66, p < 0.001, and the main effect of group on the KIDSCREEN-10 sum score, F (1, 56) = 17.64, p < 0.001. A significant correlation between HGS and the KIDSCREEN-10 sum score in the CP group (r = 0.35, p = 0.03), and the TD group (r = 0.56, p = 0.001).

Conclusion

HGS was lower in children with CP, and girls had significantly lower HGS compared to boys in both groups, CP and TD children. HRQoL was significantly lower in children with CP, with boys reporting higher HRQoL on the KIDSCREEN-10 questionnaire compared to girls. Our data showed that the higher the KIDSCREEN-10 sum score is, the stronger the HGS of children in both groups. The results of this study indicate that hand grip strength may significantly impact the QoL of children with CP. A correlation between HGS and HRQoL points to the importance of improving strength in children with CP through interventions and directed rehabilitation programs.

A Combined Comprehensive Palliative and Rehabilitative Care Plan for a Child With Cerebral Palsy

Cerebral palsy (CP) is a group of neurological disorders that affect movement, muscle tone, and motor skills. Here, we present a case of an 11-year-old female patient who presented with tightness in both lower limbs, since birth, and delayed walking, accompanied by difficulty walking due to spasticity. She was diagnosed with spastic diplegic cerebral palsy. This case highlights the combined use of palliative and rehabilitative care. Developmental milestones were delayed, and she was diagnosed with CP at an early age. A comprehensive treatment plan was implemented, including physical therapy, speech therapy, and pharmacological treatment with baclofen to reduce spasticity. Non-pharmacological treatments such as neurodevelopmental therapy, biofeedback, and orthotic support were also employed. The child's rehabilitation progress included improved mobility, speech fluency, and reduced spasticity, with notable benefits in gait. Palliative care played a critical role in addressing the emotional, psychological, and social aspects of the child's condition and providing the family support, counseling, and guidance on managing the care burden. This integrated approach emphasizes the importance of early palliative care alongside rehabilitation to optimize a child's quality of life. This case highlights how a multidisciplinary approach addressing both physical and emotional needs can lead to better overall outcomes for children with cerebral palsy, improving not just mobility but also their well-being and family support system.

Risperidone-Induced Hypothermia in a Cerebral Palsy Patient: A Case Report and Literature Review

Cerebral palsy (CP) is a debilitating disorder that can lead to life-long disability, with a high incidence in Saudi Arabia. Secondary epilepsy and cardiac complications are common in CP patients. We present a rare case of a 17-year-old female with CP, attention-deficit hyperactivity disorder (ADHD), secondary epilepsy, and a history of post-cardiac arrest, with home medications carbamazepine, risperidone, and sodium valproate. The patient presented with behavioral changes, bradycardia, hypothermia, and hypotension. The patient experienced a generalized tonic-clonic seizure, which was treated. Despite initial interventions, bradycardia and hypothermia persisted. Cardiology evaluation revealed normal cardiac function. Risperidone was temporarily replaced with clonazepam and hydrocortisone, resulting in the patient's arousal and stable vital signs. During the course of hospitalization, the patient also developed watery diarrhea, which was resolved after stopping antibiotics on the sixth day. The patient was discharged after 13 days with stable vital signs and follow-up instructions. This case highlights the complexity of managing CP patients with multiple comorbidities and the importance of a multidisciplinary approach to their care. It also underscores the urgent need for further research to improve the understanding of CP and its associated complications and develop more effective management strategies.

Artificial intelligence and machine learning approaches in cerebral palsy diagnosis, prognosis, and management: a comprehensive review

Cerebral palsy (CP) is a group of disorders that alters patients' muscle coordination, posture, and movement, resulting in a wide range of deformities. Cerebral palsy can be caused by various factors, both prenatal and postnatal, such as infections or injuries that damage different parts of the brain. As brain plasticity is more prevalent during childhood, early detection can help take the necessary course of management and treatments that would significantly benefit patients by improving their quality of life. Currently, cerebral palsy patients receive regular physiotherapies, occupational therapies, speech therapies, and medications to deal with secondary abnormalities arising due to CP. Advancements in artificial intelligence (AI) and machine learning (ML) over the years have demonstrated the potential to improve the diagnosis, prognosis, and management of CP. This review article synthesizes existing research on AI and ML techniques applied to CP. It provides a comprehensive overview of the role of AI-ML in cerebral palsy, focusing on its applications, benefits, challenges, and future prospects. Through an extensive examination of existing literature, we explore various AI-ML approaches, including but not limited to assessment, diagnosis, treatment planning, and outcome prediction for cerebral palsy. Additionally, we address the ethical considerations, technical limitations, and barriers to the widespread adoption of AI-ML for CP patient care. By synthesizing current knowledge and identifying gaps in research, this review aims to guide future endeavors in harnessing AI-ML for optimizing outcomes and transforming care delivery in cerebral palsy rehabilitation.

Transcutaneous Spinal Stimulation Combined with Locomotor Training Improves Functional Outcomes in a Child with Cerebral Palsy: A Case Study

BACKGROUND AND PURPOSE

activities-based locomotor training (AB-LT) is a restorative therapeutic approach to the treatment of movement deficits in people with non-progressive neurological conditions, including cerebral palsy (CP). Transcutaneous spinal stimulation (TSS) is an emerging tool in the rehabilitation of individuals with sensorimotor deficits caused by neurological dysfunction. This non-invasive technique delivers electrical stimulation over the spinal cord, leading to the modulation of spinal sensorimotor networks. TSS has been used in combination with AB-LT and has been shown to improve muscle activation patterns and enhance motor recovery. However, there are no published studies comparing AB-LT + TSS to AB-LT alone in children with CP. The purpose of this case study was to compare the impact of AB-LT alone versus AB-LT combined with TSS on functional movement and quality of life in a child with CP.

METHODS

A 13-year-old male with quadriplegic CP participated in this pilot study. He was classified in the Gross Motor Function Classification System (GMFCS) at Level III. He completed 20 sessions of AB-LT (5x/week), then a 2-week washout period, followed by 20 sessions of body-AB-LT + TSS. Treatment sessions consisted of 1 h of locomotor training with body weight support and manual facilitation and 30 min of overground play-based activities. TSS was applied using the RTI Xcite®, with stimulation at the T11 and L1 vertebral levels. Assessments including the Gross Motor Function Measure (GMFM), 10-m walk test (10 MWT), and Pediatric Balance Scale (PBS) were performed, while spatiotemporal gait parameters were assessed using the Zeno Walkway®. All assessments were performed at three time points: before and after AB-LT, as well as after AB-LT + TSS.

OUTCOMES

After 19/20 sessions of AB-LT alone, the participant showed modest improvements in the GMFM scores (from 86.32 to 88), 10 MWT speed (from 1.05 m/s to 1.1 m/s), and PBS scores (from 40 to 42). Following the AB-LT combined with TSS, scores improved to an even greater extent compared with AB-LT alone, with the GMFM increasing to 93.7, 10 MWT speed to 1.43 m/s, and PBS to 44. The most significant gains were observed in the GMFM and 10 MWT. Additionally, improvements were noted across all spatiotemporal gait parameters, particularly at faster walking speeds. Perhaps most notably, the child transitioned from the GMFCS level III to level II by the end of the study.

DISCUSSION

Higher frequency and intensity interventions aimed at promoting neuroplasticity to improve movement quality in children with CP are emerging as a promising alternative to traditional physical therapy approaches. This case study highlights the potential of TSS to augment neuroplasticity-driven treatment approaches, leading to improvements in neuromotor function in children with CP. These findings suggest that TSS could be a valuable addition to rehabilitation strategies, warranting further research to explore its efficacy in larger populations.

The circular RNA circNFIX regulates MEF2C expression in muscle satellite cells in spastic cerebral palsy

Cerebral palsy (CP) is a pediatric onset disorder with poorly understood molecular causes and progression, making early diagnosis difficult. Circular RNAs are regulatory RNAs that show promise as biomarkers in various diseases but the role of circular RNAs in CP is beginning to be understood. This study identified the role of circNFIX in regulating the expression of myocyte-specific enhancer factor 2C (MEF2C), an important transcription factor for sarcomere development. We found that circNFIX is downregulated in the muscle cells of individuals with CP, and its localization shifts toward the nucleus as visualized using single-molecule resolution imaging. The decreased expression of circNFIX, MEF2C, and MEF2C targets persisted throughout myoblasts to myotubes differentiation, and in the skeletal muscle tissue. Bioinformatic and experimental validation confirmed that circNFIX acts as a sponge for miR373-3p, a microRNA that represses MEF2C translation. In normal muscle, circNFIX derepresses MEF2C translation by sponging miR373-3p, allowing for normal sarcomere generation. In CP, reduced circNFIX expression results in loss of miRNA sponging, leading to lower MEF2C expression and downregulation of sarcomere genes, potentially causing shortened and dysfunctional muscle fibers. Knockdown (KD) of circNFIX reduced myogenic capacity of myoblasts to fuse and form myotubes similar to CP cells evident from the lower fusion index in CP and KD as compared to control myotubes. This is the first study reporting reduction of MEF2C in CP and single-molecule resolution imaging of circNFIX's subcellular distribution and its role in CP, suggesting circNFIX as a potential therapeutic target and biomarker for early CP diagnosis.

Epilepsy in Cerebral Palsy: Unraveling Prevalence, Risk Factors, and Subtype Associations in a Large-Scale Population Study

Background and Objective: Cerebral palsy (CP) constitutes a group of enduring movement disorders arising from non-progressive brain damage, often accompanied by epilepsy. This study aims to explore the prevalence of epilepsy in CP patients, dissecting demographic characteristics, healthcare parameters, and nuanced risk factors. Materials and Methods: The study employed the National Inpatient Sample (NIS) database (2016-2019, four years). CP patients were identified through ICD-10 codes, excluding non-CP patients and those with missing values. Baseline characteristics of CP patients, such as age, subtype distribution, and types of epilepsy, were tabulated, and disparities were assessed using the chi-squared test. Univariate and multivariate logistic regression analyses were conducted to examine predictors of epilepsy according to CP subtypes and infant-related conditions. Data were presented as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results: In this comprehensive analysis of 88,138 CP patients, 44,901 with epilepsy and 43,237 without epilepsy, disparities between those with and without epilepsy were uncovered, revealing distinct demographic patterns and healthcare characteristics. Spastic diplegic CP showed the strongest association with epilepsy (adjusted OR = 1.88, 95% CI [1.73-2.04], p < 0.0001), underscoring the significance of subtype-specific considerations. Perinatal infection emerged as a noteworthy risk factor for epilepsy development (adjusted OR = 1.61, 95% CI [1.17-2.23], p = 0.004). Conclusions: The study provides nuanced insights into the prevalence and associations of epilepsy in CP patients. Specific CP subtypes and perinatal factors play pivotal roles in epilepsy risk. These findings offer a foundation for tailored clinical management and support services, addressing the complex needs of individuals with CP and epilepsy.

Comparison of participation in out-of-school activities, activity preferences and quality of life of children with cerebral palsy and typical development

The aim of this correlational study was to compare the participation in out of school activities, activity preferences, and quality of life (QoL) of children between 8 and 12 years of age with cerebral palsy (CP) (n = 30) and typical development (n = 60) in Turkey. Outcome measures included the Children's Assessment of Participation and Enjoyment, Preferences for Activity of Children, and the Health-Related Quality of Life Questionnaire. Results suggest children with CP were at a disadvantage compared to their typically developing peers in participating in out-of-school activities, however they tended to report greater preference for these activities than their typically developing peers. Based on these findings, we recommended health professionals aim to increase the quality of life for clients with CP by including social participation as one component of rehabilitation.

Parental acceptance of dental treatment with SDF in children with CP

INTRODUCTION

This study aims to evaluate parental acceptance of dental treatment with silver diamine fluoride (SDF) in children with cerebral palsy (CP).

METHODS

The present study is a case-control study with 80 children in the age range of 6-11 years. Group I consisted of children diagnosed with CP and Group II consisted of children without any Special Health Care Needs and systemic conditions. Preoperative and postoperative behavior assessment was done using Frankl's behavior Rating Scale. 38 % SDF application was done in any one primary molar with occlusal dentinal caries. A well-designed validated structured questionnaire with 10 questions was developed to assess the parental acceptance of dental treatment with SDF. The questionnaire comprised 10 close-ended questions with subdivisions on socio-demographic details, the reason for the previous and current dental visit, and acceptance of dental treatment with SDF. The data were analyzed using SPSS (version 26, IBM, Chicago, USA). Continuous variables were expressed as mean ± standard deviation (M ± SD). Categorical variables were expressed as frequency (n) and percentage (%). The chi-square test was used for qualitative analysis. The level of significance was set at 5%.

RESULTS

The number of children showing positive behavior on Frankl's behavior Rating Scale increased from 55% to 70% after dental treatment with SDF and this difference was statistically significant in Group I (p-value < 0.001). 87.5% of parents in Group I had accepted the discoloration caused after dental treatment with SDF compared to 80% in Group II. In Group I, 95% of parents agreed strongly, while in Group II, 82.5% agreed strongly that SDF can be done on un-cooperative and special health care needs children. This difference in agreement seen between parents of Group I and Group II was found to be statistically significant (p-value = 0.02). Also, the acceptance of SDF was found to be higher in parents who were educationally more qualified in Group I. This difference in the acceptance level of SDF seen based on the educational status of parents was statistically significant (p-value < 0.001).

CONCLUSION

Parental acceptance of SDF for dental treatment was higher in Group I (children with CP) as a greater number of parents accepted dental treatment despite discoloration with the modality being noninvasive and less time-consuming. Improved behavior rating was observed among children in both groups after dental treatment with SDF.

Infant sleep spindle measures from EEG improve prediction of cerebral palsy

OBJECTIVE

Early identification of infants at risk of cerebral palsy (CP) enables interventions to optimize outcomes. Central sleep spindles reflect thalamocortical sensorimotor circuit function. We hypothesized that abnormal infant central spindle activity would predict later contralateral CP.

METHODS

We trained and validated an automated detector to measure spindle rate, duration, and percentage from central electroencephalogram (EEG) channels in high-risk infants (n = 35) and age-matched controls (n = 42). Neonatal magnetic resonance imaging (MRI) findings, infant motor exam, and CP outcomes were obtained from chart review. Using univariable and multivariable logistic regression models, we examined whether spindle activity, MRI abnormalities, and/or motor exam predicted future contralateral CP.

RESULTS

The detector had excellent performance (F1 = 0.50). Spindle rate (p = 0.005, p = 0.0004), duration (p < 0.001, p < 0.001), and percentage (p < 0.001, p < 0.001) were decreased in hemispheres corresponding to future CP compared to those without. In this cohort, PLIC abnormality (p = 0.004) and any MRI abnormality (p = 0.004) also predicted subsequent CP. After controlling for MRI findings, spindle features remained significant predictors and improved model fit (p < 0.001, all tests). Using both spindle duration and MRI findings had highest accuracy to classify hemispheres corresponding to future CP (F1 = 0.98, AUC 0.999).

CONCLUSION

Decreased central spindle activity improves the prediction of future CP in high-risk infants beyond early MRI or clinical exam alone.

SIGNIFICANCE

Decreased central spindle activity provides an early biomarker for CP.

Effects of motor and cognitive dual tasks on walking and balance in children with diparetic cerebral palsy

This study investigates the effects of motor and cognitive dual tasks on walking and balance in Children with diparetic cerebral palsy. The subjects of this study were 12 children (experimental group n = 6, control group n = 6) who were medical diagnosed with diparetic cerebral palsy. They aged 8-12 years. Experimental group was administered treatment for 30 min, 2 times a week for 8 weeks, with the experimental group performing motor and cognitive dual task, while the control group did not have such a training. Wilcoxon signed-rank test was performed to analyze changes in balance, gross motor function in the group, and the Mann-Whitney test was conducted to compare the differences between the two groups before and after intervention. In This study, the mean time for completing the Timed Up and Go Test in single and dual tasks and mean cognitive responses, there was a significant difference between the two groups (P < 0.05). Conclusion: Considering that many activities in daily life are dual tasks, these difficulties they experience in performing dual tasks show that children's daily lives are also affected. Therefore, dual task evaluations are very important for individuals to be independent in daily life.

Enhanced Infant Movement Analysis Using Transformer-Based Fusion of Diverse Video Features for Neurodevelopmental Monitoring

Neurodevelopment is a highly intricate process, and early detection of abnormalities is critical for optimizing outcomes through timely intervention. Accurate and cost-effective diagnostic methods for neurological disorders, particularly in infants, remain a significant challenge due to the heterogeneity of data and the variability in neurodevelopmental conditions. This study recruited twelve parent-infant pairs, with infants aged 3 to 12 months. Approximately 25 min of 2D video footage was captured, documenting natural play interactions between the infants and toys. We developed a novel, open-source method to classify and analyse infant movement patterns using deep learning techniques, specifically employing a transformer-based fusion model that integrates multiple video features within a unified deep neural network. This approach significantly outperforms traditional methods reliant on individual video features, achieving an accuracy of over 90%. Furthermore, a sensitivity analysis revealed that the pose estimation contributed far less to the model's output than the pre-trained transformer and convolutional neural network (CNN) components, providing key insights into the relative importance of different feature sets. By providing a more robust, accurate and low-cost analysis of movement patterns, our work aims to enhance the early detection and potential prediction of neurodevelopmental delays, whilst providing insight into the functioning of the transformer-based fusion models of diverse video features.

Arachnoid Cyst as a Late Complication of Selective Dorsal Rhizotomy: A Case Report

Background and importance  Selective dorsal rhizotomy (SDR) is a surgical technique to treat spasticity, mainly in children with spastic cerebral palsy (CP). In this report, a unique case of a late arachnoid cyst, causing radiating pain in the left leg, is presented. This is relevant to clinicians managing the long-term follow-up of patients who underwent selective dorsal rhizotomy (SDR). Clinical presentation  A 25-year-old male with bilateral spastic CP, who underwent SDR at the age of 7, presented with symptoms of progressive radiating pain in the left leg. Magnetic resonance imaging (MRI) revealed the presence of a large arachnoid cyst and a remarkable dorsal position of the cauda equina. After dissection of the cyst, the previously experienced radiating pain immediately subsided; however, the patient developed urinary retention and constipation. Cauda compression was ruled out by MRI. The constipation subsided quickly, and the patient performed self-catheterization until 1 month postoperatively for the urinary retention after which there were no signs of ongoing bladder dysfunction. Conclusion  Arachnoid cyst formation can be a late complication of SDR and can cause lumbosacral radicular syndrome in the late postoperative course in select cases.

Femoral neck-shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy

Introduction

The neck-shaft angle and head-shaft angle in children with varying levels of neurological disability were evaluated to define change over different ages.

Methods

Children aged 1-12 years with spastic cerebral palsy, spinal muscular atrophy types 1 and 2, or typical development were reviewed to evaluate the neck-shaft angle and head-shaft angle. Patients were divided into five groups: Gross Motor Function Classification System levels I and II, Gross Motor Function Classification System level III, Gross Motor Function Classification System levels IV and V, spinal muscular atrophy types 1 and 2, and typical development. A linear mixed model was utilized to evaluate neck-shaft angle and head-shaft angle.

Results

Data from 196 children (mean age 4.8 ± 4.5 years) were included. Gross Motor Function Classification System levels I and II: 22 children, 130 hip radiographs measured, neck-shaft angle 143.7 ± 7.4, and head-shaft angle 160.0 ± 7.1. Gross Motor Function Classification System level III: 8 children, 33 hips evaluated, neck-shaft angle 153.1 ± 4.3, and head-shaft angle 163.4 ± 4.2. Gross Motor Function Classification System levels IV and V: 30 children, 137 hip radiographs measured, neck-shaft angle 156.4 ± 5.6, and head-shaft angle 167.9 ± 6.8. Spinal muscular atrophy types 1 and 2: 32 children, 83 hip radiographs measured, neck-shaft angle 161.9 ± 9.7, and head-shaft angle 173.4 ± 7.4. Typical development: 104 children, 222 hip radiographs measured, neck-shaft angle 138.6 ± 7.0, and head-shaft angle 156.4 ± 5.9. There were significant statistical differences when comparing neck-shaft angle and head-shaft angle.

Conclusion

As children grow, neck-shaft angle and head-shaft angle tend to decrease in typical development and Gross Motor Function Classification System levels I and II groups. However, in low-tone (spinal muscular atrophy types 1 and 2) and high-tone groups (Gross Motor Function Classification System levels IV and V), neck-shaft angle and head-shaft angle tend to increase with age. In both low-tone and high-tone groups, coxa valga is observed. When evaluating the effect of proximal femur-guided growth, these defined normal growth patterns should be considered.

Level of Evidence

Level III Retrospective comparative study.

The Effect of Transcranial Direct Current Stimulation on M1 with and without Mirror Visual Feedback on Range of Motion and Hand Grip Strength of the Affected Upper Limb in Children with Spastic Hemiplegic Cerebral Palsy

Objectives

This study investigated the effects of transcranial direct current stimulation (tDCS) before and during the mirror visual feedback (MVF) on hand grip strength (HGS) and range of motion of the affected hand in children with spastic hemiplegia cerebral palsy (SHCP).

Materials & Methods

Twelve children with SHCP participated in this randomized, crossover, and double-blind study. They were randomly exposed to one of four intervention conditions, including 1) a-tDCS-offline, 2) s-tDCS-offline, 3) a-tDCS-online, and 4) s-tDCS-online, with a one-week interval. Participants in the online condition received either anodal or sham tDCS during MVF, while those in the offline condition received tDCS before performing MVF. The tDCS was applied over the M1 area of the affected hemisphere for 20 minutes at 1 mA intensity. The HGS and range of motion of the wrist and elbow (ROM-W and ROM-E) of the affected limb were measured before (pre) and immediately after (post) interventions in each session.

Results

The results showed that the HGS was significantly higher under a-tDCS-offline (p=0.001), s-tDCS-offline (p=0.004), and s-tDCS-online (p=0.005) compared to the a-tDCS-online. Moreover, the ROM-W was significantly higher under a-tDCS-offline (p=0.034), s-tDCS-offline (0.011), and s-tDCS-online (p=0.027) compared to the a-tDCS-online. Eventually, the ROM-E was significantly higher under a-tDCS-offline, s-tDCS-offline, and s-tDCS-online compared to the a-tDCS-online (p ˂0.001; p ˂0.001; p=0.01, respectively).

Conclusion

The results might have practical implications regarding the timing of the application of tDCS in conjunction with MVF in children with SHCP.

Narrative Review of the Theoretical-Methodological Foundations of the TREINI Program

Scientific knowledge has advanced in the implementation of safe and beneficial interventions for children and adolescents with cerebral palsy (CP). Although the importance of interdisciplinary interventions that integrate all components of the International Classification of Functioning, Disability and Health (ICF) into family-centered practices is widely recognized, this approach is not yet widely adopted. Instead, many programs remain focused on isolated domains. This study presents the theoretical and methodological foundation of TREINI, an interdisciplinary and family-centered program developed for children and youth with CP and other neurodevelopmental disorders. TREINI incorporates intervention strategies that address all ICF domains. It is grounded in the biopsychosocial model of health and utilizes principles based on the best evidence in pediatric rehabilitation, including intensive training, task-oriented training, and a naturalistic learning environment. Unlike traditional rehabilitation approaches, the care provided by the TREINI program is delivered through an intensive and interdisciplinary approach, by a team working collaboratively in a single location. In addition to including evidence-based interventions, the TREINI program features two innovative components: the "City of Tomorrow", a naturalistic learning environment, and the "TREINI Exoflex" therapeutic suit, specifically designed to address deficiencies in the body functions and structures of children with CP and other neurodevelopmental disorders. This program has been carefully designed to support the process of neurological re-education and rehabilitation for children and adolescents with neuropsychomotor developmental delays.

Physical activity and sedentary behavior among ambulatory children with cerebral palsy using accelerometer: a cross-sectional study

Background and objective

Physical activity (PA) is paramount for childhood development and growth. However, children diagnosed with Cerebral Palsy (CP) were often considered sedentary, and their physical inactivity was associated with adverse health conditions and complications. Therefore, this study aimed to objectively describe and compare the PA levels and SB levels of children with and without CP of the same age group. It also studied the factors correlating with PA, SB, and step count per day in children with CP.

Subjects and methods

A cross-sectional study using a wrist-worn accelerometer was conducted. PA and SB were measured over seven consecutive days.

Results

Eighty-five children aged 6-12 years, consisting of 41 children with CP and 44 TD children, participated in this study with a mean age of 9.18 ± 1.95 and 8.45 ± 1.78 years, respectively. According to the gross functional measures, 53.6% of children with CP were classified as first classification. A significant amount of time was spent in SB and Light PA (LPA) by children with CP compared to TD children, and no significant differences were observed in moderate PA (MPA) or step count. Gender mainly affected MPA as girls spent more time in MPA than boys. The age, height, and weight of children with CP correlate significantly with SB. As children's age, height, and weight increase, SB increases. Additionally, children with higher weights have lower step counts per day.

Conclusion

This study showed that children with CP spend more time in LPA and SB than typically developed children. Therefore, concerted efforts are needed to encourage physical activity and reduce the sedentary lifestyle, to take into account the gender and anthropometric measures of children to enhance the quality of life among children with CP, and to consider gender and anthropometric measures of the children.

Correlation between Bronchopulmonary Dysplasia and Cerebral Palsy in Children: A Comprehensive Analysis Using the National Inpatient Sample Dataset

Background: The existing literature lacks conclusive evidence regarding the relationship between bronchopulmonary dysplasia (BPD) and cerebral palsy (CP). This large epidemiological study aimed to explore the co-occurrence of BPD and CP among children. Methods: This retrospective cohort analysis utilized the National Inpatient Sample (NIS) dataset from 2016 to 2019, investigating pediatric patients with BPD and CP diagnoses. Descriptive and inferential statistics, including univariate and multivariate regression analyses, were conducted to explore the association between BPD and CP. Results: Overall, 3,951,039 patients were analyzed. Among them, 28,880 patients had CP (n = 796 with BPD and n = 28,084 without BPD). The rates of intraventricular hemorrhage grade 3 and 4, central nervous system anomalies, chromosomal disorders, retinopathy of prematurity (≥grade 3), periventricular leukomalacia, prematurity, and low birth weight were significantly higher in the CP-with-BPD arm contrasted to the CP-without-BPD arm. Univariate regression demonstrated a significant BPD-CP association (odds ratio [OR] = 7.78, 95% confidence interval [CI]: 7.24-8.37, p < 0.0001). Multivariate analysis, adjusting for various confounders, reinforced this association (OR = 5.70, 95% CI: 5.17-6.28, p < 0.0001). We observed a significant association between increasing prematurity in neonates with BPD and an elevated risk of CP. Conclusions: This nationwide study identified a strong correlation between the co-occurrence of BPD and CP, though it does not establish causality. Rigorous adjustments revealed that patients with BPD appear to have a six-fold increased likelihood of being diagnosed with CP later on, compared to those without BPD. While aligned with the existing literature, this study represents the largest sample size with recommendations for targeted preventive strategies to mitigate the burden of CP.

Comparison of the Effect of Two Therapeutic Interventions for the Treatment of Chronic Constipation in Children With Cerebral Palsy: A Randomized Clinical Trial

Objectives. Constipation is one of the most common gastrointestinal symptoms in children with neurological disorders. This study was performed to compare the therapeutic effect of polyethylene glycol (PEG) plus domperidone with PEG plus placebo in the treatment of chronic constipation in children with cerebral palsy. Methods. In this a double-blind clinical trial study was done on the children with cerebral palsy who had chronic constipation and was referred to Mohammad Kermanshahi hospital of Kermanshah city in the west of Iran. The participants were randomly divided into 2 groups with 2 therapies of PEG combined with domperidone (case group, n = 21) and PEG with placebo (control group, n = 21). The information was extracted from patients based on the checklist before and after treatment and the response to treatment in the 2 groups were determined and compared. The data were analyzed by T-test or Mann-Whitney U test to compare quantitative variables and Chi-square and Fisher's exact tests for comparing qualitative variables. Results. In both case and control groups, all Rome IV criteria for a diagnosis of chronic constipation except incontinence were significantly reduced after treatment. However, the successful response rate in the case group (PEG + domperidone) was 90.5%, while this rate was 61.9% in the control group. Conclusion. Based on the results of the present study, it seems that PEG plus domperidone had a positive effect on the treatment of children with cerebral palsy and chronic constipation.