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Karnad SD, Narayan A, Kamath N, Rao BK, Sharma M, K VK. Effect of modified scooter board therapy on trunk control and hip muscle activation in children with cerebral palsy - A pilot randomised control study. IBRO Neurosci Rep 2025; 18:705-713. [PMID: 40384852 PMCID: PMC12084500 DOI: 10.1016/j.ibneur.2025.04.009] [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] [Received: 03/07/2025] [Accepted: 04/12/2025] [Indexed: 05/20/2025] Open
Abstract
Cerebral palsy (CP), with an incidence rate of 2.95, is one of the leading causes of disability in children. The excessive tone in several muscle groups causes significant movement deficits and secondary impairments, such as hip displacement, affecting quality of life. Although age-related functional positioning treatment is effective, it does not prevent secondary deficits. Literature recommends the use of task-based training with an emphasis on the functional elongation of these spastic muscle groups. Thus, a therapy that is engaging, parent-inclusive, and addresses hip-related deficits is needed. Hence, this study aimed to develop and evaluate a therapy targeting adductor overactivity and trunk control. Modified Scooter Board Therapy (MSBT) is an intervention that uses a specially designed scooter board device, allowing children to propel themselves forward while positioned prone with hip abduction and neutral hip rotation. A convenient sample of eight children with CP were assigned to either the MSBT or conventional exercise group. The intervention lasted eight weeks, and electromyographic (EMG) recordings at rest and during volitional activity were obtained at baseline and after eight weeks. Non-parametric statistical analysis, with a significance level of p < 0.05, showed no statistically significant differences between the groups at the end of the eight weeks. However, volitional hip adductor activity significantly changed in the MSBT group, indicated by a reduction in mean motor unit potential at rest. Additionally, parents preferred MSBT for its ease of use. Thus, MSBT appears to be a clinically promising intervention to reduce adductor hypertonicity and improve active control, highlighting the importance of prone positioning with active elongation for better motor function.
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Affiliation(s)
- Shreekanth D. Karnad
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Amitesh Narayan
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Nutan Kamath
- Department of Paediatrics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Bhamini Krishna Rao
- Department of Physiotherapy, Manipal College of Health Professions,Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Monika Sharma
- Department of Paediatric Medicine, Christian Medical College, Ludhiana, India
| | - Vijaya Kumar K
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Karnad SD, Narayan A, Kamath N, Rao BK, Sharma M, K VK. A protocol to evaluate the effect of Modified Scooter Board Therapy on Trunk Control and Hip muscles Activation in children with Cerebral Palsy. MethodsX 2025; 14:103301. [PMID: 40255464 PMCID: PMC12008707 DOI: 10.1016/j.mex.2025.103301] [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] [Received: 03/17/2025] [Accepted: 04/02/2025] [Indexed: 04/22/2025] Open
Abstract
Cerebral palsy (CP) is a condition caused due to damage to a developing brain, leading to various motor, sensory and cognitive impairments. Being one of the leading cause of developmental disability among children worldwide, CP warrants a rehabilitation technique which is feasible and engaging for the child, cost effective for the family and based neurophysiological principles. Among the various impairments, the children with CP exhibit difficulty in sitting and ambulation due to abnormal tone and poor control in the muscles around the hip joint and the trunk. The previous literature supports the prone positioning and its effect in improving the girdle and trunk control, however there is lack in the studies which evaluate the type of interventions which consider the child and parent participation in intervention being delivered. Thus, the current double blinded randomized control trial aims to evaluate the effect of exercises done using Modified scooter board device in addition to conventional therapy in improving the hip muscle activation and trunk control in children with CP.•A study evaluating the effectiveness of a novel scooter board device in children with CP.•An intervention which is simple, self-engaging and cost effective to prevent most secondary complications seen in children with CP.•An intervention which is aimed at reducing the hardship experienced by parents of children with CP towards improving their functional outcome.
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Affiliation(s)
- Shreekanth D. Karnad
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India
| | - Amitesh Narayan
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India
| | - Nutan Kamath
- Department of Pediatrics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India
| | - Bhamini K. Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India
| | - Monika Sharma
- Department of Pediatric Medicine, Christian Medical College, Ludhiana, India
| | - Vijaya Kumar K
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, 576104, India
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Paget SP, Stewart K, Copeland L, Waight E, Smith N, Baker F, Lewis J, on behalf of the Australian Selective Dorsal Rhizotomy Research Group and Australian Paediatric Intrathecal Baclo-fen Research Group. Socioeconomic Disadvantage, Residential Remoteness and Access to Specialised Interventions in Cerebral Palsy: A Cross-Sectional Study. J Clin Med 2025; 14:3579. [PMID: 40429575 PMCID: PMC12112737 DOI: 10.3390/jcm14103579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 05/06/2025] [Accepted: 05/14/2025] [Indexed: 05/29/2025] Open
Abstract
Aim: Socioeconomic factors are known to influence access to health services, including for children with cerebral palsy (CP). This study aims to determine whether socioeconomic disadvantage and/or geographical remoteness influence access to specialised CP interventions: selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB). Methods: This was a cross-sectional study of children with CP from (i) the Australian SDR Research Registry and (ii) an Australian ITB audit study. Socioeconomic disadvantage was grouped (quintiles) using the Index of Relative Socioeconomic Disadvantage (IRSD). Geographical remoteness was determined using the Australian Statistical Geographical Standard. IRSD quintiles and remoteness were compared with the Australian CP Register (ACPR) (birth years 1995-2016). Results: A total of 64 children (31.3% female) had received SDR surgery and 52 children (48.1% female) had received ITB therapy. Of these, 7 (11.1%) (SDR) and 7 (13.5%) (ITB) lived in the most disadvantaged neighbourhoods (IRSD quintile 1); 41 children (65.1%) (SDR) and 42 (82.4%) (ITB) lived in major cities. In comparison, 1630 (18.8%) of children on the ACPR resided in IRSD quintile 1; 6122 (70.4%) resided in major cities. There were no statistical differences in IRSD distribution between ACPR, SDR, and ITB groups. More children in major cities received ITB therapy (p = 0.03) and more children in outer regional/remote areas had received SDR (p = 0.03). Conclusions: Access to SDR and ITB in Australia varies by geographical remoteness. Equity of access is important to monitor, and interventions should be considered to reduce inequity.
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Affiliation(s)
- Simon P. Paget
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Kids Rehab, The Children’s Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia;
| | - Kirsty Stewart
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Kids Rehab, The Children’s Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia;
| | - Lisa Copeland
- Queensland Paediatric Rehabilitation Service, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, QLD 4101, Australia;
| | - Emma Waight
- Cerebral Palsy Alliance/Research Institute, Specialty of Child & Adolescent Health, The University of Sydney, Sydney, NSW 2050, Australia;
| | - Nadine Smith
- Perth Children’s Hospital, Departments of Physiotherapy and Kids Rehab, Perth, WA 6009, Australia;
- Division of Paediatrics, Medical School, University of Western Australia, Perth, WA 6009, Australia
| | - Felicity Baker
- Women’s and Children’s Health Network, Adelaide, SA 5006, Australia;
| | - Jennifer Lewis
- Kids Rehab, The Children’s Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia;
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Mercante A, Nardocci N, Fernández-Alvarez E, Lumsden DE, Hauer J, Bernadá M, Drake R, Kreicbergs U, Palomo-Carrión R, Gemma M, Coubes P, Fasano A, Lin JP, Benini F, Pediatric Dystonia and Palliative Care Group and the European Paediatric Neurology Society (EPNS). Towards new perspectives: International consensus guidance on dystonia in pediatric palliative care. Eur J Paediatr Neurol 2025; 56:24-37. [PMID: 40267817 DOI: 10.1016/j.ejpn.2025.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 03/23/2025] [Accepted: 04/03/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Pediatric dystonias are associated with a broad spectrum of etiologies, resulting in a heterogeneous patient population in whom clinical presentation, evolution, and therapeutic needs may differ. These neurological symptoms are particularly common in children and adolescents with life-limiting and life-threatening conditions requiring pediatric palliative care (PPC). The impact on the child's quality of life is significant, as is distress for caregivers. Addressing and alleviating dystonia is key to providing good palliative care; however, there is limited evidence. A greater recognition and management of dystonia in this setting is urgently needed to provide appropriate interventions and care. OBJECTIVES To develop a standardized approach to dystonia in PPC. MATERIALS AND METHODS A two-round Delphi process explored the views of experts on the definition, assessment, monitoring, and treatment of dystonia in PPC. Professionals from different backgrounds and disciplines were invited worldwide. The final panel comprised 71 participants who completed a multi-statement online questionnaire. RESULTS Fifty-three items were endorsed, providing expert, consensus-based recommendations. CONCLUSIONS The limited clinical knowledge of childhood dystonia represents a challenge, especially in children with palliative care needs. This study is a first international consensus on dystonia in PPC and offers novel approaches to improving the dystonia-related burden and advancing clinical practice in this vulnerable population.
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Affiliation(s)
- Anna Mercante
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Nardo Nardocci
- Dipartimento di Neuroscienze Pediatriche Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milano, Italy
| | | | - Daniel E Lumsden
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; Research Department of Early Life Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julie Hauer
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Mercedes Bernadá
- Pereira Rossell Hospital Center and Asociación Española Pediatric Palliative Care Units, Montevideo, Uruguay
| | - Ross Drake
- Queensland Paediatric Palliative Care Service and Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Ulrika Kreicbergs
- The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Childhood Cancer Research Unit, Stockholm, Sweden; Department of Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rocío Palomo-Carrión
- Nursing, Physiotherapy and Occupational Therapy Department. Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | - Marco Gemma
- Neuroanesthesia and Intensive Care Unit Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Philippe Coubes
- Unité Pathologies Cérébrales Résistantes et Unité de Recherche sur ses Comportements et Mouvements Anormaux (URCMA), Département de Neurochirurgie, CHU Montpellier, France
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN. Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Jean-Pierre Lin
- Complex Motor Disorder Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; Children's Neurosciences, Department of Women and Children, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Franca Benini
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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Zhao Y, Ying D, Ouyang C, Li X, Xiong Z, Liao Z, Lu W, Zhong Y, Feng Z. Enhancing motor function in children with cerebral palsy: A Comparative study of pediatric tuina and conventional rehabilitation. J Bodyw Mov Ther 2025; 41:1-7. [PMID: 39663073 DOI: 10.1016/j.jbmt.2024.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 08/07/2024] [Accepted: 10/13/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE This study explores the impact of combining Pediatric Tuina (PT) with conventional rehabilitation on motor function in children diagnosed with cerebral palsy (CP). METHODS This controlled trial involved 115 CP-affected children aged 1 month to 13 years. They were allocated into an experimental group (n = 57) receiving PT and conventional rehabilitation, and a control group (n = 58) receiving only conventional rehabilitation for three months. The GMFM-88 scale was employed for evaluating motor function at the start and end of the treatment period. RESULTS Compared to the conventional rehabilitation group, the combination of PT and standard rehabilitation therapy showed significant improvement in motor function among children with CP after 3 months. There were no significant differences in baseline characteristics between the two groups. Children in the PT combined with the standard rehabilitation therapy group exhibited more prominent improvements in motor function (supine and rolling: experimental group 47.88 ± 5.02 vs control group 42.86 ± 10.30; sitting: experimental group 45.16 ± 18.52 vs control group 35.59 ± 18.97; total score: experimental group 147.88 ± 75.59 vs control group 118.90 ± 77.87; P = 0.045). Furthermore, there was a significant increase in scores for children after the combination therapy (pre-treatment 105.39 ± 85.76 vs post-treatment 147.88 ± 75.59; P = 0.045). CONCLUSION PT, when used in conjunction with conventional rehabilitation methods, significantly enhances motor function in children with CP. The study advocates for further extensive research to validate and understand the broader implications of PT in CP treatment.
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Affiliation(s)
- Yue Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Dexia Ying
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Chengfeng Ouyang
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Xunxin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Zhichao Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Ziqin Liao
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Wenhui Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
| | - Yingjun Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China.
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital,Jiangxi Medical College,Nanchang University,No.17 Yongwaizheng Street,Nanchang 330006,Jiangxi Province,China
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Lewis JA, Stewart K, Paget SP, Wimalasundera N, Wynter M, Zadro JR, Bonner C, McKay MJ. Development of a decision aid for Australian carers of children with cerebral palsy and their community clinicians, about selective dorsal rhizotomy surgery. Disabil Rehabil 2025:1-8. [PMID: 39935063 DOI: 10.1080/09638288.2025.2463637] [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: 09/18/2024] [Revised: 02/01/2025] [Accepted: 02/03/2025] [Indexed: 02/13/2025]
Abstract
PURPOSE Develop and user-test a patient decision aid about selective dorsal rhizotomy (SDR) surgery for carers of children with cerebral palsy (CP) and clinicians treating children with CP. METHOD This study utilised a mixed-methods design. Stage One developed the prototype. Stage Two recruited carers and clinicians to focus groups/semi-structured interviews to review the prototype. Stage Three was an iterative cycle of redrafts based on feedback from Stage Two and input from the SDR Advisory and Consumer Groups. Stage Four assessed acceptability of the SDR Decision Aid via questionnaire. RESULTS A prototype SDR decision aid was developed and reviewed by 13 clinicians and 8 carers. Five themes were identified: (1) positive and (2) constructive feedback on the presentation; and additional information considered important for future end-users regarding (3) rehabilitation, (4) lived experience, and (5) selection processes. The final version of the SDR Decision Aid was rated highly acceptable by carers and clinicians, based on length, amount of information provided, and usefulness in clinical settings. Participants indicated they would recommend the decision aid to others seeking information about SDR. CONCLUSION The SDR Decision Aid is an acceptable and valuable tool for helping parents discuss SDR as a treatment option with their clinicians.
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Affiliation(s)
- Jennifer A Lewis
- Kids Rehab, The Children's Hospital at Westmead, Sydney, Australia
| | - Kirsty Stewart
- Kids Rehab, The Children's Hospital at Westmead, Sydney, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neil Wimalasundera
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | - Joshua R Zadro
- The Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Carissa Bonner
- The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marnee J McKay
- The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Leite HR, de Sousa Junior RR, Souto DO, Medeiros E Silva JM, de Lima AFB, de Miranda Drumond C, Policiano EBC, Marques AC, de Carvalho Chagas PS, Longo E. Identificação de ingredientes de intervenções não invasivas para crianças deambuladoras com paralisia cerebral usando as minhas palavras favoritas: uma revisão de escopo. Dev Med Child Neurol 2025; 67:e16-e31. [PMID: 39208157 DOI: 10.1111/dmcn.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
ResumoObjetivoMapear os ingredientes das intervenções não invasivas fornecidas às crianças deambuladoras com Paralisia Cerebral (PC).MétodoOs artigos foram selecionados e as características dos estudos extraídas. Os ingredientes das intervenções foram descritos em termos do Sistema de Especificação de Taxonomia de Reabilitação (RTSS) e vinculados às minhas palavras favoritas. Os resultados foram interpretados e validados por meio da abordagem de Envolvimento de pacientes e do Publico em Pesquisa (EPP).ResultadosSessenta e um artigos foram incluídos, dos quais 55,5% foram classificados como ensaios clínicos randomizados. Os estudos selecionados incluíram um total de 2187 crianças (a idade média variou de 3 meses a 5,9 anos), a maioria de países desenvolvidos. Os estudos incluídos investigaram um total de 27 intervenções, que juntas apresentaram ingredientes representando todas as minhas palavras favoritas, na seguinte ordem de frequência: “Saúde” (ex., treinamento de força e resistência), “Funcionalidade” (ex., prática ativa e repetitiva de uma tarefa), “Família” (ex., terapia focada no contexto), “Diversão” (ex., inclusão de atividades amistosas para crianças), “Amigos” (ex., atividades em grupo) e “Futuro” (ex., compartilhamento de informações didáticas). Assim, os ingredientes relacionados à palavra “Futuro” foram os relatados com menos frequência.InterpretaçãoTerapeutas e famílias precisam estar cientes da correspondência mais apropriada entre as metas elencadas por meio das minhas palavras favoritas e os objetivos, ingredientes e alvos das intervenções. Finalmente, “Diversão”, “Amigos” e “Futuro” devem ser abordadas como desfechos potenciais em estudos futuros.
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Leite HR, de Sousa Junior RR, Souto DO, Medeiros E Silva JM, de Lima AFB, de Miranda Drumond C, Policiano EBC, Marques AC, de Carvalho Chagas PS, Longo E. F-words ingredients of non-invasive interventions for young ambulant children with cerebral palsy: A scoping review. Dev Med Child Neurol 2025; 67:150-164. [PMID: 39187986 DOI: 10.1111/dmcn.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/25/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024]
Abstract
AIM To map the ingredients of non-invasive interventions provided to young ambulant children with cerebral palsy. METHOD Articles were screened and each study's characteristics extracted. The intervention ingredients were described in terms of the Rehabilitation Treatment Specification System and linked to the 'F-words'. Results were interpreted and validated by a patient and public involvement group. RESULTS Sixty-one papers were included, of which 55.5% were classified as randomized controlled trial design studies. The selected studies included a total of 2187 children (mean age range 3 months to 5 years 11 months), most from high-income countries. The included studies investigated a total of 27 interventions, which together presented ingredients representing all F-words, in the following order of frequency: 'fitness' (e.g. strength and endurance training), 'functioning' (e.g. active and repetitive practice of a task), 'family' (e.g. context-focused therapy), 'fun' (e.g. inclusion of child-friendly activities), 'friends' (e.g. group activities), and 'future' (e.g. didactic information sharing). Thus, ingredients related to the F-word 'future' were the most infrequently reported. INTERPRETATION Therapists and families need to be aware of the most appropriate match between the F-word goals, ingredients, and targets. Finally, 'fun', 'friends', and 'future' should be addressed as potential outcomes in future studies.
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Affiliation(s)
- Hércules Ribeiro Leite
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Rodrigues de Sousa Junior
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deisiane Oliveira Souto
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Arthur Felipe Barroso de Lima
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolyne de Miranda Drumond
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | | | - Ariane Cristina Marques
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula Silva de Carvalho Chagas
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Egmar Longo
- Graduate Program in Decision Models and Health, Universidade Federal da Paraíba, Paraíba, Brazil
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Mohd Iqbal HA, Zanudin A, Mohd Nordin NA. Motivational influence of virtual reality in physical therapy for children with cerebral palsy: a systematic review protocol. BMJ Open 2025; 15:e075912. [PMID: 39773787 PMCID: PMC11749642 DOI: 10.1136/bmjopen-2023-075912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/01/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Emulating the vast inclusion of advanced technology in everyday practice, the medical world is no exception to its implementation, in particular, virtual reality (VR). Initially, its introduction as a therapy was accompanied by high aspirations and expectations for its growth and potential. Motivation is said to be the most associated benefit; although it is imperative to note that there exists a paucity of research that specifically quantifies its tangible impact on cerebral palsy (CP). There has yet to be a systematic review of the instruments used to precisely measure motivation and examine its association with the benefits of VR for children with cerebral palsy. METHODS AND ANALYSIS This review will evaluate comparative studies that used VR therapy as part of interventions for children with CP. Qualitative studies, single-case studies, systematic reviews, literature reviews and guideline audits will be excluded. This review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) guidelines. The methodological protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The following electronic databases will be used to access related studies published between January 2012 and December 2023: MEDLINE (via EBSCOhost), Web of Science, Scopus, PubMed and Cochrane. The Peer Review of Electronic Search Strategies checklist will be employed to develop database search strategies. ETHICS AND DISSEMINATION This review does not require ethical approval as it uses secondary data. The findings will be published in a scientific journal. We intend to contribute to the expansion of knowledge concerning the motivational implications of VR on children with CP. PROSPERO REGISTRATION NUMBER International Prospective Register of Systematic Reviews (identification number CRD42023401079).
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Affiliation(s)
- Huda Aliah Mohd Iqbal
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Asfarina Zanudin
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Cardone D, Perpetuini D, Di Nicola M, Merla A, Morone G, Ciancarelli I, Moretti A, Gimigliano F, Cichelli A, De Flaviis F, Martino Cinnera A, Paolucci T. Robot-assisted upper limb therapy for personalized rehabilitation in children with cerebral palsy: a systematic review. Front Neurol 2025; 15:1499249. [PMID: 39835154 PMCID: PMC11743387 DOI: 10.3389/fneur.2024.1499249] [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] [Received: 09/27/2024] [Accepted: 11/25/2024] [Indexed: 01/22/2025] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of permanent disorders of movement development that may cause activity limitations. In this context, robot-assisted therapy might play a key role in clinical management. This comprehensive systematic review aimed to investigate the efficacy of robotic systems in improving upper limb (UL) functions in children with CP. METHODS PubMed, EMBASE, Scopus, and PEDro were searched from inception to February 2024. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal tools battery. RESULTS Of 756 articles identified, 14 studies involving 193 children with CP with a judged to be of good methodological quality, but with a lack in the study design, were included in the final synthesis. In the included studies a wide range of devices was used, both exoskeletons and end-effectors, both wearable and non-wearable. The CP children who underwent robot-assisted therapy reported a significant overall increase in clinical assessment, specifically in UL movements and manual dexterity. The clinical improvement was often accompanied by a gain also in instrumental assessments (i.e., kinematic analysis, EMG). DISCUSSION The present review suggested that robot-assisted therapy can improve UL motor functions in children with CP. Moreover, the availability of different devices with adjustable parameters can represent an important resource in proposing patient-centered-personalized rehabilitation protocols to enhance the efficacy of rehabilitation and integration into daily life. However, the limited sample size and lack of standardized and clearly reproducible protocols impose to recommend the use of robot-assisted therapy as an integration to usual rehabilitation and not as a replacement. SYSTEMATIC REVIEW REGISTRATION https://osf.io/a78zb/.
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Affiliation(s)
- Daniela Cardone
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, Pescara, Italy
| | - David Perpetuini
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, Pescara, Italy
| | - Marta Di Nicola
- Department of Oral Medical Science and Biotechnology, Physical and Rehabilitation Medicine, BIND, CARES, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Arcangelo Merla
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, Pescara, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Napels, Italy
- Multidisciplinary Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Gimigliano
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Napels, Italy
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alice Cichelli
- Department of Oral Medical Science and Biotechnology, Physical and Rehabilitation Medicine, BIND, CARES, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Francesco De Flaviis
- Department of Oral Medical Science and Biotechnology, Physical and Rehabilitation Medicine, BIND, CARES, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Alex Martino Cinnera
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Napels, Italy
| | - Teresa Paolucci
- Department of Oral Medical Science and Biotechnology, Physical and Rehabilitation Medicine, BIND, CARES, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
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11
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Feygin MS, Larkin M, Curry D, Rosenfeld SB, Schwabe A, Gadgil N. Obturator Neurectomy for the Treatment of Adductor Spasticity: A Novel Technique and Case Series. Cureus 2024; 16:e74177. [PMID: 39712683 PMCID: PMC11663034 DOI: 10.7759/cureus.74177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
Background The management of adductor spasticity and long-term sequelae for cerebral palsy (CP) patients is complex. Hip displacement is a common consequence of CP, and obturator neurectomy (ON) is a potentially underutilized procedure to address the underlying adductor spasticity. The aim of this study is to describe the operational technique of ON and highlight the potential efficacy of ON in reducing spasticity, as well as pain, hip, and functional outcomes in these patients. Methods A total of eight patients from Texas Children's Hospital who underwent ON between 2008 and 2023 were included in this case series. Results ON led to a qualitative decrease in adductor spasticity and had high patient-reported satisfaction. The average length of stay was 1.6 days (range: 1-4 days). Hip outcomes improved in all patients, evidenced by increased hip range of motion, improved mobility/gait, and decreased migration index (MI) in one patient. Conclusions ON is an efficient procedure that has the potential to reduce adductor tone and improve hip outcomes. The operative technique described and the reported patient satisfaction support the integration of ON into the paradigm of adductor spasticity management. Further prospective studies, however, are needed to objectively measure tone and hip outcomes in these patients.
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Affiliation(s)
| | - Michael Larkin
- Neurological Surgery, Baylor College of Medicine, Houston, USA
| | - Dan Curry
- Pediatric Neurosurgery, Texas Children's Hospital, Houston, USA
| | - Scott B Rosenfeld
- Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, USA
| | - Aloysia Schwabe
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, USA
| | - Nisha Gadgil
- Neurological Surgery, Baylor College of Medicine, Houston, USA
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Nahar A, Paul S, Saikia MJ. A systematic review on machine learning approaches in cerebral palsy research. PeerJ 2024; 12:e18270. [PMID: 39434788 PMCID: PMC11493061 DOI: 10.7717/peerj.18270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/17/2024] [Indexed: 10/23/2024] Open
Abstract
Background This review aims to explore advances in the field of cerebral palsy (CP) focusing on machine learning (ML) models. The objectives of this study is to analyze the advances in the application of ML models in the field of CP and to compare the performance of different ML algorithms in terms of their effectiveness in CP identification, classifying CP into its subtypes, prediction of abnormalities in CP, and its management. These objectives guide the review in examining how ML techniques are applied to CP and their potential impact on improving outcomes in CP research and treatment. Methodology A total of 20 studies were identified on ML for CP from 2013 to 2023. Search Engines used during the review included electronic databases like PubMed for accessing biomedical and life sciences, IEEE Xplore for technical literature in computer, Google Scholar for a broad range of academic publications, Scopus and Web of Science for multidisciplinary high impact journals. Inclusion criteria included articles containing keywords such as cerebral palsy, machine learning approaches, outcome response, identification, classification, diagnosis, and treatment prediction. Studies were included if they reported the application of ML techniques for CP patients. Peer reviewed articles from 2013 to 2023 were only included for the review. We selected full-text articles, clinical trials, randomized control trial, systematic reviews, narrative reviews, and meta-analyses published in English. Exclusion criteria for the review included studies not directly related to CP. Editorials, opinion pieces, and non-peer-reviewed articles were also excluded. To ensure the validity and reliability of the findings in this review, we thoroughly examined the study designs, focusing on the appropriateness of their methodologies and sample sizes. To synthesize and present the results, data were extracted and organized into tables for easy comparison. The results were presented through a combination of text, tables, and figures, with key findings emphasized in summary tables and relevant graphs. Results Random forest (RF) is mainly used for classifying movements and deformities due to CP. Support vector machine (SVM), decision tree (DT), RF, and K-nearest neighbors (KNN) show 100% accuracy in exercise evaluation. RF and DT show 94% accuracy in the classification of gait patterns, multilayer perceptron (MLP) shows 84% accuracy in the classification of CP children, Bayesian causal forests (BCF) have 74% accuracy in predicting the average treatment effect on various orthopedic and neurological conditions. Neural networks are 94.17% accurate in diagnosing CP using eye images. However, the studies varied significantly in their design, sample size, and quality of data, which limits the generalizability of the findings. Conclusion Clinical data are primarily used in ML models in the CP field, accounting for almost 47%. With the rise in popularity of machine learning techniques, there has been a rise in interest in developing automated and data-driven approaches to explore the use of ML in CP.
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Affiliation(s)
- Anjuman Nahar
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Manob Jyoti Saikia
- Electrical and Computer Engineering Department, University of Memphis, Memphis, TN, United States
- Biomedical Sensors & Systems Lab, University of Memphis, Memphis, TN, United States
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13
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Lewis JA, Paget SP, Wimalasundera N, Wynter M, Campbell L, Lee OS, Stewart K, Shah R, McKay MJ. Informing knowledge translation for selective dorsal rhizotomy: A survey of Australian clinicians and people with lived experience of cerebral palsy. J Paediatr Child Health 2024; 60:443-448. [PMID: 38973618 DOI: 10.1111/jpc.16605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 07/09/2024]
Abstract
AIM Selective dorsal rhizotomy (SDR) is a neurosurgical intervention used to reduce spasticity in children with cerebral palsy (CP). There is minimal relevant, evidence-based information available for Australian families and clinicians. This study aims to investigate the knowledge of people with lived experience and clinicians regarding SDR, including how they currently access information and what information they seek. METHODS Adults with CP, carers of children with CP and clinicians treating children with CP were invited to complete an online survey. Data regarding participant demographics, current knowledge and confidence in knowledge about CP and SDR, information source/s used and participants level of trust in these sources are presented as counts and percentages. Comparisons in knowledge between groups were analysed. RESULTS A total of 114 surveys were completed: 63 clinicians, 48 carers, and 3 adults with CP. Eighty percent of clinicians were allied health professionals. People with lived experience were less confident in their knowledge about SDR compared to knowledge of CP (P < 0.001). Clinicians rated scientific research literature and the hospital team as the most useful and trustworthy information source. People with lived experience used a wider range of information sources including the internet, rating their community therapy team and other people with lived experience as the most useful. CONCLUSION This study identified a lack of confidence in knowledge of SDR for people with lived experience, likely due to a gap in accessible and readable evidence-based information. While both groups differed in how they access information, there was agreement that greater information about SDR is needed.
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Affiliation(s)
- Jennifer A Lewis
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Neil Wimalasundera
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Honorary Fellow, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lani Campbell
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia S Lee
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Honorary Fellow, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kirsty Stewart
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - R Shah
- Selective Dorsal Rhizotomy Knowledge Translation Research Group, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Marnee J McKay
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Pereira SDC, Manhães-de-Castro R, Souza VDS, Calado CMSDS, Souza de Silveira B, Barbosa LNF, Torner L, Guzmán-Quevedo O, Toscano AE. Neonatal resveratrol treatment in cerebral palsy model recovers neurodevelopment impairments by restoring the skeletal muscle morphology and decreases microglial activation in the cerebellum. Exp Neurol 2024; 378:114835. [PMID: 38789024 DOI: 10.1016/j.expneurol.2024.114835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Cerebral Palsy (CP) is the main motor disorder in childhood resulting from damage to the developing brain. Treatment perspectives are required to reverse the primary damage caused by the early insult and consequently to recover motor skills. Resveratrol has been shown to act as neuroprotection with benefits to skeletal muscle. This study aimed to investigate the effects of neonatal resveratrol treatment on neurodevelopment, skeletal muscle morphology, and cerebellar damage in CP model. Wistar rat pups were allocated to four experimental groups (n = 15/group) according CP model and treatment: Control+Saline (CS), Control+Resveratrol (CR), CP + Saline (CPS), and CP + Resveratrol (CPR). CP model associated anoxia and sensorimotor restriction. CP group showed delay in the disappearance of the palmar grasp reflex (p < 0.0001) and delay in the appearance of reflexes of negative geotaxis (p = 0.01), and free-fall righting (p < 0.0001), reduced locomotor activity and motor coordination (p < 0.05) than CS group. These motor skills impairments were associated with a reduction in muscle weight (p < 0.001) and area and perimeter of soleus end extensor digitorum longus muscle fibers (p < 0.0001), changes in muscle fibers typing pattern (p < 0.05), and the cerebellum showed signs of neuroinflammation due to elevated density and percentage of activated microglia in the CPS group compared to CS group (p < 0.05). CP animals treated with resveratrol showed anticipation of the appearance of negative geotaxis and free-fall righting reflexes (p < 0.01), increased locomotor activity (p < 0.05), recovery muscle fiber types pattern (p < 0.05), and reversal of the increase in density and the percentage of activated microglia in the cerebellum (p < 0.01). Thus, we conclude that neonatal treatment with resveratrol can contribute to the recovery of the delay neurodevelopment resulting from experimental CP due to its action in restoring the skeletal muscle morphology and reducing neuroinflammation from cerebellum.
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Affiliation(s)
- Sabrina da Conceição Pereira
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil
| | - Raul Manhães-de-Castro
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil; Graduate Program in Nutrition, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil
| | - Vanessa da Silva Souza
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil
| | - Caio Matheus Santos da Silva Calado
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil
| | - Beatriz Souza de Silveira
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil
| | - Letícia Nicoly Ferreira Barbosa
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil
| | - Luz Torner
- Centro de Investigación Biomédica de Michoacán, Instituto Mexicano del Seguro Social, 58330, Morelia, Michoacán, Mexico
| | - Omar Guzmán-Quevedo
- Centro Laboratory of Experimental Neuronutrition and Food Engineering, Tecnológico Nacional de México (TECNM), Instituto Tecnológico Superior de Tacámbaro, 61651, Tacámbaro, Michoacán, Mexico
| | - Ana Elisa Toscano
- Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-901, Brazil; Graduate Program in Nutrition, Center for Health Sciences, Federal University of Pernambuco, Recife, Pernambuco, 50670-420, Brazil; Nursing Unit, Vitória Academic Center, Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, 55608-680, Brazil.
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Nahar A, Jain S, Paul S. Advances in Cerebral Palsy Treatment. RECENT PATENTS ON ENGINEERING 2024; 18. [DOI: 10.2174/1872212118666230822124440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 01/05/2025]
Abstract
Background:Cerebral palsy is a complex neurodevelopmental disorder with various etiological factors and treatment options. This narrative review aimed to summarize the causes of cerebral palsy, identify areas needing additional research in treatment approaches, and highlight areas requiring further investigation. In order to provide a thorough overview of management techniques to lessen the effects of the illness and its consequences, this review has drawn data from a number of studies.Introduction:Prematurity increases the risk of brain damage during the developing stage and accounts for a sizable fraction of cerebral palsy cases. In a sizable portion of cases, maternal diabetes and hypertension are listed as the main causes. Damage to the brain tissue results from hypoxic-ischemic injuries sustained during pregnancy that upset the equilibrium of oxidants and antioxidants. To alter the oxidative stress pathway and ease related issues, pharmacological treatments, such as therapeutic hypothermia, free radical inhibition therapy, and mitochondrial therapy, have been proposed. Therapeutic strategies, such as physiotherapy, occupational therapy, speech therapy, and surgical interventions, have added quality to the lives of the children. Some of the most recent developments in this area include the development of biomarkers for muscle activity detection, machine learning to predict the types of cerebral palsy and abnormal movements, disease prediction with eye images, wireless inertia measuring unit for spasticity detection, computerbased video analysis of typical and atypical infants, identification of intellectual disabilities with algorithms, and deep learning methods for predicting cerebral palsy.Methods:This narrative review is based on a careful analysis of numerous researches conducted on cerebral palsy, which have served as the basis for statistical distribution. It reviews the causes of cerebral palsy, available treatments, and ongoing research with the goal of providing physicians and researchers in the field with useful information. The objectives, study questions, inclusion criteria, and search approach have all been outlined in a thorough protocol. To find pertinent research published up to September 2021, a literature search was carried out using electronic databases, including Google Scholar, PubMed, Cochrane Library, Scopus, and Web of Science. A combination of pertinent keywords, such as "cerebral palsy," "management," "technology," "wearable technology," "prematurity," and "artificial intelligence," has been used in the search approach.Results:Recent advances in the field include the discovery of biomarkers for the detection of muscle activity, machine learning algorithms to predict the types of cerebral palsy and abnormal movements, disease prediction using eye images, wireless inertia measuring units for the detection of spasticity, computer-based video analysis for the detection of atypical infants, and algorithms to identify intellectual disabilities. Additionally, employing technologies, like virtual reality systems, electrical stimulators, activity trackers, machine learning, and deep learning approaches, has shown promise in evaluating, diagnosing, and predicting treatment outcomes linked to gait, upper limb, and lower limb function.Conclusion:Future research should examine the clinical application of nanomedicine, stem cell therapy, and cutting-edge therapeutic strategies to prevent hypoxic-ischemic damage in the developing brain. Additionally, research is required to effectively assist children with severe speech difficulties using alternate communication modalities and cutting-edge computational tools. The outcomes for people with cerebral palsy can be improved by combining interdisciplinary efforts with cutting-edge technological interventions.
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Affiliation(s)
- Anjuman Nahar
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
| | - Shruti Jain
- Department of ECE, Jaypee University of Information Technology, Solan, Himachal Pradesh, India
| | - Sudip Paul
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, India
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Mickiewicz-Góra D, Sznurkowska K, Skonieczna-Żydecka K, Drozd A, Borkowska A, Zagierski M, Troch J, Szlagatys-Sidorkiewicz A. Markers of Intestinal Permeability and Inflammation in Enterally Fed Children with Cerebral Palsy. Nutrients 2024; 16:2447. [PMID: 39125328 PMCID: PMC11314602 DOI: 10.3390/nu16152447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/16/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Cerebral palsy (CP) results in non-progressive damage to the central nervous system, leading to functional disorders of the gastrointestinal tract and requiring enteral nutrition via gastrostomy in some patients. The aim of the study was to assess the impact of enteral nutrition on intestinal inflammation expressed by stool calprotectin and intestinal permeability determined by fecal zonulin and IFABP, and to determine whether CP affects these parameters. The study group consisted of 30 children with CP, fed enterally (Cerebral Palsy Enteral Nutrition-CPEN), and two reference groups: 24 children with CP, fed orally with a standard diet (CPC-Cerebral Palsy Controls) and 24 healthy children (HC-healthy controls). The differences between these groups and between the combined CP groups (CPG and CPEN + CPC) and HC were analyzed. Fecal zonulin, calprotectin, and intestinal fatty acid-binding protein 2 (IFABP2) levels were determined by ELISA. The concentrations of fecal calprotectin and zonulin were significantly higher in the CPEN group than in the CPC group (p = 0.012, p = 0.025). When comparing the CPG (n = 53) with the HC group (n = 24), statistically significant differences were observed for calprotectin (p = 0.000018, higher in the CPG) and IFABP (p = 0.021, higher in HC). Enteral nutrition was associated in our cohort with increased fecal calprotectin and zonulin. Children with cerebral palsy presented with increased fecal calprotectin but not increased intestinal permeability expressed by stool zonulin.
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Affiliation(s)
- Dorota Mickiewicz-Góra
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Katarzyna Sznurkowska
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | | | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland;
| | - Anna Borkowska
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Maciej Zagierski
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Joanna Troch
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (A.B.); (M.Z.); (J.T.); (A.S.-S.)
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Wang X, Hu W. MRCT and CT in the diagnosis of pediatric disease imaging: assessing imaging performance and clinical effects. BMC Med Imaging 2024; 24:96. [PMID: 38664762 PMCID: PMC11046952 DOI: 10.1186/s12880-024-01273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study focused on analyzing the clinical value and effect of magnetic resonance imaging plus computed tomography (MRCT) and CT in the clinical diagnosis of cerebral palsy in children. METHODS From February 2021 to April 2023, 94 children diagnosed with cerebral palsy were selected from our hospital for study subjects. These patients were divided into CT and MRI groups, with CT examination given to the CT group and MRI examination given to the MRI group. The positive rate of the two examination methods in the diagnosis of cerebral palsy was compared, different imaging signs in two groups of children with cerebral palsy were compared, and the diagnostic test typing results between two groups were further analyzed. RESULTS The diagnostic positivity rate of the children in the MRI group was 91.49%, which was significantly higher than that of the children in the CT group (70.21%) (P < 0.05). In both groups, encephalomalacia, bilateral frontal subdural effusions, and gray-white matter atrophy of the brain were the main signs, and the difference in the proportion of these three imaging signs between the two groups was not significant (P > 0.05). Differences between the two groups examined for cerebral palsy subtypes were not significant (P > 0.05). CONCLUSION The positive rate of pediatric cerebral palsy examined by MRI is higher than that of CT diagnosis, but the clinic should organically combine the two to further improve the detection validity and accuracy.
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Affiliation(s)
- Xiaofei Wang
- Department of Radiology, Xi'an Children's Hospital, No. 69, Xijuyuan Lane, Lianhu District, 710003, Xi'an, Shaanxi Province, China
| | - Wen Hu
- Department of Radiology, Xi'an Children's Hospital, No. 69, Xijuyuan Lane, Lianhu District, 710003, Xi'an, Shaanxi Province, China.
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Mickiewicz-Góra D, Sznurkowska K, Drozd A, Borkowska A, Zagierski M, Troch J, Skonieczna-Żydecka K, Szlagatys-Sidorkiewicz A. No Impact of Enteral Nutrition on Fecal Short-Chain Fatty Acids in Children with Cerebral Palsy. Biomedicines 2024; 12:897. [PMID: 38672250 PMCID: PMC11048600 DOI: 10.3390/biomedicines12040897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Bacteria can impact the host organism through their metabolites, with short-chain fatty acids (SCFAs) being the most important, including acetate (C2), propionate (C3), butyrate (C4), valerate (C5n), and isovalerate (C5i). This study aimed to identify the impact of enteral nutrition on SCFAs in children with cerebral palsy and to test the hypothesis that the type of nutrition in cerebral palsy affects gut SCFA levels. Cerebral palsy is a heterogeneous syndrome resulting from non-progressive damage to the central nervous system. The study group included 30 children diagnosed with cerebral palsy, receiving enteral nutrition (Cerebral Palsy Enteral Nutrition (CPEN)) via gastrostomy. The first reference group (Cerebral Palsy Controls (CPCs)) consisted of 24 children diagnosed with cerebral palsy and fed orally on a regular diet. The second reference group (Healthy Controls (HCs)) consisted of 24 healthy children with no chronic disease and fed on a regular diet. Isolation and measurement of SCFAs were conducted using gas chromatography. Differences were observed in the median contents of isobutyric acid, valeric acid, and isovaleric acid between the CPC group, which had significantly higher levels of those acids than the HC group. No differences were found between the CPEN and CPC groups nor between the CPEN and HC groups. We conclude that enteral nutrition in cerebral palsy has no influence on the levels of SCFAs.
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Affiliation(s)
- Dorota Mickiewicz-Góra
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Katarzyna Sznurkowska
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Arleta Drozd
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland
| | - Anna Borkowska
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Maciej Zagierski
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | - Joanna Troch
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
| | | | - Agnieszka Szlagatys-Sidorkiewicz
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdansk, 80-803 Gdansk, Poland; (K.S.); (A.B.); (M.Z.); (J.T.); (A.S.-S.)
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19
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Hu Y, Zheng Y, Yang Y, Fang W, Huang M, Li D, Xu Z, Xu F, Wang J. A bibliometric analysis of cerebral palsy from 2003 to 2022. Front Neurol 2024; 15:1292587. [PMID: 38628701 PMCID: PMC11018907 DOI: 10.3389/fneur.2024.1292587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose This bibliometric study explores cerebral palsy (CP) research from 2003 to 2022 to reveal the topic hotspots and collaborations. Methods We retrieved studies on CP from the Web of Science Core Collection from 2003 to 2022 and then used CiteSpace and Bibliometrix to perform a bibliometric analysis and attain knowledge mapping, including publication outputs, funding, journals, authors, institutions, countries/territories, keywords, collaborative relationships, and topic hotspots. Results In total, 8,223 articles were published from 2003 to 2022. During this period, the number of publications increased continuously. Developmental Medicine and Child Neurology was the most productive and frequently co-cited journal. Boyd was the most productive and influential author, with 143 publications and 4,011 citations. The United States and Vrije Universiteit Amsterdam were the most productive countries and institutions, respectively. Researchers and institutions from the USA, Australia, and Canada constituted the core research forces, with extensive collaborations worldwide. The most common keywords were gait (553), rehabilitation (440), spasticity (325), botulinum toxin (174), therapy (148), upper extremity (141), quality of life (140), disability (115), pain (98), electromyography (97), kinematics (90), balance (88), participation (85), and walking (79). Conclusion This study provides a systematic and comprehensive analysis of the CP-related literature. It reveals that Developmental Medicine and Child Neurology is the most active journal in this field. The USA, Vrije Universiteit Amsterdam, and Boyd are the top countries, institutions, and authors, respectively. Emerging treatment methods, complication management, and functional recovery comprise the future research directions and potential topic hotspots for CP.
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Affiliation(s)
- Yue Hu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Yang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Wenfeng Fang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Maomao Huang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dan Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhangyu Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fangyuan Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jianxiong Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China
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Zhou Y, He LN, Wang LN, Chen KY, Qian SD, Li XH, Zang J, Wang DM, Yu XF, Gao J. Human amniotic mesenchymal stromal cell-derived exosomes promote neuronal function by inhibiting excessive apoptosis in a hypoxia/ischemia-induced cerebral palsy model: A preclinical study. Biomed Pharmacother 2024; 173:116321. [PMID: 38394849 DOI: 10.1016/j.biopha.2024.116321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a condition resulting from perinatal brain injury and can lead to physical disabilities. Exosomes derived from human amniotic mesenchymal stromal cells (hAMSC-Exos) hold promise as potential therapeutic options. OBJECTIVE This study aimed to investigate the impact of hAMSC-Exos on neuronal cells and their role in regulating apoptosis both in vitro and in vivo. METHODS hAMSC-Exos were isolated via ultracentrifugation and characterized via transmission electron microscopy, particle size analysis, and flow cytometry. In vitro, neuronal damage was induced by lipopolysaccharide (LPS). CP rat models were established via left common carotid artery ligation. Apoptosis levels in cells and CP rats were assessed using flow cytometry, quantitative reverse transcription polymerase chain reaction (RT-qPCR), Western blotting, and TUNEL analysis. RESULTS The results demonstrated successful isolation of hAMSC-Exos via ultracentrifugation, as the isolated cells were positive for CD9 (79.7%) and CD63 (80.2%). Treatment with hAMSC-Exos significantly mitigated the reduction in cell viability induced by LPS. Flow cytometry revealed that LPS-induced damage promoted apoptosis, but this effect was attenuated by treatment with hAMSC-Exos. Additionally, the expression of caspase-3 and caspase-9 and the Bcl-2/Bax ratio indicated that excessive apoptosis could be attenuated by treatment with hAMSC-Exos. Furthermore, tail vein injection of hAMSC-Exos improved the neurobehavioral function of CP rats. Histological analysis via HE and TUNEL staining showed that apoptosis-related damage was attenuated following hAMSC-Exo treatment. CONCLUSIONS In conclusion, hAMSC-Exos effectively promote neuronal cell survival by regulating apoptosis, indicating their potential as a promising therapeutic option for CP that merits further investigation.
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Affiliation(s)
- Yu Zhou
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China
| | - Lu-Na He
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China
| | - Li-Na Wang
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China
| | - Kai-Yun Chen
- Drug Clinical Trials Office, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330003, China
| | - Shi-Da Qian
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330003, China
| | - Xu-Huan Li
- Department of General Medicine, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330003, China
| | - Jing Zang
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China
| | - Dong-Ming Wang
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China
| | - Xue-Feng Yu
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330003, China.
| | - Jing Gao
- Department of Pediatric Rehabilitation, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China; Affiliated Hospital of Yang Zhou University Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu 223021, China.
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21
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Dar H, Stewart K, McIntyre S, Paget S. Multiple motor disorders in cerebral palsy. Dev Med Child Neurol 2024; 66:317-325. [PMID: 37579020 DOI: 10.1111/dmcn.15730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 08/16/2023]
Abstract
AIM To characterize motor disorders in children and young people with cerebral palsy (CP). METHOD This was a cross-sectional study of 582 children and young people with CP (mean age 9 years 7 months; range 11 months-19 years 9 months; standard deviation 4 years 11 months; 340 males) attending a rehabilitation clinic at a specialized children's hospital (May 2018-March 2020). Data on motor disorders, topography, functional classifications, and non-motor features, such as epilepsy, intellectual disability, and sensory impairments, were collected using the Australian Cerebral Palsy Register CP Description Form. RESULTS Fifty-five per cent (n = 321) of children and young people with CP presented with multiple motor disorders, often affecting the same limb(s). The most common motor disorders were spasticity and dystonia (50%), spasticity only (36%), and dystonia only (6%), but 18 different combinations were identified, including choreoathetosis, ataxia, and generalized hypotonia with increased reflexes. Children with spasticity only had less severe functional deficits (p < 0.001) and lower rates of associated intellectual disability (p < 0.01) and epilepsy (p < 0.001) than those with both spasticity and dystonia. INTERPRETATION Multiple motor disorders in children and young people with CP are common and associated with more severe functional impairment. Accurate assessment of motor disorders is essential to guide prognosis and ensure personalized evidence-based interventions. WHAT THIS PAPER ADDS More than half of children and young people with cerebral palsy presented with multiple motor disorders. Dystonia was identified in 60% of study participants. Dystonia was associated with more severe functional impairments and rates of non-motor features.
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Affiliation(s)
- Hayim Dar
- Sydney University Medical School, The University of Sydney, Sydney, Australia
| | - Kirsty Stewart
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Children's Hospital Westmead, Sydney, Australia
| | - Sarah McIntyre
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Children's Hospital Westmead, Sydney, Australia
- Specialty of Child and Adolescent Health, Cerebral Palsy Alliance, Sydney, Australia
| | - Simon Paget
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Children's Hospital Westmead, Sydney, Australia
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22
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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23
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Tezol Ö, Yalçin SS, Yirün A, Balci Özyurt A, Okuyaz Ç, Erkekoğlu P. Plasma bisphenol a and phthalate levels in children with cerebral palsy: a case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:499-513. [PMID: 36519276 DOI: 10.1080/09603123.2022.2153811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
The case-control study aimed to evaluate potential sources of exposure and the plasma concentrations of bisphenol A (BPA) and phthalates in prepubertal children having cerebral palsy (CP) and healthy control. Blood samples of 68 CP and 70 controls were analyzed for BPA, di-(2-ethylhexyl)-phthalate (DEHP), mono-(2-ethylhexyl)-phthalate (MEHP), and dibutyl phthalate (DBP). BPA and DBP levels were similar in groups. The median DEHP and MEHP levels of the children with CP were significantly lower than those of the controls (p = 0.035, p < 0.001, respectively). Exposure to plastic food containers/bags, personal care hygiene products, household cleaners, wood/coal stove heating, and city water supplies were associated with increased odds of higher BPA and phthalate levels in children with CP. In conclusion, potential exposure sources for BPA and phthalates differ in children with CP and healthy controls, and children with CP are not exposed to higher levels of BPA and phthalates.
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Affiliation(s)
- Özlem Tezol
- Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sıddıka Songül Yalçin
- Department of Social Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anıl Yirün
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Çukurova University, Ankara, Turkey
| | - Aylin Balci Özyurt
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Bahçeşehir University, İstanbul, Turkey
| | - Çetin Okuyaz
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Pınar Erkekoğlu
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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Sadur A, Martinez C, Dance S, Travers R, Gonzalez A, Tabaie SA. From Hip Screening to Hip Surveillance: Transforming Care for Patients With Cerebral Palsy: An Analysis of a Single Institution. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00009. [PMID: 38063442 PMCID: PMC10697633 DOI: 10.5435/jaaosglobal-d-23-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Surveillance programs aimed at monitoring hip displacement in patients with cerebral palsy have been demonstrated to decrease the incidence of hip dislocations and properly time surgical intervention, ultimately improving patient outcomes. The objective of this study was to determine whether the implementation of a hip screening to surveillance program at a tertiary academic teaching hospital in 2017 increased the frequency of radiographic evaluations and changed the timing of surgical intervention. METHODS A total of 592 patients with cerebral palsy were identified, and 468 of these patients had initial radiograph date data available. In this analysis, 246 patients with initial radiograph dates after 2012 were included. The study population was divided into two groups based on the initial radiograph date, 2012 to 2016 versus 2017 to 2022. One hundred sixty patients (65%) were in the 2012 to 2016 group, and 86 (35%) were in the 2017 to 2022 group. Statistical analysis was conducted using various techniques, such as two-sample Student t-test, Mann-Whitney U test, chi square/Fisher exact test, and multivariable linear regression analysis. RESULTS The average number of radiographs per year in the 2017 to 2022 group was 0.11 (95% CI: 0.02, 0.20, P = 0.017) higher than the 2012 to 2016 group. After adjusting for confounders using multivariable linear regression analysis, this difference was even larger (difference 0.16, 95% CI: 0.06, 0.25, P = 0.001). The surgical intervention rate was significantly lower in the 2017 to 2022 group compared with the 2012 to 2016 group (12.9% versus 40.6%, P < 0.001). DISCUSSION The results of this study suggest that the implementation of a hip screening to surveillance program results in more frequent radiographic evaluations and possibly a reduced need for surgical intervention from 2017 to 2022. In the 2012 to 2016 group, more surgical interventions were performed likely because of the lack of any hip surveillance or screening program in place.
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Affiliation(s)
- Alana Sadur
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Curt Martinez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sarah Dance
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ryan Travers
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Ariana Gonzalez
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
| | - Sean A. Tabaie
- From the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Ms. Sadur and Mr. Martinez), and the Department of Orthopaedic Surgery, Children's National Hospital, Washington, DC (Ms. Dance, Ms. Travers, Ms. Gonzalez, and Dr. Tabaie)
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Kittelson T, Coombs NC. Therapeutic positioning to address neuromuscular scoliosis on an adolescent child with Aicardi syndrome: a case study. Assist Technol 2023; 35:506-512. [PMID: 36862581 DOI: 10.1080/10400435.2023.2179684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
Among persons with neuromuscular mobility limitations, therapeutic positioning has been implemented to improve body function, avoid secondary complications such as contractures and body shape distortions, and optimize body energy through restorative sleep. This case study describes the application of a 24-hour posture care management intervention for a preadolescent girl with Aicardi syndrome. The intervention was administered by adding therapeutic bed positioning to use of a custom molded wheelchair seating system. Over the 6-year intervention period overlapping with the subject's adolescent years (age 11-17), marked improvement was observed in thoracic shape and symmetry. Moreover, the subject's mother reported regular full-nights of uninterrupted sleep, relaxed muscle tone upon waking, a stronger cough with less audible congestion, more efficient swallowing and zero hospitalizations. The 24-hour posture care management intervention offers an alternative option for families and caregivers of persons with neuromuscular mobility impairments who wish to use a low-risk, noninvasive, locally available approach to improve body symmetry, increase hours of restorative sleep, and ease caregiving routines. Further research in 24-hour posture care management, including positioning for sleep and rest, should be explored in individuals with complex movement limiting disabilities who are at risk of developing neuromuscular scoliosis.
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Affiliation(s)
| | - Nicholas C Coombs
- School of Public & Community Health Sciences, University of Montana, Missoula, Montana, USA
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26
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Basoya S, Kumar S, Wanjari A. Cerebral Palsy: A Narrative Review on Childhood Disorder. Cureus 2023; 15:e49050. [PMID: 38116360 PMCID: PMC10728574 DOI: 10.7759/cureus.49050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
Cerebral palsy, one of the most common reasons for infirmity in children and young people in developed countries, refers to several neurological diseases that impact movement and coordination. Central nervous system damage received during the first stages of brain development can cause cerebral palsy, a non-progressive condition that manifests as impairments of movement and posture. Two cases per 1000 are reported, and the causes include those mentioned for high-risk infants. Mental retardation, sensory deficiencies, failure to thrive, seizures, and behavioral or emotional issues are some of the associated difficulties. To enable interdisciplinary intervention, early identification is crucial. The result varies depending on the topography, severity, and presence of concomitant abnormalities in cerebral palsy. Cerebral palsy is caused by a static injury to the cerebral motor cortex that happens before, during, or within five years after birth. Various circumstances can influence the disease, including cerebral anoxia, cerebral hemorrhage, infection, and hereditary disorders. Interventions for children are typically provided as part of multidisciplinary rehabilitation programs. Musculoskeletal complaints are common, and pain is a significant underreported symptom.
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Affiliation(s)
- Sakshi Basoya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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27
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Expósito D, Morales-Suarez MM, Soriano JM, Soler C. Tools for Nutrition Assessment of Adults with Cerebral Palsy: Development of a Gold Standard. Curr Nutr Rep 2023; 12:545-553. [PMID: 37486592 DOI: 10.1007/s13668-023-00485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Cerebral palsy (CP) is a group of disorders caused by non-stabilized cerebral lesions. Individuals with this disorder are at a higher risk of suffering from malnutrition and other related detrimental effects to their quality of life. For this reason, accurate methods of nutritional assessment are vital for people suffering from this condition. While assessment of nutritional status in children with CP has been extensively studied, very few studies have been carried out on adults. These limitations are due to the great anatomical-functional variability characteristic of this syndrome. Difficulties that derive from this variability in adult patients with CP mean that there remains an urgent need for certain standards of nutritional assessment for this population. The objective of this review is to compile the latest trends in nutritional assessment in adults with CP to guide the development of a conceptual framework for future research. RECENT FINDINGS With this aim, relevant studies have been identified. The most commonly used technique to evaluate nutritional status is the BMI because of its ease-of-use. However, its well-known limitations fail to adequately estimate the nutritional status in this population, with measurements of patients with CP yielding results that are much less accurate than those that already exist in the general population. Although more studies are needed, kinanthropometry is considered one of the most reliable techniques; nevertheless, the anatomical limitation characteristic of CP plays a limiting factor.
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Affiliation(s)
- D Expósito
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain.
- Department of Basic Medical Sciences, Universidad Católica de Valencia, 46001, Valencia, Spain.
- Department of Nutrition, Universidad Católica de Valencia, 46001, Valencia, Spain.
| | - M M Morales-Suarez
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100, Burjassot, Valencia, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - J M Soriano
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
| | - C Soler
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
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Sulaimani GH, Kamel S, Alotaibi G, Telmesani N. Quality of Life Among Family Caregivers of Disabled Children in Saudi Arabia. Cureus 2023; 15:e41320. [PMID: 37539394 PMCID: PMC10395756 DOI: 10.7759/cureus.41320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The physical and mental health of parents can be adversely affected by their child's disability, leading to a potential decline in their overall Quality of Life (QoL). This research aimed to determine the QoL of family caregivers and compare this based on sociodemographic factors and child characteristics. MATERIALS AND METHODS An analytical cross-sectional design was employed, and data were collected from multiple rehabilitation centers for children with special needs and learning disorders in the Kingdom of Saudi Arabia. The study sample comprised 95 family caregivers who completed a self-structured questionnaire. The questionnaire included sections on sociodemographic characteristics, child characteristics, and caregivers' QoL assessed using the RAND 36-Item Short Form Health Survey (SF-36). The collected data were analyzed using the IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp, employing descriptive statistics and multivariate linear regression analysis. RESULTS Our findings revealed that the overall mean QoL score among caregivers was 57, ranging from 12 to 94. There were no statistically significant differences in QoL scores based on caregivers' age, gender, occupational status, or income. However, further analysis indicated significant associations between certain factors and specific domains of QoL. Specifically, caregiver education was found to be associated with role limitations due to emotional problems, while relationships with disabled children were linked to emotional well-being. The severity of the child's disability and the presence of another child with a disability in the family were associated with the bodily pain domain. Additionally, the presence of another child with a disability had an impact on perceived change in the health domain. CONCLUSIONS The QoL of family caregivers varied, highlighting the significant challenges faced by certain individuals. Factors such as education level, the relationship with the child, the severity of the disability, and the presence of multiple disabled children in the family were identified as influencing caregivers' QoL. These findings emphasize the importance of developing targeted interventions that can address emotional well-being and fatigue management while promoting a supportive society.
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Affiliation(s)
- Ghofran H Sulaimani
- Preventive Medicine and Public Health Department, Ministry of Health, Riyadh, SAU
| | - Shady Kamel
- Saudi Field Epidemiology Training Program, Ministry of Health, Riyadh, SAU
| | - Ghadi Alotaibi
- Preventive Medicine and Public Health Department, Ministry of Health, Riyadh, SAU
| | - Nada Telmesani
- Neurological Service of Physical Medicine and Rehabilitation, Nantes Université, Nantes, FRA
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van Tittelboom V, Heyrman L, De Cat J, Algoet P, Peeters N, Alemdaroğlu-Gürbüz I, Plasschaert F, Van Herpe K, Molenaers G, De Bruyn N, Deschepper E, Desloovere K, Calders P, Feys H, Van den Broeck C. Intensive Therapy of the Lower Limbs and the Trunk in Children with Bilateral Spastic Cerebral Palsy: Comparing a Qualitative Functional and a Functional Approach. J Clin Med 2023; 12:4078. [PMID: 37373771 DOI: 10.3390/jcm12124078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Few studies have examined the effect of intensive therapy on gross motor function and trunk control in children with cerebral palsy (CP). This study evaluated the effects of an intensive burst of therapy on the lower limbs and trunk by comparing qualitative functional and functional approaches. This study was designed as a quasi-randomized, controlled, and evaluator-blinded trial. Thirty-six children with bilateral spastic CP (mean age = 8 y 9 mo; Gross Motor Function Classification II and III) were randomized into functional (n = 12) and qualitative functional (n = 24) groups. The main outcome measures were the Gross Motor Function Measure (GMFM), the Quality Function Measure (QFM), and the Trunk Control Measurement Scale (TCMS). The results revealed significant time-by-approach interaction effects for all QFM attributes and the GMFM's standing dimension and total score. Post hoc tests showed immediate post-intervention gains with the qualitative functional approach for all QFM attributes, the GMFM's standing and walking/running/jumping dimension and total score, and the total TCMS score. The qualitative functional approach shows promising results with improvements in movement quality and gross motor function.
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Affiliation(s)
- Vanessa van Tittelboom
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Lieve Heyrman
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Josse De Cat
- Belgian Bobath Association (ABBV), 1082 Brussels, Belgium
| | - Patrick Algoet
- Belgian Bobath Association (ABBV), 1082 Brussels, Belgium
| | - Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | | | - Frank Plasschaert
- Department of Orthopedic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Katrin Van Herpe
- Rehabilitation Centre for Children and Youth, 2242 Pulderbos, Belgium
| | - Guy Molenaers
- Pediatric Orthopedics, Department of Orthopedics, University Hospital Leuven, 3000 Leuven, Belgium
| | - Nele De Bruyn
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, 9000 Ghent, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
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Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Viganò M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol 2023; 14:1171224. [PMID: 37305763 PMCID: PMC10248244 DOI: 10.3389/fneur.2023.1171224] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Evidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic. Methods Guidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2-18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data. Results Four guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs. Conclusion A multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Ph.D. Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuela Pagliano
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Adriano Ferrari
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Maghini
- Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, Bosisio Parini, Italy
| | - Maria F. Siani
- Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, Ravenna, Italy
| | - Giada Sgherri
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gina Cappetta
- Physical Medicine and Rehabilitation Unit, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Giulia Borelli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina M. Farella
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Foscan
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Viganò
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Sghedoni
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Grodon C, Bassett P, Shannon H. The 'heROIC' trial: Does the use of a robotic rehabilitation trainer change quality of life, range of movement and function in children with cerebral palsy? Child Care Health Dev 2023. [PMID: 36788457 DOI: 10.1111/cch.13101] [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: 09/29/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Children with severe cerebral palsy (CP) (GMFCS IV/V) can find it difficult to access equipment that allows them to exercise effectively, potentially impacting their quality of life. Physiotherapists working within special schools are well placed to facilitate increased physical activity as part of the school day. This study explored whether the Innowalk Pro, a robotic rehabilitation trainer, could influence quality of life (measured by the CPCHILD questionnaire), in children with CP, alongside, joint range of movement, spasticity and functional goals of the lower limbs, measured by goniometry, modified Tardieu scale and goal attainment scoring, GAS, respectively. METHODS A prospective single-arm, pre-post trial was undertaken. The Innowalk Pro was used four times a week for 30 min alongside usual physiotherapy care in a school setting over a 6-week period. Outcomes were evaluated immediately pre/post intervention and at 6 weeks and 3 months post intervention. Analysis also explored differences between primary and secondary age participants. RESULTS Twenty-seven participants aged 5-18 years with a diagnosis of CP GMFCS IV/V (10 female, 17 male, mean age 12 years) were included from a convenience sample in a special school. Quality of life improved in 36% of participants, the majority of these being secondary aged. Knee extension reduced significantly 3 months post intervention. There were no meaningful changes in spasticity. GAS goals improved in 88% of participants after using the Innowalk Pro. GAS goals tended to decline after a break from using the equipment, with 21% declining by two or more units at 3 months post intervention. CONCLUSION A 6-week course of the Innowalk Pro can improve quality of life and functional goals for children with CP aged 5-18 years. After a break of 6-12 weeks, functional goals tend to return to baseline. Further research is needed to explore different prescriptions of the Innowalk Pro, to see if increasing the time used/increasing the frequency or number of weeks it is used for can provide longer lasting benefits.
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Affiliation(s)
| | | | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
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Paget SP, McIntyre S, Goldsmith S, Ostojic K, Shrapnel J, Schneuer F, Waugh M, Kyriagis M, Nassar N. Non-attendance at outpatient clinic appointments by children with cerebral palsy. Dev Med Child Neurol 2022; 64:1106-1113. [PMID: 35244200 PMCID: PMC9545710 DOI: 10.1111/dmcn.15197] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/12/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine factors that influence non-attendance at outpatient clinics by children with cerebral palsy (CP). METHOD This was a retrospective cohort study of 1395 children with CP (59.6% male; born 2005 to 2017) identified from the New South Wales (NSW)/Australian Capital Territory CP Register, who had scheduled appointments at outpatient clinics at two NSW tertiary paediatric hospitals between 2012 and 2019. Associations between sociodemographic, clinical, and process-of-care factors and non-attendance were examined using multivariate logistic regression with generalized estimating equations. RESULTS A total of 5773 (12%) of 50 121 scheduled outpatient days were not attended. Non-attendance increased over time (average increase 5.6% per year, 95% confidence interval [CI]: 3.7-7.3). Older children aged 5 to 9 years (adjusted odds ratio [aOR] 1.11; 95% CI: 1.02-1.22) and 10 to 14 years (aOR 1.17; 95% CI: 1.03-1.34), socioeconomic disadvantage (aOR 1.29; 95% CI: 1.11-1.50), previous non-attendance (aOR 1.38; 95% CI: 1.23-1.53), and recent rescheduled or cancelled appointments (aOR 1.08; 95% CI: 1.01-1.16) were associated with increased likelihood of non-attendance. INTERPRETATION One in eight outpatient appointments for children with CP were not attended. Non-attendance was associated with increasing age, socioeconomic disadvantage, previous non-attendance, and recent rescheduled or cancelled appointments. Identifying specific barriers and interventions to improve access to outpatient services for these groups is needed. WHAT THIS PAPER ADDS Twelve per cent of scheduled appointments for children with cerebral palsy are not attended. Proportions of appointments not attended has increased over the last decade. Increasing age and socioeconomic disadvantage increase the likelihood of non-attendance. Previous non-attendance and recent cancelled or rescheduled appointments increase the likelihood of further non-attendance.
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Affiliation(s)
- Simon P. Paget
- Faculty of Medicine and HealthThe Children’s Hospital at Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,The Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Sarah McIntyre
- Specialty of Child & Adolescent HealthSydney Medical SchoolFaculty of Medicine & HealthCerebral Palsy Alliance Research InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Shona Goldsmith
- Specialty of Child & Adolescent HealthSydney Medical SchoolFaculty of Medicine & HealthCerebral Palsy Alliance Research InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Katarina Ostojic
- Specialty of Child & Adolescent HealthSydney Medical SchoolFaculty of Medicine & HealthCerebral Palsy Alliance Research InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Jane Shrapnel
- The Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Francisco Schneuer
- Faculty of Medicine and HealthThe Children’s Hospital at Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Mary‐Clare Waugh
- Faculty of Medicine and HealthThe Children’s Hospital at Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia,The Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Maria Kyriagis
- Sydney Children’s HospitalRandwickNew South WalesAustralia
| | - Natasha Nassar
- Faculty of Medicine and HealthThe Children’s Hospital at Westmead Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
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Cross A, Soper AK, Tomas V, Grahovac D, Brocklehurst J, Kay D, Baptiste S, Gorter JW, Rosenbaum P. Exploring 10 years of dissemination of the F-words for Child Development: A multifaceted case study. Child Care Health Dev 2022; 48:751-762. [PMID: 35128716 DOI: 10.1111/cch.12983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing interest in exploring how to move research findings into practice. Since 2014, a team of families and researchers has been working to promote and study the dissemination of the "F-words for Child Development" (Function, Family, Fitness, Fun, Friends, and Future). This case study describes our dissemination strategies and uses the Diffusion of Innovation theory to understand the factors contributing to the uptake of the F-words-a function-promoting, strengths-based, and family-centred innovation in child health and development. METHODS Between November 2011 and November 2021, we collected data from multiple sources: our dissemination strategies, including affiliated documents/artefacts (e.g., videos and presentations) and evaluation data (e.g., surveys and Google/video analytics). We used a two-step analysis: (1) a chronological time series to describe the processes involved along with indicators of dissemination over time (e.g., increase knowledge and awareness); and (2) Diffusion of Innovation theory to explore the factors that contributed to the uptake of the F-words. RESULTS Multifaceted dissemination strategies were essential to raise awareness and increase families' and service providers' knowledge of the F-words. These included three primary strategies: (i) development and distribution of educational materials; (ii) presentations at educational meetings; and (iii) educational outreach visits. Additional strategies, such as the use of mass media, collaboration with early adopters/champions, and the involvement of family members further supported dissemination efforts. Diffusion of Innovation factors (innovation characteristics, time, social systems, and communication channels) all contributed to the uptake of this innovation. CONCLUSIONS Purposeful planned dissemination practice, to increase knowledge and awareness of an innovation, is an important step in the knowledge translation process. Over a period of 10 years, through the use of multiple dissemination strategies conducted in partnership with families and service providers, the F-words have spread globally. Diffusion of Innovation theory has served to help understand how and why the F-words are being shared and adopted around the world.
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Affiliation(s)
- Andrea Cross
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alice Kelen Soper
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Tomas
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Danijela Grahovac
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Julie Brocklehurst
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Diane Kay
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Sue Baptiste
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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A Review on Recent Advances of Cerebral Palsy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2622310. [PMID: 35941906 PMCID: PMC9356840 DOI: 10.1155/2022/2622310] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022]
Abstract
This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.
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Zhang H, Shum HPH, Ho ESL. Cerebral Palsy Prediction with Frequency Attention Informed Graph Convolutional Networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1619-1625. [PMID: 36086367 DOI: 10.1109/embc48229.2022.9871230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Early diagnosis and intervention are clinically con-sidered the paramount part of treating cerebral palsy (CP), so it is essential to design an efficient and interpretable automatic prediction system for CP. We highlight a significant difference between CP infants' frequency of human movement and that of the healthy group, which improves prediction performance. However, the existing deep learning-based methods did not use the frequency information of infants' movement for CP prediction. This paper proposes a frequency attention informed graph convolutional network and validates it on two consumer-grade RGB video datasets, namely MINI-RGBD and RVI-38 datasets. Our proposed frequency attention module aids in improving both classification performance and system interpretability. In addition, we design a frequency-binning method that retains the critical frequency of the human joint position data while filtering the noise. Our prediction performance achieves state-of-the-art research on both datasets. Our work demonstrates the effectiveness of frequency information in supporting the prediction of CP non-intrusively and provides a way for supporting the early diagnosis of CP in the resource-limited regions where the clinical resources are not abundant.
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Provencher J, Beaulieu-Guay ÉM, Loranger SD, Schneider C. Repetitive Peripheral Magnetic Stimulation to Improve Ankle Function and Gait in Cerebral Palsy at Adulthood: An open-label Case Study. Brain Res 2022; 1792:147999. [PMID: 35780866 DOI: 10.1016/j.brainres.2022.147999] [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: 09/17/2021] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
Repetitive peripheral magnetic stimulation (rPMS) is noninvasive and painless. It drives plasticity of the primary motor cortex (M1) in children with cerebral palsy (CP) and this improves the ankle function and gait. Our study explored whether rPMS of muscles could influence motricity in an adult CP case. A 30-year-old woman with mixed CP participated in four sessions (S1 to S4, one per week) where rPMS was applied bilaterally on leg and trunk muscles (tibialis anterior-TA, hamstrings, transverse abdominis, paraspinal multifidus). Clinical scores and M1 excitability (probed by transcranial magnetic stimulation) were tested at pre-rPMS at S1 (baseline) and S4, then 40 days later (follow-up). The active ankle dorsiflexion was significantly increased and the plantar flexors resistance to stretch reduced as compared to baseline. The improvement of the ankle function was carried-over to the quality of locomotor patterns. Changes persisted until follow-up and were paralleled by drastic changes of M1 excitability. These original findings of rPMS influence on M1 plasticity and motricity are promising for the functional improvement of adult people living with CP and should be replicated in larger-sampled studies.
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Affiliation(s)
- Janie Provencher
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Éva Marion Beaulieu-Guay
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Sophy Desbiens Loranger
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Cyril Schneider
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
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Frequência de comorbidades em crianças com paralisia cerebral de diferentes níveis de função motora grossa. CONSCIENTIAE SAÚDE 2022. [DOI: 10.5585/21.2022.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ResumoIntrodução: A paralisia cerebral (PC) é uma desordem predominantemente motora, no entanto, pode estar associada a outras disfunções, que também impactam a funcionalidade das crianças. Objetivo: Documentar a frequência das comorbidades em crianças com PC nos diferentes níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). Métodos: Estudo observacional, descritivo, de corte transversal. Foram coletados dados de 70 crianças com diagnóstico de PC, que recebiam tratamento fisioterapêutico em Belo Horizonte e na região metropolitana, por meio de entrevistas, e realizada análise descritiva e quantitativa. Resultados: As comorbidades mais frequentes foram as limitações do uso das mãos e dos braços, deficiências de continência urinária e fecal, deficiências da voz e da fala, deficiências de comportamento limitação para andar e epilepsia. Um número maior de comorbidades foi encontrado em crianças com maior comprometimento da função motora grossa. Conclusão: Profissionais da saúde devem observar com atenção a ocorrência das comorbidades na PC, proporcionando intervenções para preveni-las ou tratá-las, melhorando a funcionalidade desses indivíduos.
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Zardo F, Paludo T, Mattos BTPD, Frata B, Ling CC, Cechetti F. Analysis of muscle activation in children and adolescents with severe cerebral palsy. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Children and adolescents with spastic quadriparesis have a worse selective motor control, and studies with this population are still very scarce. The same is true with scientific evidence of one of the methods most used as a physiotherapeutic treatment in this population, the Bobath Concept. Objective: To evaluate spine erector muscles activation, gluteus medius and gluteus maximus, through the handling of the Bobath Concept and the sustained kneeling posture in subjects with a diagnosis of severe cerebral palsy; and to compare muscle activation with a reference group, in order to increase the reliability of this study. Methods: A cross-sectional study was carried out with 38 children and adolescents with cerebral palsy, classified by GMFCS at levels IV and V, and 20 healthy participants, aged between 3 and 18 years. They were submitted to the handling of the Bobath Concept and to the sustained kneeling posture, with muscle activation obtained by electromyography. Results: We observed significant muscle activation during handling in side-sitting, with weight transfer and without the help of another therapist, and in the sustained kneeling posture, for the erector of the spine and gluteus medius. Conclusion: The evidence from this study suggests that both the handling in side-sitting and the sustained kneeling posture cause significant muscle activation in the erector of the spine and gluteus medius for severe quadriparesis subjects, GMFCS IV and V, which can contribute to the improvement of postural control and decision-making in physical therapy practice.
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Affiliation(s)
- Franciele Zardo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Tatiane Paludo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | | | - Bruna Frata
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Chen Chai Ling
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Fernanda Cechetti
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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Hayakawa H, Pincott E, Ali U. Anaesthesia and cerebral palsy. BJA Educ 2022; 22:26-32. [PMID: 34992798 PMCID: PMC8703146 DOI: 10.1016/j.bjae.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
| | | | - U. Ali
- Great Ormond Street Hospital, London, UK
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Comprehensive rehabilitation of patients with movement disorders with spastic forms of cerebral palsy. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Until now, there is no radical method of treating children with cerebral palsy, which allows us to consider scientific research in this direction reasonable and promising.The aim of the research: to study the effect of exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback on the indicators of motor skills in children with spastic cerebral palsy.Materials and methods. We conducted an open, non-randomized, prospective, comparative, controlled study in pairs (each participant in the main group corresponds to a participant in the control group). The study involved 53 patients aged 4–12 years with cerebral palsy: the intervention group (group 1: n = 27 (13 boys, 14 girls)) and the control group (group 2: n = 26 (11 boys, 15 girls)), comparable in terms of gender, age and severity of movement disorders. Characteristics of the medical intervention: group 1 – botulinum toxin type A (BTA, for exercising against the background of relative muscular normotonus) + exercise therapy + exercises on the mini-simulator “Kinesioplatform-swing” with biofeedback (BFB); group 2 – BTA + exercise therapy. Duration of the study: 2019–2020. The difference between groups in terms of motor skills on the day of hospitalization and after completion of the training program (10 sessions each) was determined. Motor skills were assessed according to the GMFM-66/88 (Gross Motor Function Measure) table using the “Scales for measuring global motor functions”.Results. The inclusion of additional exercises on the mini-simulator “Kinesioplatformswing” with biofeedback in the rehabilitation of patients with movement disorders with spastic cerebral palsy (BTA + exercise therapy) in comparison with the control group. However, the question of the long-term effects of such training remains open and requires further study.
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Pereira SDC, Benoit B, de Aguiar Junior FCA, Chanon S, Vieille‐Marchiset A, Pesenti S, Ruzzin J, Vidal H, Toscano AE. Fibroblast growth factor 19 as a countermeasure to muscle and locomotion dysfunctions in experimental cerebral palsy. J Cachexia Sarcopenia Muscle 2021; 12:2122-2133. [PMID: 34704398 PMCID: PMC8718044 DOI: 10.1002/jcsm.12819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/06/2021] [Accepted: 09/04/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) associates cerebral function damages with strong locomotor defects and premature sarcopenia. We previously showed that fibroblast growth factor 19 (FGF19) exerts hypertrophic effects on skeletal muscle and improves muscle mass and strength in mouse models with muscle atrophy. Facing the lack of therapeutics to treat locomotor dysfunctions in CP, we investigated whether FGF19 treatment could have beneficial effects in an experimental rat model of CP. METHODS Cerebral palsy was induced in male Wistar rat pups by perinatal anoxia immediately after birth and by sensorimotor restriction of hind paws maintained until Day 28. Daily subcutaneous injections with recombinant human FGF19 (0.1 mg/kg bw) were performed from Days 22 to 28. Locomotor activity and muscle strength were assessed before and after FGF19 treatment. At Day 29, motor coordination on rotarod and various musculoskeletal parameters (weight of tibia bone and of soleus and extensor digitorum longus (EDL) muscles; area of skeletal muscle fibres) were evaluated. In addition, expression of specific genes linked to human CP was measured in rat skeletal muscles. RESULTS Compared to controls, CP rats had reduced locomotion activity (-37.8% of distance travelled, P < 0.05), motor coordination (-88.9% latency of falls on rotarod, P < 0.05) and muscle strength (-25.1%, P < 0.05). These defects were associated with reduction in soleus (-51.5%, P < 0.05) and EDL (-42.5%, P < 0.05) weight, smaller area of muscle fibres, and with lower tibia weight (-38%, P < 0.05). In muscles from rats submitted to CP, changes in the expression levels of several genes related to muscle development and neuromuscular junctions were similar to those found in wrist muscle of children with CP (increased mRNA levels of Igfbp5, Kcnn3, Gdf8, and MyH4 and decreased expression of Myog, Ucp2 and Lpl). Compared with vehicle-treated CP rats, FGF19 administration improved locomotor activity (+53.2%, P < 0.05) and muscle strength (+25.7%, P < 0.05), and increased tibia weight (+13.8%, P < 0.05) and soleus and EDL muscle weight (+28.6% and +27.3%, respectively, P < 0.05). In addition, it reduced a number of very small fibres in both muscles (P < 0.05). Finally, gene expression analyses revealed that FGF19 might counteract the immature state of skeletal muscles induced by CP. CONCLUSIONS These results demonstrate that pharmacological intervention with recombinant FGF19 could restore musculoskeletal and locomotor dysfunction in an experimental CP model, suggesting that FGF19 may represent a potential therapeutic strategy to combat the locomotor disorders associated with CP.
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Affiliation(s)
- Sabrina da Conceição Pereira
- Studies in Nutrition and Phenotypic Plasticity Unit, Department of NutritionFederal University of PernambucoRecifePernambucoBrazil
| | - Bérengère Benoit
- CarMeN laboratory, French National Institute of Health and Medical Research (INSERM) U1060, National Research Institute for Agriculture, Food and Environment (INRAE) U1397University of Lyon, Claude Bernard University Lyon 1OullinsFrance
| | | | - Stéphanie Chanon
- CarMeN laboratory, French National Institute of Health and Medical Research (INSERM) U1060, National Research Institute for Agriculture, Food and Environment (INRAE) U1397University of Lyon, Claude Bernard University Lyon 1OullinsFrance
| | - Aurélie Vieille‐Marchiset
- CarMeN laboratory, French National Institute of Health and Medical Research (INSERM) U1060, National Research Institute for Agriculture, Food and Environment (INRAE) U1397University of Lyon, Claude Bernard University Lyon 1OullinsFrance
| | - Sandra Pesenti
- CarMeN laboratory, French National Institute of Health and Medical Research (INSERM) U1060, National Research Institute for Agriculture, Food and Environment (INRAE) U1397University of Lyon, Claude Bernard University Lyon 1OullinsFrance
| | - Jérome Ruzzin
- Department of Molecular Medicine, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
| | - Hubert Vidal
- CarMeN laboratory, French National Institute of Health and Medical Research (INSERM) U1060, National Research Institute for Agriculture, Food and Environment (INRAE) U1397University of Lyon, Claude Bernard University Lyon 1OullinsFrance
| | - Ana Elisa Toscano
- Studies in Nutrition and Phenotypic Plasticity Unit, Department of NutritionFederal University of PernambucoRecifePernambucoBrazil
- Department of Nursing, CAVFederal University of PernambucoVitória de Santo AntãoPernambucoBrazil
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Mårtensson U, Cederlund M, Jenholt Nolbris M, Mellgren K, Wijk H, Nilsson S. Experiences before and after nasogastric and gastrostomy tube insertion with emphasis on mealtimes: a case study of an adolescent with cerebral palsy. Int J Qual Stud Health Well-being 2021; 16:1942415. [PMID: 34167445 PMCID: PMC8231357 DOI: 10.1080/17482631.2021.1942415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Adolescents with cerebral palsy may need a feeding tube due to feeding challenges, since nutritional intake and mealtimes may be negatively affected. The purpose of the study was to describe and better understand how one adolescent with cerebral palsy and her parents experienced mealtimes before and after a nasogastric and gastrostomy tube insertion and how the use of these feeding tubes was experienced in daily life.Methods: Individual interviews were performed with one adolescent and each of her parents. In total, six interviews were conducted on two separate occasions. The qualitative approach known as Interpretive Description was used during the analysis.Results: Four thematic patterns were identified within the data: (i) struggling with nutritional intake, (ii) the paradox of using an aid, (iii) being different, and (iv) challenges of public mealtimes.Conclusions: The results showed that four themes influenced daily mealtimes in adolescents with cerebral palsy and a gastrostomy tube. Nutritional intake and mealtimes may be difficult, which is why using a gastrostomy tube can be a relief. However, the gastrostomy tube can also pose a challenge and a paradox. Time of change and acceptance seems necessary in order to meet these challenges.
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Affiliation(s)
- Ulrika Mårtensson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Mats Cederlund
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margaretha Jenholt Nolbris
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE-405 30, Gothenburg, Sweden and Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Paediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
- Department of Quality Strategies, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers Technology University/Centre for Health Care Architecture, Gothenburg, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; University of Gothenburg Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
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Bohn E, Goren K, Switzer L, Falck‐Ytter Y, Fehlings D. Pharmacological and neurosurgical interventions for individuals with cerebral palsy and dystonia: a systematic review update and meta-analysis. Dev Med Child Neurol 2021; 63:1038-1050. [PMID: 33772789 PMCID: PMC8451898 DOI: 10.1111/dmcn.14874] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 12/30/2022]
Abstract
AIM To update a systematic review of evidence published up to December 2015 for pharmacological/neurosurgical interventions among individuals with cerebral palsy (CP) and dystonia. METHOD Searches were updated (January 2016 to May 2020) for oral baclofen, trihexyphenidyl, benzodiazepines, clonidine, gabapentin, levodopa, botulinum neurotoxin (BoNT), intrathecal baclofen (ITB), and deep brain stimulation (DBS), and from database inception for medical cannabis. Eligible studies included at least five individuals with CP and dystonia and reported on dystonia, goal achievement, motor function, pain/comfort, ease of caregiving, quality of life (QoL), or adverse events. Evidence certainty was evaluated using GRADE. RESULTS Nineteen new studies met inclusion criteria (two trihexyphenidyl, one clonidine, two BoNT, nine ITB, six DBS), giving a total of 46 studies (four randomized, 42 non-randomized) comprising 915 participants when combined with those from the original systematic review. Very low certainty evidence supported improved dystonia (clonidine, ITB, DBS) and goal achievement (clonidine, BoNT, ITB, DBS). Low to very low certainty evidence supported improved motor function (DBS), pain/comfort (clonidine, BoNT, ITB, DBS), ease of caregiving (clonidine, BoNT, ITB), and QoL (ITB, DBS). Trihexyphenidyl, clonidine, BoNT, ITB, and DBS may increase adverse events. No studies were identified for benzodiazepines, gabapentin, oral baclofen, and medical cannabis. INTERPRETATION Evidence evaluating the use of pharmacological and neurosurgical management options for individuals with CP and dystonia is limited to between low and very low certainty. What this paper adds Meta-analysis suggests that intrathecal baclofen (ITB) and deep brain stimulation (DBS) may improve dystonia and pain. Meta-analysis suggests that DBS may improve motor function. Clonidine, botulinum neurotoxin, ITB, and DBS may improve achievement of individualized goals. ITB and DBS may improve quality of life. No direct evidence is available for oral baclofen, benzodiazepines, gabapentin, or medical cannabis.
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Affiliation(s)
- Emma Bohn
- Holland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada,Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - Katherine Goren
- Holland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada,Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - Lauren Switzer
- Holland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada,Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - Yngve Falck‐Ytter
- Division of Gastroenterology and HepatologyVeteran Affairs North East Ohio Health Care SystemCase Western Reserve UniversityClevelandOHUSA
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada,Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
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da Conceição Pereira S, Manhães-de-Castro R, Visco DB, de Albuquerque GL, da Silva Calado CMS, da Silva Souza V, Toscano AE. Locomotion is impacted differently according to the perinatal brain injury model: Meta-analysis of preclinical studies with implications for cerebral palsy. J Neurosci Methods 2021; 360:109250. [PMID: 34116077 DOI: 10.1016/j.jneumeth.2021.109250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Different approaches to reproduce cerebral palsy (CP) in animals, contribute to the knowledge of the pathophysiological mechanism of this disease and provide a basis for the development of intervention strategies. Locomotion and coordination are the main cause of disability in CP, however, few studies highlight the quantitative differences of CP models, on locomotion parameters, considering the methodologies to cause brain lesions in the perinatal period. METHODS Studies with cerebral palsy animal models that assess locomotion parameters were systematically retrieved from Medline/PubMed, SCOPUS, LILACS, and Web of Science. Methodological evaluation of included studies and quantitative assessment of locomotion parameters were performed after eligibility screening. RESULTS CP models were induced by hypoxia-ischemia (HI), Prenatal ischemia (PI), lipopolysaccharide inflammation (LPS), intraventricular haemorrhage (IVH), anoxia (A), sensorimotor restriction (SR), and a combination of different models. Overall, 63 studies included in qualitative synthesis showed a moderate quality of evidence. 16 studies were included in the quantitative meta-analysis. Significant reduction was observed in models that combined LPS with HI related to distance traveled (SMD -7.24 95 % CI [-8.98, -5.51], Z = 1.18, p < 0.00001) and LPS with HI or anoxia with sensory-motor restriction (SMD -6.01, 95 % CI [-7.67, -4.35], Z = 7.11), or IVH (SMD -4.91, 95 % CI [-5.84, -3.98], Z = 10.31, p < 0.00001) related to motor coordination. CONCLUSION The combination of different approaches to reproduce CP in animals causes greater deficits in locomotion and motor coordination from the early stages of life to adulthood. These findings contribute to methodological refinement, reduction, and replacement in animal experimentation, favoring translational purposes.
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Affiliation(s)
- Sabrina da Conceição Pereira
- Posgraduate Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Raul Manhães-de-Castro
- Posgraduate Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Postgraduate Program in Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego Bulcão Visco
- Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Postgraduate Program in Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Vanessa da Silva Souza
- Posgraduate Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ana Elisa Toscano
- Posgraduate Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Postgraduate Program in Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Nursing, CAV, Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil.
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Ribeiro Volpini Lana M, Pimenta Maia J, Horta AA, Teixeira da Fonseca S, Guimarães Assis M. 'What if it were like this?' Perception of mothers of children with cerebral palsy about the ankle-foot orthosis of their children: A qualitative study. Child Care Health Dev 2021; 47:252-260. [PMID: 33326118 DOI: 10.1111/cch.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/05/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The family-centred approach is fundamental in the therapeutic process of children with cerebral palsy (CP), and the increased competence of parents about therapeutic devices, especially orthoses, can facilitate its implementation, thus intensifying the benefits that this device provides. The aim of this study was to understand the perception of mothers of children with CP in relation to their children's ankle-foot orthosis. METHODS This is a qualitative study using thematic content analysis technique. Data were collected using semi-structured interviews from 24 mothers of children with Levels IV and V of CP according to the Gross Motor Function Classification System (GMFCS), who were attended at a philanthropic rehabilitation centre. RESULTS Three categories were identified from analyzing the interviews: benefits of the orthosis, the orthosis in the child's daily life and 'What if it were like this?' CONCLUSIONS According to the mothers' perceptions, the ankle-foot orthosis improved their child's mobility. The orthoses are used in different contexts in the child's daily life, and the mothers pointed out suggestions regarding personalizing the orthosis with different colors and patterns, increasing comfort and facilitating the way in which the device is placed.
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Affiliation(s)
- Mariana Ribeiro Volpini Lana
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Joana Pimenta Maia
- Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Anderson Antônio Horta
- Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil.,Escola de Design, Universidade Estadual de Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcella Guimarães Assis
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Damiano DL, Longo E, Carolina de Campos A, Forssberg H, Rauch A. Systematic Review of Clinical Guidelines Related to Care of Individuals With Cerebral Palsy as Part of the World Health Organization Efforts to Develop a Global Package of Interventions for Rehabilitation. Arch Phys Med Rehabil 2021; 102:1764-1774. [PMID: 33453191 DOI: 10.1016/j.apmr.2020.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The World Health Organization's (WHO) Rehabilitation 2030 initiative is working to develop a set of evidence-based interventions selected from clinical practice guidelines for Universal Health Coverage. As an initial step, the WHO Rehabilitation Programme and Cochrane Rehabilitation convened global content experts to conduct systematic reviews of clinical practice guidelines for 20 chronic health conditions, including cerebral palsy. DATA SOURCES Six scientific databases (Pubmed, EMBASE, Scopus, Web of Science, PEDro, CINAHL), Google Scholar, guideline databases, and professional society websites were searched. STUDY SELECTION A search strategy was implemented to identify clinical practice guidelines for cerebral palsy across the lifespan published within 10 years in English. Standardized spreadsheets were provided for process documentation, data entry, and tabulation of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Each step was completed by 2 or more group members, with disagreements resolved by discussion. Initially, 13 guidelines were identified. Five did not meet the AGREE II established threshold or criteria for inclusion. Further review by the WHO eliminated 3 more, resulting in 5 remaining guidelines. DATA EXTRACTION All 339 recommendations from the 5 final guidelines, with type (assessment, intervention, or service), strength, and quality of evidence, were extracted, and an International Classification of Functioning, Disability and Health Functioning (ICF) category was assigned to each. DATA SYNTHESIS Most guidelines addressed mobility functions, with comorbid conditions and lifespan considerations also included. However, most were at the level of body functions. No guideline focused specifically on physical or occupational therapies to improve activity and participation, despite their prevalence in rehabilitation. CONCLUSIONS Despite the great need for high quality guidelines, this review demonstrated the limited number and range of interventions and lack of explicit use of the ICF during development of guidelines identified here. A lack of guidelines, however, does not necessarily indicate a lack of evidence. Further evidence review and development based on identified gaps and stakeholder priorities are needed.
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Affiliation(s)
- Diane L Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD.
| | - Egmar Longo
- Federal University of Rio Grande do Norte-UFRN-FACISA, Santa Cruz, Brazil
| | - Ana Carolina de Campos
- Department of Physical Therapy, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Alexandra Rauch
- Sensory Functions, Disability and Rehabilitation Unit, Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Stewart K, Copeland L, Lewis J. The Impact of Intrathecal Baclofen Therapy on Health-related Quality of Life for Children with Marked Hypertonia. Dev Neurorehabil 2020; 23:542-547. [PMID: 32338172 DOI: 10.1080/17518423.2020.1753841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the effects of intrathecal baclofen therapy (ITB) on health-related quality of life for children with cerebral palsy and neurological conditions. Method: This study is part of a longitudinal, multicentre audit. The primary outcome measure, the Caregiver Priorities and Child Health Index of Life with Disabilities, was completed at baseline, 6 and 12 months post ITB implant. Results: Forty subjects with cerebral palsy and other neurological conditions demonstrated significant improvement in aspects of health-related quality of life following ITB therapy, mean change 42.3 (SD 14.9) at baseline to 53.3 (SD 14.7) at 12 months (p< .001). Conclusion: Evidence to demonstrate the utility of ITB in pediatric populations beyond spasticity and dystonia reduction is limited. Our findings suggest that ITB improves aspects of quality of life, comfort, and ease of caregiving in children with cerebral palsy and other neurological conditions.
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Affiliation(s)
- Kirsty Stewart
- Kids Rehab, The Children's Hospital at Westmead , Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney , Sydney, Australia
| | - Lisa Copeland
- Queensland Children's Hospital , Brisbane, Australia
| | - Jennifer Lewis
- Kids Rehab, The Children's Hospital at Westmead , Sydney, Australia.,Queensland Children's Hospital , Brisbane, Australia.,Royal Children's Hospital , Melbourne, Australia.,Monash Children's Health , Melbourne, Australia.,Women and Children's Hospital , Adelaide, South Australia.,Perth Children's Hospital , Perth, Australia
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