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Developmental Trajectories of Mobility and Self-Care Capabilities in Young Children with Cerebral Palsy

JOURNAL OF PEDIATRICS 2014年第4期164卷 769-774页

作者： Ketelaar, Marjolijn Gorter, Jan Willem Westers, Paul Hanna, Steven Verhoef, Marjolein Univ Med Ctr Utrecht Brain Ctr Rudolf Magnus NL-3583 TM Utrecht Netherlands Univ Med Ctr Utrecht Ctr Excellence Rehabil Med NL-3583 TM Utrecht Netherlands De Hoogstraat Rehabil NL-3583 TM Utrecht Netherlands Partner NetChild Network Childhood Disabil Res Utrecht Netherlands McMaster Univ CanChild Centrer Childhood Disabil Res Hamilton ON Canada Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care NL-3583 TM Utrecht Netherlands McMaster Univ Dept Clin Epidemiol & Biostat Hamilton ON Canada

Objective To describe development of mobility and self-care capabilities in young children (aged 1-4 years) with cerebral palsy, and to examine whether the development of mobility and self-care capabilities differs by cerebral palsy severity in terms of 5 distinct gross motor function classification system (GMFCS) levels. Study design This prospective longitudinal cohort study included 100 children with cerebral palsy (aged 1.5 or 2.5 years at baseline) and their parents. Mobility and self-care capabilities were assessed by the Pediatric Evaluation of Disability Inventory during yearly assessments from inclusion up to age 4.5 years. Longitudinal data for 92 children were available for analysis. Repeated-measures analyses with random coefficient analysis were performed using linear mixed models. Results Despite large variations among individuals in the development of mobility and self-care capabilities in young children with cerebral palsy, distinct developmental trajectories were found for children in different GMFCS levels. The estimated change per month differed significantly by GMFCS level for both outcomes. Conclusions This longitudinal study provides an evidence base for prognosis in daily mobility and self-care skills in young children with cerebral palsy. The developmental trajectories for GMFCS levels can be helpful in communication between professionals and also in discussions of expectations and goal setting with families regarding mobility and self-care in the daily life of young children with cerebral palsy in neonatal follow-up and pediatric practice.

关键词： GMFCS gross motor function classification system PEDI Pediatric Evaluation of Disability Inventory PEDI-CAT Pediatric Evaluation of Disability Inventory, computer adaptive testing PEDI-FSS Pediatric Evaluation of Disability Inventory, functional Skills Scale

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Effects of botulinum toxin injections on function and quality of life in children with cerebral palsy

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Annals of Physical and Rehabilitation Medicine 2015年 58卷 e131-e131页

作者： Ghroubi, S., Prof Elleuch, W., Dr Mallek, A., Dr Mahersi, S., Dr Elleuch, M.H., Prof Service de médecine physique et de réadaptation CHU Habib Bourguiba unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18 université de Sfax Sfax Tunisia

Introduction Our objective was to show the effects of botulinum toxin injections (BT) on function and quality of life in children with cerebral palsy (CP). Patients and methods A prospective study including 60 children, aged from 2 to 18 years old, who received repeated injections of BT was conducted. Evaluations were done before and after injections including spasticity using the modified Ashworth scale (MAS), functional evaluation using the gross motor function classification system (GMFCS) and the Manual Ability classification system (MACS), a videographic record, an evaluation of satisfaction (Visual Analogical Scale) and an evaluation of the quality of life using the Child Health Questionnaire Parent form 50 Questionnaire (CHQ-PF50). Results The average of the MAS was 2.5 for all injected muscles. Sixty-five percent of children were classed level I, II or III of MACS. All our patients had BT injections. The sural triceps was the most injected muscle. The improvement of spasticity after BT injections in the lower limb was more important for 6-year-old children (improvement of 46%, P < 0.001). We noted a significant increase of the number of walking patients ( P < 0.001) and a beneficial effect on the pattern gait especially for children level III of GMFCS. The percentage of children improved (in GMFCS and MACS) and the average of visual analogical satisfaction scale as well, increased from one injection to another reaching a constant level in the last 2 injections ( P < 0.001). We have noted an improvement in the score of CHQ-PF50 (physical and psychosocial score), which was correlated with the functional improvement. Discussion Our study shows how BT injections can induce a functional gain in children with CP. An improvement of upper extremity's function, gait pattern and the quality of life upturn were plainly noticed after these injections. Similar benefits of BT [1,2] were mentioned in literature.

关键词： Cerebral palsy Botulinium toxin gross motor function classification system Manual Ability Classificaton system Child Health Questionnaire parent form 50 function Qualitiy of life

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The Relationship Between Manual Ability and Ambulation in Adolescents with Cerebral Palsy

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PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS 2013年第2期33卷 243-252页

作者： Majnemer, Annette Shikako-Thomas, Keiko Shevell, Michael Poulin, Chantal Lach, Lucyna Law, Mary Schmitz, Norbert McGill Univ Sch Phys & Occupat Hlth Montreal PQ Canada McGill Univ Dept Pediat Montreal PQ H3A 2T5 Canada McGill Univ Dept Neurol & Neurosurg Montreal PQ Canada McGill Univ Dept Pediat Montreal Childrens Hosp Montreal PQ H3A 2T5 Canada McGill Univ Sch Social Work Montreal PQ Canada McMaster Univ Sch Rehabil Sci Hamilton ON Canada McGill Univ Dept Psychiat Inst Douglas Montreal PQ Canada

This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the gross motor function classification system (GMFCS) and the Manual Ability classification system (MACS). A neurologist classified CP subtype. Most adolescents were ambulatory with or without utilization of aids (GMFCS level I: 35.0%, II: 30.0%, III: 5.8%, IV: 10.8%, and V: 18.3%). MACS levels were I: 34.2%, II: 25.8%, III: 16.7%, IV: 7.5%, and V: 15.8%. Correlations between GMFCS and MACS were strong in youth with quadriplegia (r = .89, p < .001), moderate in individuals with diplegia (r = .58, p = .01), but weakly associated for adolescents with hemiplegia (r = .24, p = .23). The findings provide evidence for maintaining a clinical distinction between spastic quadriplegia and spastic diplegia. Manual ability may not be congruent with mobility in adolescents with CP and should be specifically evaluated given its importance to daily life functioning.

关键词： Adolescents cerebral palsy gross motor function classification system manual ability classification system

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The agreement between GMFCS and GMFCS-E&R in children with cerebral palsy

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EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013年第3期15卷 127-133页

作者： Gudmundsson, Caroline Nordmark, Eva Lund Univ Dept Hlth Sci Fac Med SE-22100 Lund Sweden

Aims: The aims of this study were to examine the agreement between the original gross motor function classification system (GMFCS) and the revised version, GMFCS-E&R, and to describe the characteristics of the persons who changed level when the GMFCS-E&R classifi cation was used. Methodology: During 2009 there were 706 persons (aged 1 - 20 years) with cerebral palsy (CP), living in the southernmost part of Sweden, who participated in a secondary prevention follow-up programme for persons with CP. Of the 706 participants, 561 were assessed by physiotherapists using both GMFCS and GMFCS-E&R. The agreement between 665 assessment forms, including both GMFCS and GMFCS-E&R levels, was analysed. Descriptive, unweighted and weighted Kappa statistics were used. Major findings: The absolute agreement, with corresponding levels according to GMFCS and GMFCS-E & R was 96.8% (n = 644). Unweighted Kappa showed K = 0.96 (95% confidence interval: 0.94-0.98) and weighted Kappa showed K = 0.97 (95% confidence interval: 0.96 -0.99). Both were interpreted as an agreement corresponding to an "almost perfect agreement ". Principal conclusion: This study suggests that the GMFCS-E & R, if administrated carefully, could be used when comparing longitudinal data with the GMFCS.

关键词： Agreement cerebral palsy GMFCS GMFCS-E & R gross motor function classification system

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Clinical, Biochemical, and Neuroimaging Findings Predict Long-Term Neurodevelopmental Outcome in Symptomatic Congenital Cytomegalovirus Infection

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JOURNAL OF PEDIATRICS 2013年第3期163卷 828-+页

作者： Alarcon, Ana Martinez-Biarge, Miriam Cabanas, Fernando Hernanz, Angel Quero, Jose Garcia-Alix, Alfredo St Joan de Deu Univ Hosp Dept Neonatol Barcelona Spain La Paz Univ Hosp Dept Neonatol Madrid Spain La Paz Univ Hosp Dept Biochem Madrid Spain

Objective To evaluate clinical, biochemical, and neuroimaging findings as predictors of neurodevelopmental outcome in patients with symptomatic congenital cytomegalovirus (CMV). Study design The study cohort comprised 26 patients with symptomatic congenital CMV born between 1993 and 2009 in a single center. Absolute and weight deficit-adjusted head circumference were considered. Cerebrospinal fluid (CSF) investigations included standard cytochemical analysis, determination of beta(2)-microglobulin (beta(2)-m), neuron-specific enolase, and CMV DNA detection. Neuroimaging was classified according to a validated scoring system comprising calcifications, ventriculomegaly, and atrophy, with findings graded from 0 to 3. systematic long-term neurodevelopmental assessment included motor function, cognition, behavior, hearing, vision, and epilepsy. Sequelae were graded as mild/absent, moderate, or severe;adverse outcome was defined as death or moderate to severe disability. Results Three children died. The mean age at follow-up of the survivors was 8.7 +/- 5.3 years (range, 19 months to 18.0 years). Neonatal findings showing a significant association with adverse outcome were relative microcephaly, CSF beta(2)-m concentrations, and grade 2-3 neuroimaging abnormalities (P < .05). Receiver operator characteristic curve analysis indicated that the most accurate single factor for predicting unfavorable outcome was CSF beta(2)-m > 7.9 mg/L (area under the curve, 0.84 +/- 0.08;sensitivity, 69%;specificity, 100%). The combination of CSF beta(2)-m > 7.9 mg/L and moderate-severe neuroimaging alterations improved predictive ability (area under the curve, 0.92 +/- 0.06;sensitivity, 87%;specificity, 100%). Conclusion Adjusted head circumference, CSF beta(2)-m level, and neuroimaging studies have prognostic significance for neurodevelopmental outcome in newborns with congenital CMV. A combination of early findings improves the predictive value.

关键词： β2-m Beta2-microglobulin BSID-III Bayley Scales of Infant and Toddler Development Third Edition CMV Cytomegalovirus CNS Central nervous system CP Cerebral palsy CSF Cerebrospinal fluid CT Computed tomography GMFCS gross motor function classification system HC Head circumference MRI Magnetic resonance imaging NSE Neuron-specific enolase PV Periventricular US Ultrasonography WBC White blood cell

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Severity of disability in patients with cerebral palsy secondary to symptomatic congenital cytomegalovirus encephalopathy

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JOURNAL OF PEDIATRIC REHABILITATION MEDICINE 2013年第4期6卷 239-242页

作者： Cameron, Nathan A. Gormley, Mark E., Jr. Deshpande, Supreet Gillette Childrens Specialty Healthcare 200 Univ Ave East St Paul MN 55101 USA Univ Minnesota Sch Med Dept Phys Med & Rehabil Minneapolis MN 55455 USA

PURPOSE: Cytomegalovirus (CMV) is a leading cause of congenital encephalopathy and cerebral palsy (CP). In this study we report the severity of disability in individuals who developed CP secondary to symptomatic congenital CMV encephalopathy. METHODS: The medical records of patients with CP secondary to symptomatic congenital CMV encephalopathy diagnosed from 1995 to 2011 were retrospectively reviewed. gross motor functional classification Scale (GMFCS) level, language function, and swallowing function were collected. RESULTS: Twenty-three patients were found. Of those 23 patients, 83% (19/23) were at a GMFCS level IV or V, 9% (2/23) each GMFCS level II or III and none (0%) at GMFCS I. Eighteen patients were non-verbal, 3 had minimal to moderate verbal skills and 2 had no verbal impairment. Eighteen patients also had severe dysphagia requiring gastrostomy tube (GT) feedings, and 5 ate orally. There was a strong correlation between the severity of GMFCS and having a gastrostomy tube (p < 0.0006) and GMFCS and verbal skills (p < 0.0023). CONCLUSION: This study shows that patients with CP secondary to symptomatic congenital cytomegalovirus encephalopathy have a very high risk of having severe physical and cognitive disabilities. This information can help healthcare providers and caregivers plan for the potential long-term medical, rehabilitation, and financial needs of this group of patients.

关键词： Cerebral palsy cytomegalovirus encephalopathy gross motor function classification system

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White Matter and Cortical Injury in Hypoxic-Ischemic Encephalopathy: Antecedent Factors and 2-Year Outcome

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JOURNAL OF PEDIATRICS 2012年第5期161卷 799-807页

作者： Martinez-Biarge, Miriam Bregant, Tina Wusthoff, Courtney J. Chew, Andrew T. M. Diez-Sebastian, Jesus Rutherford, Mary A. Cowan, Frances M. Univ London Imperial Coll Sci Technol & Med Ctr Dev Brain London England Univ London Imperial Coll Sci Technol & Med MRC Clin Sci Ctr London England Univ London Imperial Coll Sci Technol & Med Dept Pediat & Imaging Sci London England Univ Childrens Hosp Univ Med Ctr Dept Pediat Neurol Ljubljana Slovenia La Paz Univ Hosp Dept Biostat Madrid Spain

Objective To examine the spectrum of isolated white matter (WM)/cortical injury and its relation to outcomes in infants with hypoxic-ischemic encephalopathy (HIE) and normal appearing basal ganglia and thalami. Study design From 1992-2007, 84 term infants with HIE and normal basal ganglia and thalami on neonatal magnetic resonance imaging were studied;WM/cortical lesions were classified by site and severity. Neurodevelopmental outcomes and head growth were documented at a median age of 2 years. Results The WM was normal or mildly abnormal in 33.5%, moderate in 40.5%, and severely abnormal in 26% of infants. Cortical involvement was not seen or was only mild in 75.5%, moderate in 13%, and severe in 12% of infants. WM and cortical injury severity were highly correlated (Spearman rho = 0.74;P < .001). Infants with severe WM injury had more severe neonatal courses and a higher incidence of hypoglycemia. No infant died. Five infants (6%) developed cerebral palsy but all could walk independently. Cognitive, visual, language, behavioral, and seizure problems were highly prevalent and correlated significantly with the severity of WM injury and poor postnatal head growth. Conclusion Infants with HIE and selective WM/cortical injury have a low prevalence of cerebral palsy but have a wide range of other problems, which occur more often with severe WM/cortical lesions. (J Pediatr 2012;161:799-807).

关键词： CP Cerebral palsy DQ Developmental quotient GMDS Griffiths Mental Developmental Scales GMFCS gross motor function classification system HC Head circumference HIE Hypoxic-ischemic encephalopathy MRI Magnetic resonance imaging OS Optimality score WM White matter

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Energy requirements in preschool-age children with cerebral palsy

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AMERICAN JOURNAL OF CLINICAL NUTRITION 2012年第6期96卷 1309-1315页

作者： Walker, Jacqueline L. Bell, Kristie L. Boyd, Roslyn N. Davies, Peter S. W. Univ Queensland Sch Med Childrens Nutr Res Ctr Brisbane Qld Australia Univ Queensland Sch Med Queensland Cerebral Palsy & Rehabil Res Ctr Brisbane Qld Australia Univ Queensland Queensland Childrens Med Res Inst Brisbane Qld Australia Royal Childrens Hosp Queensland Paediat Rehabil Serv Brisbane Qld Australia

Background: There is a paucity of data concerning the energy requirements (ERs) of preschool-age children with cerebral palsy (CP), the knowledge of which is essential for early nutritional management. Objective: We aimed to determine the ERs for preschool-age children with CP in relation to functional ability, motor type, and distribution and compared with typically developing children (TDC) and published estimation equations. Design: Thirty-two children with CP (63% male) of all functional abilities, motor types, and distributions and 16 TDC (63% male) aged 2.9-4.4 y participated in this study. The doubly labeled water method was used to determine ERs. Statistical analyses were conducted by 1-factor ANOVA and post hoc Tukey honestly significant difference tests, independent and paired t tests, Bland and Altman analyses, correlations, and multivariable regressions. Results: As a population, children with CP had significantly lower ERs than did TDC (P < 0.05). No significant difference in ERs was found between ambulant children and TDC. Marginally ambulant and nonambulant children had ERs that were similar to 18% lower than those of ambulant children and 31% lower than those of TDC. A trend toward lower ERs with greater numbers of limbs involved was observed. The influence of motor type could not be determined statistically. Published equations substantially underestimated ERs in the nonambulant children by similar to 22%. Conclusions: In preschool-age children with CP, ERs decreased as ambulatory status declined and more limbs were involved. The greatest predictor of ERs was fat-free mass, then ambulatory status. Future research should build on the information presented to expand the knowledge base regarding ERs in children with CP. This trial was registered with the Australian New Zealand Clinical Trials Registry as ACTRN 12612000686808. Am J Clin Mar 2012;96:1309-15.

关键词： CP cerebral palsy DLW doubly labeled water ER energy requirement FFM fat-free mass FFMI fat-free mass index GMFCS gross motor function classification system MD mean difference TBW total body water TDC typically developing children TEE total energy expenditure

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Are Outcomes of Extremely Preterm Infants Improving? Impact of Bayley Assessment on Outcomes

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JOURNAL OF PEDIATRICS 2012年第2期161卷 222-+页

作者： Vohr, Betty R. Stephens, Bonnie E. Higgins, Rosemary D. Bann, Carla M. Hintz, Susan R. Das, Abhik Newman, Jamie E. Peralta-Carcelen, Myriam Yolton, Kimberly Dusick, Anna M. Evans, Patricia W. Goldstein, Ricki F. Ehrenkranz, Richard A. Pappas, Athina Adams-Chapman, Ira Wilson-Costello, Deanne E. Bauer, Charles R. Bodnar, Anna Heyne, Roy J. Vaucher, Yvonne E. Dillard, Robert G. Acarregui, Michael J. McGowan, Elisabeth C. Myers, Gary J. Fuller, Janell Brown Univ Women & Infants Hosp Dept Pediat Providence RI 02905 USA Eunice Kennedy Shriver Natl Inst Child Hlth & Hum NIH Bethesda MD USA RTI Int Stat & Epidemiol Unit Res Triangle Pk NC USA Stanford Univ Sch Med Dept Pediat Palo Alto CA 94304 USA RTI Int Stat & Epidemiol Unit Rockville MD USA Univ Alabama Birmingham Div Neonatol Birmingham AL USA Univ Cincinnati Dept Pediat Cincinnati OH 45221 USA Indiana Univ Sch Med Dept Pediat Indianapolis IN USA Univ Texas Houston Med Sch Houston Dept Pediat Houston TX USA Duke Univ Dept Pediat Durham NC 27706 USA Yale Univ Sch Med Dept Pediat New Haven CT 06510 USA Wayne State Univ Dept Pediat Detroit MI 48202 USA Emory Univ Sch Med Dept Pediat Atlanta GA USA Childrens Healthcare Atlanta Atlanta GA USA Case Western Reserve Univ Rainbow Babies & Childrens Hosp Dept Pediat Cleveland OH 44106 USA Univ Miami Miller Sch Med Miami FL 33136 USA Univ Utah Sch Med Dept Pediat Div Neonatol Salt Lake City UT USA Univ Texas SW Med Ctr Dallas Dept Pediat Dallas TX 75390 USA Univ Calif San Diego Div Neonatol La Jolla CA 92093 USA Wake Forest Univ Bowman Gray Sch Med Winston Salem NC USA Univ Iowa Dept Pediat Iowa City IA 52242 USA Floating Hosp Children Dept Pediat Div Newborn Med Tufts Med Ctr Boston MA USA Univ Rochester Sch Med & Dent Rochester NY USA Univ New Mexico Hlth Sci Ctr Albuquerque NM 87131 USA

Objectives To compare 18- to 22-month cognitive scores and neurodevelopmental impairment (NDI) in 2 time periods using the National Institute of Child Health and Human Development's Neonatal Research Network assessment of extremely low birth weight infants with the Bayley Scales of Infant Development, Second Edition (Bayley II) in 2006-2007 (period 1) and using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III), with separate cognitive and language scores, in 2008-2011 (period 2). Study design Scores were compared with bivariate analysis, and regression analyses were run to identify differences in NDI rates. Results Mean Bayley III cognitive scores were 11 points higher than mean Bayley II cognitive scores. The NDI rate was reduced by 70% (from 43% in period 1 to 13% in period 2;P < .0001). Multivariate analyses revealed that Bayley III contributed to a decreased risk of NDI by 5 definitions: cognitive score < 70 and < 85, cognitive or language score < 70;cognitive or motor score < 70, and cognitive, language, or motor score < 70 (P < .001). Conclusion Whether the Bayley III is overestimating cognitive performance or whether it is a more valid assessment of emerging cognitive skills than the Bayley II is uncertain. Because the Bayley III identifies significantly fewer children with disability, it is recommended that all extremely low birth weight infants be offered early intervention services at the time of discharge from the neonatal intensive care unit, and that Bayley scores be interpreted with caution. (J Pediatr 2012;161:222-8).

关键词： Bayley II Bayley Scales of Infant Development Second Edition Bayley III Bayley Scales of Infant and Toddler Development Third Edition BPD Bronchopulmonary dysplasia CA Corrected age Cog Cognitive composite CP Cerebral palsy ELBW Extremely low birth weight GA Gestational age GMFCS gross motor function classification system IVH Intraventricular hemorrhage MDI Mental Developmental Index NDI Neurodevelopmental impairment NEC Necrotizing enterocolitis NRN Neonatal Research Network PDI Psychomotor Developmental Index PT Preterm PVL Periventricular leukomalacia ROP Retinopathy of prematurity

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Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial

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BMC MUSCULOSKELETAL DISORDERS 2012年第1期13卷 71-71页

作者： Giannasi, Lilian Chrystiane Matsui, Miriam Yumi de Freitas Batista, Sandra Regina Hardt, Camila Teixeira Gomes, Carla Paes Oliveira Amorim, Jose Benedito Aguiar, Isabella de Carvalho Collange, Luanda dos Santos, Israel dos Reis Dias, Ismael Souza de Oliveira, Claudia Santos Franco de Oliveira, Luis Vicente Gomes, Monica Fernandes Sao Paulo State Univ Sch Dent Dept Biosci & Oral Diag Sao Jose Dos Campos SP Brazil Nove Julho Univ Sleep Lab Sao Paulo Brazil

Background: Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP), given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide-Aluminun, =780 nm) and LED (= 660 nm) irradiation in CP patients. Methods/design: 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation;Group 2: laser therapy;Group 3: LED therapy;Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. Discussion: This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies.

关键词： Obstructive Sleep Apnea Cerebral Palsy Laser Therapy Gallium Arsenide gross motor function classification system

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