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Can Clinical Assessment of Locomotive Body function Explain gross motor Environmental Performance in Cerebral Palsy?

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JOURNAL OF CHILD NEUROLOGY 2016年第4期31卷 474-480页

作者： Mengibar, Jose Manuel Sanz Santonja-Medina, Fernando Sanchez-de-Muniain, Paloma Canteras-Jordana, Manuel Kikis Children Clin 124 Thurleigh Rd London SW12 8TU England Univ Murcia Fac Med Murcia Spain Clin Rehabil Infantil Madrid Spain

gross motor function classification system has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between gross motor function classification system level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for gross motor function classification system and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the gross motor function classification system depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.

关键词： motor development cerebral palsy child development gross motor function classification system assessment disability development delays

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Effects of severity of gross motor disability on anticipatory postural adjustments while standing in individuals with bilateral spastic cerebral palsy

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RESEARCH IN DEVELOPMENTAL DISABILITIES 2016年 57卷 92-101页

作者： Tomita, Hidehito Fukaya, Yoshiki Takagi, Yukina Yokozawa, Asami Aichi Prefectural Hosp 5-1 Aza YanagisawaMotojyuku Cho Okazaki Aichi 4443505 Japan Rehabil Ctr Disabled Children 5-1 Aza YanagisawaMotojyuku Cho Okazaki Aichi 4443505 Japan Toyohashi SOZO Univ Grad Sch Hlth Sci 20-1 MatsushitaUshikawa Cho Toyohashi Aichi 4408511 Japan Yachiyo Hosp 2-2-7 Sumiyoshi Cho Anjo 4468510 Japan Suzukake Hlth Care Hosp 2042-4 Ohara Iwata 4380043 Japan

Background: Although individuals with bilateral spastic cerebral palsy (BSCP) exhibit several deficits in anticipatory postural adjustments (APAs) while standing, effects of severity of motor disability on their APAs are unclear. Aims: To determine whether individuals with BSCP exhibit severity-dependent deficits in APAs. Methods and procedures: Seven individuals with level II BSCP (BSCP-II group) and seven with level III BSCP (BSCP-III group) according to the gross motor function classification system and seven healthy controls lifted a load under two different load conditions. Outcomes and results: Anticipatory activities of the erector spinae (ES), medial hamstring (MH), and gastrocnemius (GCM) were smaller in the two BSCP groups than in the control group. Although the anticipatory GCM activity was similar between the BSCP groups, the ES and MH activities were larger in the BSCP-II group than in the BSCP-III group. In the BSCP-II group, an increase in anticipatory activity with an increase in load was observed in the MH, but not in the GCM. In the BSCP-III group, load-related modulation was not found in the MH or GCM. Conclusions and implications: The present findings suggest that in individuals with BSCP with severe motor disability, APA deficits extend to more proximal parts of the body. (C) 2016 Elsevier Ltd. All rights reserved.

关键词： Bilateral spastic cerebral palsy Anticipatory postural adjustments gross motor function classification system Electromyography Center of pressure

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Weight Status in the First 2 Years of Life and Neurodevelopmental Impairment in Extremely Low Gestational Age Newborns

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JOURNAL OF PEDIATRICS 2016年 168卷 30-+页

作者： Belfort, Mandy B. Kuban, Karl C. K. O'Shea, T. Michael Allred, Elizabeth N. Ehrenkranz, Richard A. Engelke, Stephen C. Leviton, Alan Brigham & Womens Hosp Dept Pediat Newborn Med 75 Francis St Boston MA 02115 USA Boston Med Ctr Div Pediat Neurol Boston MA USA Wake Forest Univ Dept Pediat Winston Salem NC 27109 USA Boston Childrens Hosp Dept Neurol Neuroepidemiol Unit Boston MA USA Yale Univ Sch Med Dept Pediat Sect Neonatal Perinatal Med New Haven CT 06510 USA Eastern Carolina Univ Sch Med Div Neonatol Dept Pediat Greenville NC USA

Objective To examine the extent to which weight gain and weight status in the first 2 years of life relate to the risk of neurodevelopmental impairment in extremely preterm infants. Study design In a cohort of 1070 infants born between 23 and 27 weeks' gestation, we examined weight gain from 7-28 days of life (in quartiles) and weight z-score at 12 and 24 months corrected age (in 4 categories: <-2;>= -2, < -1;>= 1, <1;and >= 1) in relation to these adverse neurodevelopmental outcomes: Bayley-II mental development index < 55, Bayley-II psychomotor development index < 55, cerebral palsy, gross motor function classification system >= 1 (cannot walk without assistance), microcephaly. We adjusted for confounders in logistic regression, stratified by sex, and performed separate analyses including the entire sample, and excluding children unable to walk without assistance (motor impairment). Results Weight gain in the lowest quartile from 7-28 days was not associated with higher risk of adverse outcomes. Children with a 12-month weight z-score <-2 were at increased risk for all adverse outcomes in girls, and for microcephaly and gross motor function classification system >= 1 in boys. However, excluding children with motor impairment attenuated all associations except that of weight z-score <-2 with microcephaly in girls. Similarly, most associations of low weight z-score at 24 months with adverse outcomes were attenuated with exclusion of children with motor impairment. Conclusion Excluding children who have gross motor impairment appears to eliminate the association of low weight status with neurodevelopmental impairments at 2 years in extremely preterm infants.

关键词： BSID-II Bayley Scales of Infant Development, Second Edition ELGAN Extremely low gestational age newborn GMFCS gross motor function classification system MDI Mental Development Index NICU Neonatal intensive care unit PDI Psychomotor Development Index

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gross motor function Measure Evolution Ratio: Use as a Control for Natural Progression in Cerebral Palsy

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ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 2016年第5期97卷 807-814页

作者： Marois, Pierre Marois, Mikael Pouliot-Laforte, Annie Vanasse, Michel Lambert, Jean Ballaz, Laurent St Justine Univ Hosp Ctr Marie Enfant Rehabil Ctr 5200 Rue Belanger Est Montreal PQ H1T 1C9 Canada Ecole Polytech Dept Engn Phys Montreal PQ H3C 3A7 Canada Univ Quebec Dept Phys Act Sci Montreal PQ H3C 3P8 Canada Univ Montreal Dept Neurol Sci Montreal PQ Canada Univ Montreal Sch Med Dept Social & Prevent Med Montreal PQ H3C 3J7 Canada

Objective: To develop a new way to interpret gross motor function Measure (GMFM-66) score improvement in studies conducted without control groups in children with cerebral palsy (CP). Design: The curves, which describe the pattern of motor development according to the children's gross motor function classification system level, were used as historical control to define the GMFM-66 expected natural evolution in children with CP. These curves have been modeled and generalized to fit the curve to particular children characteristics. Setting: Research center. Participants: Not applicable. Interventions: Not applicable. Mean Outcome Measures: Not applicable. Results: Assuming that the GMFM-66 score evolution followed the shape of the Rosenbaum curves, by taking into account the age and GMFM-66 score of children, the expected natural evolution of the GMFM-66 score was predicted for any group of children with CP who were <8 years old. Because the expected natural evolution could be predicted for a specific group of children with CP, the efficacy of a treatment could be determined by comparing the GMFM-66 score evolution measured before and after treatment with the expected natural evolution for the same period. A new index, the gross motor function Measure Evolution Ratio, was defined as follows: gross motor function Measure Evolution Ratio = measured GMFM-66 score change/expected natural evolution. Conclusions: For practical or ethical reasons, it is almost impossible to use control groups in studies evaluating effectiveness of many therapeutic modalities. The gross motor function Measure Evolution Ratio gives the opportunity to take into account the expected natural evolution of the gross motor function of children with CP, which is essential to accurately interpret the therapy effect on the GMFM-66. (C) 2016 by the American Congress of Rehabilitation Medicine

关键词： Cerebral palsy Child Control groups motor skills disorders Rehabilitation CP cerebral palsy GMFCS gross motor function classification system GMFM-66 gross motor function Measure PT physical therapy

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Assessment of Abilities and Comorbidities in Children With Cerebral Palsy

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JOURNAL OF CHILD NEUROLOGY 2015年第12期30卷 1640-1645页

作者： Gabis, Lidia V. Tsubary, Netta Misgav Leon, Odelia Ashkenasi, Arie Shefer, Shahar Safra Childrens Hosp Weinberg Dev Ctr Tel Hashomer Israel Tel Aviv Univ Sakler Sch Med IL-69978 Tel Aviv Israel

This study examines major comorbidities in children with severe cerebral palsy and the feasibility of psychological tests for measuring abilities in a more impaired population. Eighty psychological evaluations of children with cerebral palsy aged 1.8 to 15.4 years (mean = 5.6) were analyzed. Major comorbid disorders were correlated with severity of motor disability. More than half of the cohort were diagnosed with severe cerebral palsy according to the gross motor function classification system. Multiple subtests were combined in order to assess the intellectual level. Normal intelligence was found in 22.5%, and 41.3% had moderate or severe intellectual impairment. Epilepsy occurred in 32.5% and attention-deficit hyperactivity disorder (ADHD) in 22.5%. Intellectual disability correlated with motor ability and with epilepsy. In a logistic regression model, epilepsy and motor ability score predicted 29.9% of IQ score variance. Intellectual impairment and epilepsy are common comorbidities. Subtests from different scales should be applied and interpreted with caution.

关键词： epilepsy intelligence cerebral palsy comorbidities gross motor function classification system

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Neonatal Magnetic Resonance Imaging Pattern of Brain Injury as a Biomarker of Childhood Outcomes following a Trial of Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy

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JOURNAL OF PEDIATRICS 2015年第5期167卷 987-+页

作者： Shankaran, Seetha McDonald, Scott A. Laptook, Abbot R. Hintz, Susan R. Barnes, Patrick D. Das, Abhik Pappas, Athina Higgins, Rosemary D. Wayne State Univ Sch Med Dept Pediat Detroit MI 48201 USA Res Triangle Inst Int Biostat & Epidemiol Div Res Triangle Pk NC USA Brown Univ Women & Infants Hosp Dept Pediat Providence RI 02908 USA Stanford Univ Sch Med Dept Pediat Palo Alto CA 94304 USA Stanford Univ Sch Med Dept Radiol Palo Alto CA 94304 USA

Objective To examine the ability of magnetic resonance imaging (MRI) patterns of neonatal brain injury defined by the National Institute of Child Health and Human Development Neonatal Research Network to predict death or IQ at 6-7 years of age following hypothermia for neonatal encephalopathy. Study design Out of 208 participants, 124 had MRI and primary outcome (death or IQ <70) data. The relationship between injury pattern and outcome was assessed. Results Death or IQ <70 occurred in 4 of 50 (8%) of children with pattern 0 (normal MRI), 1 of 6 (17%) with 1A (minimal cerebral lesions), 1 of 4 (25%) with 1B (extensive cerebral lesions), 3 of 8 (38%) with 2A (basal ganglia thalamic, anterior or posterior limb of internal capsule, or watershed infarction), 32 of 49 (65%) with 2B (2A with cerebral lesions), and 7 of 7 (100%) with pattern 3 (hemispheric devastation), P < .001;this association was also seen within hypothermia and control subgroups. IQ was 90 +/- 13 among the 46 children with a normal MRI and 69 +/- 25 among the 50 children with an abnormal MRI. In childhood, for a normal outcome, a normal neonatal MRI had a sensitivity of 61%, specificity of 92%, a positive predictive value of 92%, and a negative predictive value of 59%;for death or IQ < 70, the 2B and 3 pattern combined had a sensitivity of 81%, specificity of 78%, positive predictive value of 70%, and a negative predictive value of 87%. Conclusions The Neonatal Research Network MRI pattern of neonatal brain injury is a biomarker of neurodevelopmental outcome at 6-7 years of age.

关键词： ALIC Anterior limb of the internal capsule BGT Basal ganglia or thalamus CP Cerebral palsy GMFCS gross motor function classification system HIE Hypoxic-ischemic encephalopathy MRI Magnetic resonance imaging NICHD National Institute of Child Health and Human Development NPV Negative predictive value NRN Neonatal Research Network PLIC Posterior limb of the internal capsule PPV Positive predictive value WM White matter WPPSI Wechsler Preschool and Primary Scale of Intelligence WS Watershed

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Corticospinal Tract Injury Precedes Thalamic Volume Reduction in Preterm Infants with Cystic Periventricular Leukomalacia

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JOURNAL OF PEDIATRICS 2015年第2期167卷 260-+页

作者： Kersbergen, Karina J. de Vries, Linda S. Groenendaal, Floris van Haastert, Ingrid C. Chew, Andrew T. M. Makropoulos, Antonios Dawson, Sarah L. Cowan, Frances M. Benders, Manon J. N. L. Counsell, Serena J. Wilhelmina Childrens Hosp Dept Perinatol Utrecht Netherlands Univ Med Ctr Utrecht Brain Ctr Rudolf Magnus Utrecht Netherlands Kings Coll London Ctr Developing Brain Div Imaging Sci & Biomed Engn London WC2R 2LS England Univ London Imperial Coll Sci Technol & Med Dept Comp Biomed Image Anal Grp London England Univ London Imperial Coll Sci Technol & Med Dept Pediat London England

Objectives To measure both fractional anisotropy (FA) values in the corticospinal tracts (CSTs) and volume of the thalami in preterm infants with cystic periventricular leukomalacia (c-PVL) and to compare these measurements with control infants. Study design Preterm infants with c-PVL and controls with magnetic resonance imaging data acquired between birth and term equivalent age (TEA) were retrospectively identified in 2 centers. Tractography of the CST and segmentation of the thalamus were performed, and values from infants with c-PVL and controls were compared. Results Thirty-three subjects with c-PVL and 31 preterm controls were identified. All had at least 1 scan up to TEA, and multiple scans were performed in 31 infants. A significant difference in FA values of the CST was found between cases and controls on the scans both before and at TEA. Absolute thalamic volumes were significantly reduced at TEA but not on the earlier scans. Data acquired in infancy showed lower FA values in infants with c-PVL. Conclusions Damage to the CST can be identified on the early scan and persists, whereas the changes in thalamic volume develop in the weeks between the early and term equivalent magnetic resonance imaging. This may reflect the difference between acute and remote effects of the extensive injury to the white matter caused by c-PVL.

关键词： AD Axial diffusivity AUC Area under the curve CP Cerebral palsy c-PVL Cystic periventricular leukomalacia CST Corticospinal tract DTI Diffusion tensor imaging FA Fractional anisotropy GA Gestational age GMFCS gross motor function classification system MD Mean diffusivity MRI Magnetic resonance imaging NPV Negative predictive value PLIC Posterior limb of the internal capsule PMA Postmenstrual age PPV Positive predictive value PVL Periventricular leukomalacia RD Radial diffusivity TBV Total brain volume TE Echo time TEA Term equivalent age TR Repetition time

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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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Eye Movement During Reading in Young Adults With Cerebral Palsy Measured With Eye Tracking

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POSTGRADUATE MEDICINE 2014年第5期126卷 146-158页

作者： Lampe, Renee Turova, Varvara Blumenstein, Tobias Alves-Pinto, Ana Tech Univ Munich Klinikum Rechts Isar D-80290 Munich Germany

Background: Cerebral palsy is a nonprogressive brain disorder associated with lifelong motor impairments and often with cognitive deficits, impaired communication, and impaired sensory perception. Vision deficits, in particular, occur frequently in cerebral palsy and can lead to reading difficulties. Objective: Investigate the extent to which the motor impairments in this clinical group affect patients' ability to read. Methods: An eye-tracking system was used to record the eye movements during a reading task in 31 adults diagnosed with cerebral palsy and in 10 healthy controls. Participants were asked to read out loud 1 to 5 excerpts from children's books. Results: In comparison to the healthy readers, cerebral palsy patients took longer to read the excerpts;made more saccades, fixations, and regressions;and made shorter saccades. Average fixation times were similar between the 2 groups, but the average saccade duration was significantly longer for the cerebral palsy group, as a function of the degree of severity of motor impairment. The latter was not a determinant of the level of text comprehension achieved by these patients. Conclusions: Objective measures of eye movement during a reading task can be obtained in cerebral palsy patients using eye-tracking techniques. Results suggest that cerebral palsied patients may experience difficulties in searching for words during reading.

关键词： cerebral palsy eye tracking vision reading gross motor function classification system

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Botulinum Toxin A for Nonambulatory Children with Cerebral Palsy: A Double Blind Randomized Controlled Trial

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JOURNAL OF PEDIATRICS 2014年第1期165卷 140-+页

作者： Copeland, Lisa Edwards, Priya Thorley, Megan Donaghey, Samantha Gascoigne-Pees, Laura Kentish, Megan Lindsley, Jayne McLennan, Kim Sakzewski, Leanne Boyd, Roslyn N. Univ Queensland Queensland Cerebral Palsy Hlth Serv Dept Rehabil Royal Childrens Hosp Brisbane Qld Australia Univ Queensland Queensland Cerebral Palsy & Rehabil Res Ctr Sch Med Brisbane Qld Australia

Objectives To examine the efficacy and safety of intramuscular botulinum toxin A (BoNT-A) to reduce spasticity and improve comfort and ease of care in nonambulant children with cerebral palsy (CP). Study design Nonambulant children with CP (n = 41;gross motor function classification system level IV = 3, level V = 38;mean age 7.1 years, range 2.3-16 years, 66% male) were randomly allocated to receive either intramuscular BoNT-A injections (n = 23) or sham procedure (n = 18) combined with therapy. The analysis used generalized estimating equations with primary outcome the Canadian Occupational Performance Measure (COPM) at 4 weeks postintervention and retention of effects at 16 weeks. Adverse events (AE) were collected at 2, 4, and 16 weeks by a physician masked to group allocation. Results There were significant between group differences favoring the BoNT-A-treated group on COPM performance at 4 weeks (estimated mean difference 2.2, 95% CI 0.8, 3.5;P = .002) and for COPM satisfaction (estimated mean difference 2.2, 95% CI 0.5, 3.9;P = .01). These effects were retained at 16 weeks for COPM satisfaction (estimated mean difference 1.8, 95% CI 0.1, 3.5;P = .04). There were more mild AE at 4 weeks for the BoNT-A group (P = .002), however, there were no significant between-group differences in the reporting of moderate and serious AE. Conclusions In a double-blind randomized sham-controlled trial, intramuscular BoNT-A and therapy were effective for improving ease of care and comfort for nonambulant children with CP. There was no increase in moderate and severe AE in the children who had BoNT-A injections compared with the sham group.

关键词： AE Adverse events BoNT-A Botulinum toxin A CCHQ Care and Comfort Hypertonicity Questionnaire COPM Canadian Occupational Performance Measure CP Cerebral palsy CPCHILD Caregiver Priorities and Child Health Index of Life with Disabilities CPQOL-child Cerebral Palsy Quality of Life Questionnaire for Children GEE Generalized estimating equation GMFCS gross motor function classification system PPP Pediatric Pain Profile SS Sample size

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