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Selective percutaneous myofascial lengthening of the lower extremities in children with spastic cerebral palsy

Clinics in Podiatric Medicine and Surgery 2010年第2期27卷 335-343页

作者： Mitsiokapa, Evanthia A. Mavrogenis, Andreas F. Skouteli, Helen Vrettos, Stamatios G. Tzanos, George Kanellopoulos, Anastasios D. Korres, Demetrios S. Papagelopoulos, Panayiotis J. Department of Physical Medicine and Rehabilitation Thriasio Hospital 19018 Elefsina Greece First Department of Orthopaedics Athens University Medical School 15562 Holargos Athens 41 Ventouri Street Greece Third Department of Orthopaedics Athens University Medical School Athens Nikis 2 14561 Kifisia Greece

Children with spastic cerebral palsy commonly acquire lower extremity musculoskeletal deformities that at some point may need surgical correction. The authors present 58 children with spastic cerebral palsy who underwent selective percutaneous myofascial lengthening of the hip adductor group and the medial or the lateral hamstrings. All the patients were spastic diplegic, hemiplegic, or quadriplegic. The indications for surgery were a primary contracture that interfered with the patients' walking or sitting ability or joint subluxation. gross motor ability and gross motor function of the children were evaluated using the gross motor function classification system (GMFCS) and the gross motor function measure (GMFM), respectively. The mean time of the surgical procedure was 14 minutes (range, 1 to 27 minutes). All patients were discharged from the hospital setting the same day after the operation. There were no infections, overlengthening, nerve palsies, or vascular complications. Three patients required repeat procedures for relapsed hamstring and adductor contractures at 8, 14, and 16 months postoperatively. At 2 years after the initial operation, all the children improved on their previous functional level;34 children improved by one GMFCS level, and 5 children improved by two GMFCS levels. The overall improvement in mean GMFM scores was from 71.19 to 83.19. © 2010 Elsevier Inc.

关键词： Cerebral palsy gross motor function classification system gross motor function measure Selective percutaneous myofascial lengthening Spasticity

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Growth in Children with Cerebral Palsy during five years after Selective Dorsal Rhizotomy: a practice-based study

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BMC NEUROLOGY 2010年第1期10卷 57-57页

作者： Westbom, Lena Josenby, Annika Lundkvist Wagner, Philippe Nordmark, Eva Lund Univ Dept Clin Sci Lund Div Paediat Lund Sweden Lund Univ Dept Hlth Sci Div Physiotherapy Lund Sweden Skane Univ Hosp Dept Orthopaed Swedish Natl Competence Ctr Musculoskeletal Disor SE-22185 Lund Sweden Skane Univ Hosp Childrens Hosp SE-22185 Lund Sweden

Background: Overweight is reported as a side effect of SDR. The aims were to study the development of weight, height and body mass index (BMI) during five years after SDR. Methods: This prospective, longitudinal and practice-based study included all 56 children with CP spastic diplegia undergoing SDR from the start in March 1993 to April 2003 in our hospital. The preoperative gross motor function classification system (GMFCS) levels were I-II in 17, III in 15, IV-V in 24 children. Median age at SDR was 4.3 years (range 2.4-7.4 years). Weight and height/recumbent length were measured. Swedish growth charts for typically developing children generated weight, height and BMI z-scores for age and gender. Results: The preoperative median z-scores were for height-1.92 and for body mass index (BMI)-0.22. Five years later, the median BMI z-score was increased by + 0.57 (p < 0.05). The occurrence of thinness (BMI < -2 SD) was decreased (n.s.) and obesity (BMI > + 2 SD) increased (p < 0.05). Baseline BMI and age at the start of follow-up influenced the BMI change during the five years (p < 0.001 and p < 0.05 respectively). The individual growth was highly variable, but a tendency towards increasing stunting with age was seen in severe gross motor dysfunction (GMFCS levels IV-V) and the opposite, a slight catch-up of height in children with walking ability (GMFCS levels I-III). Conclusions: These are the first available subtype-and GMFCS-specific longitudinal growth data for children with CP spastic diplegia. Their growth potential according to these data should be regarded as a minimum, as some children were undernourished. It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic". For some children the weight increase was highly desirable. In others, it resulted in overweight and obesity with risk of negative health effects. Weight and height should be monitored

关键词： Cerebral Palsy gross motor function classification system Preoperative Body Mass Index Body Mass Index Change Selective Dorsal Rhizotomy

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Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study

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BMC PEDIATRICS 2010年第1期10卷 59-59页

作者： Rodby-Bousquet, Elisabet Hagglund, Gunnar Lund Univ Dept Orthopaed Univ Lund Hosp S-22185 Lund Sweden Uppsala Univ Cent Hosp Clin Res Ctr S-72189 Vasteras Sweden

Background: Mobility is important for the cognitive and psychosocial development of children. Almost one third of children with cerebral palsy (CP) are non-ambulant. Wheelchairs can provide independent mobility, allowing them to explore their environment. Independent mobility is vital for activity and participation and reduces the dependence on caregivers. The purpose of this study was to describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in a total population of children with CP. Methods: A cross-sectional study was performed including all children aged 3-18 years with CP living in southern Sweden during 2008. Data was extracted from a register and health care programme for children with CP (CPUP). There were a total of 562 children (326 boys, 236 girls) in the register. Information on the child's use of manual and powered wheelchair indoors and outdoors and the performance in self-propelling or need for assistance were analysed related to age, CP subtype and gross motor function. Results: Wheelchairs for mobility indoors were used by 165 (29%) of the 562 children;61 used wheelchair for independent mobility (32 using manual only, 12 powered only, 17 both) and 104 were pushed by an adult. For outdoor mobility wheelchairs were used by 228 children (41%);66 used a wheelchair for independent mobility (18 using manual only, 36 powered only, 12 both) and 162 were pushed. The use of wheelchair increased with age and was most frequent in the spastic bilateral and dyskinetic subtypes. Most powered wheelchairs were operated by children at GMFCS level IV. Conclusion: In this total population of children with CP, aged 3-18 years, 29% used a wheelchair indoors and 41% outdoors. A majority using manual wheelchairs needed adult assistance (86%) while powered wheelchairs provided independent mobility in most cases (86%). To achieve a high level of independent mobility, both manu

关键词： Cerebral Palsy gross motor function classification system Independent Mobility Wheelchair User gross motor function classification system Level

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INCITE: A randomised trial comparing constraint induced movement therapy and bimanual training in children with congenital hemiplegia

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BMC NEUROLOGY 2010年第1期10卷 4-4页

作者： Boyd, Roslyn Sakzewski, Leanne Ziviani, Jenny Abbott, David F. Badawy, Radwa Gilmore, Rose Provan, Kerry Tournier, Jacques-Donald Macdonell, Richard A. L. Jackson, Graeme D. Univ Queensland Sch Med Queensland Cerebral Palsy & Rehabil Res Ctr Brisbane Qld Australia Florey Neurosci Inst Austin Brain Res Inst Melbourne Vic Australia Univ Queensland Sch Hlth & Rehabil Sci St Lucia Qld Australia Univ Melbourne Dept Med Melbourne Vic 3010 Australia Univ Melbourne Dept Radiol Melbourne Vic 3010 Australia Austin Hlth Dept Neurol Heidelberg Vic Australia

Background: Congenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia. Methods/Design: A matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs) will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days). A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking), cortical excitability using Transcranial Magnetic Stimulation (TMS), functional use of the hand in everyday tasks (Manual Ability classification system) and gross motor function classification system (GMFCS). Outcomes will address neurovascular changes (functional MRI, functional connectivity), and brain (re) organisation (TMS), body structure and function (range of motion, spasticity, strength and se

关键词： Cerebral Palsy Transcranial Magnetic Stimulation motor Evoke Potential gross motor function classification system Abductor Pollicis Brevis

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Feeding and gastrointestinal problems in children with cerebral palsy

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INTERNATIONAL JOURNAL OF REHABILITATION RESEARCH 2010年第3期33卷 218-224页

作者： Erkin, Gulten Culha, Canan Ozel, Sumru Kirbiyik, Eylem Gulsen Ankara Phys Med & Rehabil Educ & Res Hosp Minist Hlth Ankara Turkey

The aim of our study was to identify feeding and gastrointestinal system (GIS) problems in children with cerebral palsy (CP), and to evaluate the relationship between these problems and the severity of CP. A total of 120 children with CP were enrolled consecutively into the study (67 males, 53 females;mean age: 6.0 +/- 2.4 years;range: 2-12 years). The children were classified according to the Swedish classification as diplegic, hemiplegic, or quadriplegic. Severity of CP was classified based on the gross motor function classification system. The amount of time that the caregiver allocated to mealtimes, modifications of the food, as well as feeding and GIS problems was evaluated. Feeding dysfunction was classified as mild, moderate, or severe. Comparisons of GIS and feeding disorders and the severity of CP were carried out using chi(2) test. The results indicated lack of appetite in 46 of the 120 children (38.3%), sialorrhea in 37 (30.8%), constipation in 30 (25%), difficulty in swallowing in 23 (19.2%), and feeding dysfunction in 26 (21.7%). On the basis of the gross motor function classification system (GMFCS), the incidence of GIS problems and feeding dysfunction was found to be significantly higher in the children classified in the severe group. The time taken to consume meals was significantly longer among children with feeding dysfunction. Feeding and GIS problems are frequent in children with CP, and more marked in those with severe CP. Approximately one fourth of children with CP suffer from feeding dysfunction, and more time has to be allocated to consume meals. International Journal of Rehabilitation Research 33: 218-224 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

关键词： cerebral palsy feeding dysfunction gastrointestinal problems gross motor function classification system severity of cerebral palsy

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Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

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BMC NEUROLOGY 2010年第1期10卷 52-52页

作者： Vles, Georges F. Vles, Johan S. van Kleef, Maarten van Zundert, Jan Staal, Heleen M. Weber, Wim E. van Rhijn, Lodewijk W. Soudant, Dan Graham, H. Kerr de Louw, Anton J. Maastricht Univ Med Ctr Maastricht Netherlands Royal Childrens Hosp Melbourne Vic Australia Epilepsy Ctr Kempenhaeghe Heeze Netherlands

Background: Cerebral palsy (CP) may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG) could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis. Methods: We performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS), gross motor function Measure (GMFM) and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS) for spasticity, pain and ease of care. Results: A total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options. Conclusion: RF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial.

关键词： Dorsal Root Ganglion Cerebral Palsy Visual Analogue Scale Score gross motor function classification system Dysport

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A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy

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BMC PUBLIC HEALTH 2010年第1期10卷 179-179页

作者： Bell, Kristie L. Boyd, Roslyn N. Tweedy, Sean M. Weir, Kelly A. Stevenson, Richard D. Davies, Peter S. W. Univ Queensland Queensland Cerebral Palsy & Rehabil Res Ctr Discipline Paediat & Child Hlth Sch Med Brisbane Qld Australia Univ Queensland Childrens Nutr Res Ctr Discipline Paediat & Child Hlth Sch Med Brisbane Qld Australia Queensland Childrens Med Res Inst Brisbane Qld Australia Univ Queensland Sch Human Movement Studies Brisbane Qld Australia Royal Childrens Hosp Dept Speech Pathol Brisbane Qld Australia Univ Virginia Kluge Childrens Rehabil Ctr & Res Inst Childrens Hosp UVA Sch Med Charlottesville VA USA

Background: Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors-linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods: This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1(st) September 2006 and 31(st) December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 +/- 1 months and 60 +/- 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion: This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of y

关键词： Body Composition Cerebral Palsy Sedentary Behaviour Total Body Water gross motor function classification system

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A systematic review of the psychometric properties of Quality of Life measures for school aged children with cerebral palsy

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BMC PEDIATRICS 2010年第1期10卷 81-81页

作者： Carlon, Stacey Shields, Nora Yong, Katherine Gilmore, Rose Sakzewski, Leanne Boyd, Roslyn Austin Repatriat Hosp Florey Neurosci Inst Heidelberg West Vic Australia La Trobe Univ Sch Physiotherapy Bundoora Vic Australia Univ Queensland Sch Med Queensland Cerebral Palsy & Rehabil Res Ctr Herston Qld Australia La Trobe Univ Musculoskeletal Res Ctr Bundoora Vic Australia Univ Queensland Dept Paediat & Child Hlth Royal Childrens Hosp Herston Qld Australia

Background: This systematic review aimed to evaluate the psychometric properties and clinical utility of all condition specific outcome measures used to assess quality of life (QOL) in school aged children with cerebral palsy (CP). Methods: Relevant outcome measures were identified by searching 8 electronic databases, supplemented by citation tracking. Two independent reviewers completed data extraction and analysis of the measures using a modified version of the CanChild Outcome Measures Rating Form. Results: From the 776 papers identified 5 outcome measures met the inclusion criteria: the Care and Comfort Hypertonicity Questionnaire (C&CHQ), the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), CP QOL-Child, DISABKIDS and PedsQL 3.0 CP Module. There was evidence of construct validity for all five measures. Content validity was reported for all measures except PedsQL 3.0. The CPCHILD and CP QOL-Child were the only outcome measures to have reported data on concurrent validity. All measures, with the exception of one (C&CHQ) provided evidence of internal reliability. The CPCHILD and the CP-QOL-Child had evidence of test-retest reliability and DISABKIDS had evidence of inter-rater reliability. There were no published data on the responsiveness of these outcome measures. Conclusions: The CPCHILD and the CP QOL-Child demonstrated the strongest psychometric properties and clinical utility. Further work is needed, for all measures, on data for sensitivity to change.

关键词： Cerebral Palsy School Aged Child gross motor function classification system gross motor function classification system Level Pediatric Outcome Data Collection Instrument

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Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial

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BMC MUSCULOSKELETAL DISORDERS 2010年第1期11卷 71-71页

作者： Herrero, Pablo Asensio, Angel Garcia, Elena Marco, Alvaro Olivan, Barbara Ibarz, Alejandro Gomez-Trullen, Eva M. Casas, Roberto Univ San Jorge Fac Hlth Sci Zaragoza 50830 Spain AIDIMO Zaragoza 50019 Spain Univ Zaragoza Tecnodiscap Grp Zaragoza 50018 Spain Aragonese Hlth Sci Inst Zaragoza 50009 Spain Univ Zaragoza Dpto Fisiatria & Enfermeria E-50009 Zaragoza Spain

Background: Although hippotherapy treatment has been demonstrated to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is to analyse the therapeutic effects or the contraindications of the use of a commercial hippotherapy simulator on several important factors relating to children with cerebral palsy such as their motor development, balance control in the sitting posture, hip abduction range of motion and electromyographic activity of adductor musculature. Methods/Design: The study is a randomised controlled trial. It will be carried out with a sample of 37 children with cerebral palsy divided into two treatment groups. Eligible participants will be randomly allocated to receive either (a) Treatment Group with hippotherapy simulator, maintaining sitting posture, with legs in abduction and rhythmic movement of the simulator or (b) Treatment Group maintaining sitting posture, with legs in abduction and without rhythmic movement of the simulator. Data collection and analysis: all measurements will be carried out by a specially trained blind assessor. To ensure standardization quality of the assessors, an inter-examiner agreement will be worked out at the start of the study. The trial is funded by the Department of Research, Innovation and Development of the Regional Government of Aragon (Official Bulletin of Aragon 23 July 2007), project number PM059/2007. Discussion: Interest in this project is due to the following factors: Clinical originality (there are no previous studies analysing the effect of simulators on the population group of children with CP, nor any studies using as many variables as this project);Clinical impact (infantile cerebral palsy is a chronic multisystemic condition that affects not

关键词： Cerebral Palsy Treatment Session Rhythmic Movement gross motor function classification system Electromyographic Activity

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Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy

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BMC PEDIATRICS 2010年第1期10卷 26-26页

作者： Sorsdahl, Anne Brit Moe-Nilssen, Rolf Kaale, Helga K. Rieber, Jannike Strand, Liv Inger Univ Bergen Dept Publ Hlth & Primary Hlth Care Sect Physiotherapy Sci N-5020 Bergen Norway Bergen Univ Coll Dept Physiotherapy Bergen Norway Barnas Fysioterapisenter Bergen Norway

Background: The effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks. Methods: A repeated measures design was applied with three baseline and two follow up assessments;immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7), diplegia (n = 11), quadriplegia (n = 2) and ataxia (n = 2) participated, age ranging 3-9 y. All levels of gross motor function classification system (GMFCS) and Manual Ability classification system ( MACS) were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures. Results: A main effect of time was shown in the primary outcome measure;gross motor function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged 2.0-6.7, p < 0.01 in the Self-care domain of the functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The children's individual goals were on average attained, Mean Goal Attainment Scaling ( GAS) T-score being 51.3. Non-significant improved scores on the gross motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score. Conclusions: Basic motor abilities and sel

关键词： Cerebral Palsy gross motor function classification system gross motor function classification system Level Goal Attainment Scaling Manual Ability classification system

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