Bilateral Spastic Cerebral Palsy Research Articles

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach.

Objective To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design Monocentric, clinically prospective intervention study. Patients Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial.

To evaluate the effect of stretching and progressive resistance exercise on range of motion and muscle strength in children with cerebral palsy. Thirty-seven children with spastic bilateral cerebral palsy and Gross Motor Function Classification System levels I to III were randomized to an intervention and a comparison group. The intervention included stretching of hamstrings and progressive resistance exercise, targeting the lower extremities for 16 weeks, followed by a 16-week maintenance program. Passive and active popliteal angle and muscle strength were evaluated at 0, 16, and 32 weeks. After 16 weeks nonsignificant improvements were found in passive, active popliteal angle and quadriceps and hamstrings strength. A 16-week stretching and progressive resistance exercise program followed by a 16-week maintenance program showed nonsignificant improvements in passive, active popliteal angle and muscle strength for the intervention group.

Spastik Serebral Palsili Çocuklarda Gövde Eğitiminin Gövde, Üst ve Alt Ekstremite Motor Fonksiyonları Üzerine Etkisi: Tabakalı Randomize Kontrollü Çalışma

Objective: The aim of this study was to investigate the effects of trunk training on the trunk, upper and lower limb motor functions of children with bilateral spastic Cerebral Palsy. Methods: 36 children were recruited for this study; 19 children were included in the trunk training group and 17 children were included in the control group. Motor functions of the children were assessed by the Trunk Control Measurement Scale, Gross Motor Function Measurement, Quality of Upper Extremity Skills Test, Pediatric Balance Scale, Gillette Functional Assessment Scale, Functional Independence Measure for Children and Impact on Family Scale at baseline and after an 8 week of intervention period. Wilcoxon Signed-Rank Test and Mann–Whitney U Test were used to assess the differences. Results: The Trunk Control Measurement Scale (p=0.008), Gross Motor Function Measurement (p=0.047), Quality of Upper Extremity Skills Test (p=0.032), Pediatric Balance Scale (p=0.006), Gillette Functional Assessment Scale (p=0.011) and Functional Independence Measure for Children (p=0.03) scores improved in favor of the trunk training group (p<0.05). Conclusion: Individually structured trunk training is a promising method to improve trunk, upper and lower extremity motor functions and activity levels of children with bilateral spastic Cerebral Palsy.

Identification of gait events in children with spastic cerebral palsy: comparison between the force plate and algorithms

ObjectiveTo compare the gait event identification of five algorithms recommended in the literature with those provided by force plate (gold standard) in children with unilateral or bilateral spastic cerebral palsy (SCP). MethodsThis was a cross-sectional study of the gait of three girls and four boys with a mean age of 8.6±4.7 years. Four children had unilateral SCP with an equinus gait pattern, and the remaining three children exhibited bilateral SCP with a slide/drag gait pattern. Kinematic and kinetic gait data were collected during barefoot walking at a comfortable speed. From a total of 202 steps, the detection of 202 foot-strike (FS) and 194 toe-off (TO) events by each algorithm was compared with the detection of these same events by the force plate. The error between the events detected by the algorithms and those detected by the force plate was determined in milliseconds. Repeated measures ANOVA was used to compare the errors among the algorithms. ResultsThe algorithm reported by Ghoussayni et al. showed the best performance in all situations, except for the identification of FS events on the unaffected side in children with unilateral SCP. For these events, the algorithms reported by Desailly et al. and Zeni et al. showed the best performance. ConclusionGhoussayni et al.’s algorithm can be used to detect gait events in children with SCP when a force plate is not available.

Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination

Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis-footwear combination on the acquisition of walking in a single subject with cerebral palsy. This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. The subject developed the ability to stand and walk using an ankle-foot orthosis-footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis-footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. An ankle-foot orthosis-footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.

Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol

IntroductionSpasticity is one of the primary pathologies associated with cerebral palsy (CP), yet no definitive evidence exists to guide the appropriate level of spasticity management for an individual. Spasticity management...

Influence of Visual Dependence on Inter-Segmental Coordination during Upright Stance in Cerebral Palsy

The presence of visual dependence as an influential factor on the development of functional stability in ambulatory individuals with cerebral palsy (CP) was studied in 22 adults with spastic bilateral CP, 11 of whom were considered visually dependent, and 18 healthy adults. Participants stood upright during pitch plane disturbances of the visual field and support surface. Intersegmental coordination behaviors were assessed by fitting trajectories of adjacent body segments to an ellipse. Mixed-model repeated measures ANOVAs were performed on ellipse orientation angle and area. Dissimilar stabilizing strategies adopted by the two groups with CP imply that visual dependence impacts postural control. Postural reorganization in response to visual flow in all groups indicates that we cannot ignore perceptual aspects of postural control when designing therapeutic interventions.

EFFECTS OF INDIVIDUALLY STRUCTURED TRUNK TRAINING ON BODY FUNCTION AND STRUCTURES IN CHILDREN WITH SPASTIC CEREBRAL PALSY: A STRATIFIED RANDOMIZED CONTROLLED TRIAL

Purpose: This study aimed to investigate the effects of trunk training on body function and structures of children with spastic cerebral palsy (CP). Methods: Children included in this study were classified according to the Gross Motor Function Classification System (GMFCS) and divided into two groups by stratified randomization based on their GMFCS levels and ages. A total of 36 children with bilateral spastic CP were recruited for this study, and 19 children (4 females, 15 males, age=8.81±3.92 years) were included in the trunk training group, and 17 children (6 females, 11 males, age=10.44±4.63 years) were included in the control group. Muscle tone of upper and lower extremity muscles was assessed using the Modified Tardieu Scale (MTS), and muscle activation of the trunk muscles was assessed using Surface Electromyography during rest (sEMG minimum) and forward reaching (sEMG maximum) at baseline and after an eight-week intervention. Results: When the therapy-induced changes were considered, it was seen that there was no difference in muscle tone in both groups (p>0.05). The sEMG maximum scores for erector spinae muscles (p=0.025 for right and p=0.006 for left) improved in the trunk training group. There was no change in the sEMG scores of lumbar multifidus, M. rectus abdominis, internal oblique-transversus abdominis, external oblique, and M. gluteus maximus muscles (p>0.05). Conclusion: Individually-structured trunk training is a promising method to increase activation of trunk extensors. This intervention can be used safely without the risk of increasing muscle tone of upper and lower extremities in children with CP.

Cerebral palsy prevalence, subtypes, and associated impairments: a population‐based comparison study of adults and children

To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP. CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), andwiththe most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males). Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01). Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed. Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.

Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy

BackgroundCrouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries.ObjectiveTo evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP.Patients and methodsA total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively.ResultsHighly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance.ConclusionThe rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery.

Prevalence and classification of equinus foot in bilateral spastic cerebral palsy.

Equinus is a common deformity in children with bilateral spastic cerebral palsy (BSCP). While dynamic equinus usually is treated by conservative therapy, fixed contractures need surgical correction. To choose the appropriate surgical method, it is important to discriminate between isolated gastrocnemius shortening and combined gastrosoleus complex contracture. In a retrospective study 938 patients with BSCP were studied. Patients underwent gait analysis and clinical examination. 248 patients (496 limbs) met the inclusion criteria. Data from motion analysis and clinical examination were used to calculate the prevalence and to further classify fixed equinus foot. The prevalence of equinus was 83.3%. During clinical exam 246 (59.6%) limbs showed combined gastrosoleus complex contracture and 167 (40.4%) isolated gastrocnemius contracture. Max. DF at stance and mean DF at initial contact were significantly reduced in combined contracture, while max. ROM was increased (P < 0.05). Corroborating the results of previous studies, in this study there was a high prevalence of fixed equinus in patients with BSCP. The prevalence of equinus correlated with increasing age. As half of the patients with fixed equinus show a different involvement of gastrocnemius and soleus muscle, we recommend to apply Silfverskiöld's test to discriminate between those two types to choose the appropriate surgical therapy.

Dual Mode Feedback-Controlled Cycling System for Upper Limb Rehabilitation of Children with Cerebral Palsy

Background/Objectives: This paper proposes a dual mode feedback-controlled cycling system for children with spastic cerebral palsy to rehabilitate upper extremities. Repetitive upper limb exercise in this therapy aims to both reduce and analyze the abnormal torque patterns of arm movements in three- dimensional space. Methods/Statistical analysis: We designed an exercycle robot which consists of a BLDC motor, a torque sensor, a bevel gear and bearings. Mechanical structures are customized for children of age between 7~13 years old and induces reaching and pulling task in a symmetric circulation. The shafts and external frames were designed and printed using 3D printer. While the child performs active/passive exercise, angular position, angular velocity, and relative torque of the pedal shaft are measured and displayed in real time. Findings: Experiment was designed to observe the features of a cerebral palsy child’s exercise. Two children with bilateral spastic cerebral palsy participated in the experiment and conducted an active exercise at normal speed for 3 sets, 15 seconds for each. As the pedal reached 90 degrees and 270 degrees, the subject showed minimum torque, in which the child showed difficulty in the pulling task of the cycle. The passive exercise assisted the child to maintain a relatively constant torque while visually observing the movement patterns. Using two types of exercise enabled the child to overcome the abnormal torque measured in the active data by performing the passive exercise. Thus, this system has advantage not only in allowing the child to perform the difficult task, which may contribute in improving the muscle strength and endurance and reducing the spasticity but also provide customizable system according to the child’s motion characteristic. Improvements/Applications: Further study is needed to observe how passive exercise influences the movement characteristics of an active motion and how customized experiment settings can optimize the effect of pediatric rehabilitation for spastic cerebral palsy.

Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status.

Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR=0.59 (95% CI:0.38-0.91) for Western and OR=0.79 (95% CI:0.61-1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR=1.27 (95% CI:1.05-1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99-1.14) for children of Non-Western immigrants. While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.

Influence of impaired selective motor control on gait in children with cerebral palsy.

PurposeSpastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP.MethodsThe relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years.ResultsMean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width.ConclusionResults indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening.Level of evidenceLevel II Retrospective Study

Association of Infants Exposed to Prenatal Zika Virus Infection With Their Clinical, Neurologic, and Developmental Status Evaluated via the General Movement Assessment Tool

There is an urgent need to assess neurodevelopment in Zika virus (ZIKV)-exposed infants. To perform general movement assessment (GMA) at 9 to 20 weeks' postterm age and to evaluate whether the findings are associated with neurodevelopmental outcomes at age 12 months in infants prenatally exposed to acute maternal illness with rash in Brazil during the ZIKV outbreak and in age-matched controls. In this cohort study, infants prenatally exposed to acute maternal illness with rash were recruited at medical institutions in Rio de Janeiro and Belo Horizonte, Brazil, from February 1, 2016, to April 30, 2017, while infants without any exposure to maternal illness originated from the Graz University Audiovisual Research Database for the Interdisciplinary Analysis of Neurodevelopment. Participants were 444 infants, including 76 infants without congenital microcephaly, 35 infants with microcephaly, and 333 neurotypical children matched for sex, gestational age at birth, and age at GMA. General movement assessment performed at 9 to 20 weeks' postterm age, with negative predictive value, positive predictive value, sensitivity, and specificity generated, as well as clinical, neurologic, and developmental status (Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] scores) at age 12 months. Motor Optimality Scores were generated based on the overall quality of the motor repertoire. Adverse outcomes were defined as a Bayley-III score less than 2 SD in at least 1 domain, a score less than 1 SD in at least 2 domains, and/or atypical neurologic findings. A total of 444 infants were enrolled, including 111 children prenatally exposed to a maternal illness with rash and 333 children without any prenatal exposure to maternal illness (57.7% male and mean [SD] age, 14 [2] weeks for both groups); 82.1% (46 of 56) of ZIKV-exposed infants without congenital microcephaly were healthy at age 12 months. Forty-four of 46 infants were correctly identified by GMA at 3 months, with a negative predictive value of 94% (95% CI, 85%-97%). Seven of 10 ZIKV-exposed children without microcephaly with adverse neurodevelopmental outcomes were identified by GMA. The GMA positive predictive value was 78% (95% CI, 46%-94%), sensitivity was 70% (95% CI, 35%-93%), specificity was 96% (95% CI, 85%-99%), and accuracy was 91% (95% CI, 80%-97%). Children with microcephaly had bilateral spastic cerebral palsy; none had normal movements. The Motor Optimality Score differentiated outcomes: the median Motor Optimality Score was 23 (interquartile range [IQR], 21-26) in children with normal development, 12 (IQR, 8-19) in children with adverse outcomes, and 5 (IQR, 5-6) in children with microcephaly, a significant difference (P = .001). This study suggests that although a large proportion of ZIKV-exposed infants without microcephaly develop normally, many do not. The GMA should be incorporated into routine infant assessments to enable early entry into targeted treatment programs.

The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy

BackgroundTreatment of cerebral palsy includes an interdisciplinary concept and in more severe cases the well-established multi-level surgery (MLS). Different kinds of orthoses are typically part of postoperative treatment but there is a lack of knowledge about their additional benefit. Research questionDo ankle foot orthoses lead to an additional, measurable improvement of gait after MLS? Methods20 children with bilateral spastic cerebral palsy (9 retrospective, 11 in a postoperative clinical routine) were included. All had a preoperative gait analysis before MLS. Postoperatively, they were fitted with different ankle foot orthoses (AFO), depending on their individual needs. Dynamic ankle foot orthoses (DAFO), combined DAFO with additional dynamic, elastic shank adaptation (DESA) and ground reaction force AFOs (GRAFO) were used. Patients underwent a second gait analysis 1.5 (± 0.6) years postoperatively barefoot and with orthoses. Data analysis included testing for normal distribution (Shapiro-Wilk-Test) and further nonparametric statistical testing on basis of a Wilcoxon Single-Rank Test. ResultsThe operation produced changes in the hip, knee and ankle joint, and the pelvis. Spatiotemporal parameters showed significant changes due to additional use of the orthoses. Further, additional kinematic changes occurred at the hip, knee and ankle joint as well as the foot. The Gillette Gait Index (GGI) improved significantly by supplementary orthoses, but not by surgery alone. The Gait Profile Score (GPS) and Gait Deviation Index (GDI) rather showed changes due to the surgery. SignificanceMLS significantly improves GPS and GDI more than a year after surgery, which can be interpreted as an improvement in gait pattern. In contrast, the GGI is improved by additional postoperative orthotic treatment, which implies that walking ability itself has improved, rather than the gait pattern. Orthoses show a positive additional effect on surgical results at different anatomical levels. Spatiotemporal parameters are positively influenced solely by additional orthotic support.

Improving gait and lower-limb muscle strength in children with cerebral palsy following Selective Percutaneous Myofascial Lengthening and functional physiotherapy

Selective Percutaneous Myofascial Lengthening (SPML) is an innovative minimally invasive surgical procedure, using micro incisions often combined with alcohol nerve block, for managing muscle contractures and stiffness in children with cerebral palsy (CP). There is lack of evidence of effects of a combined intervention of SPML and physiotherapy on gait function and muscle strength in CP. This study investigated the change in gait function and muscle strength in children with CP who underwent gait laboratory assessment before and after SPML, combined with obturator nerve blocks, and 9-month post-surgical functional physiotherapy. Ten children with bilateral spastic CP, Gross Motor Function Classification System (GMFCS) level II-IV, age 5-7 years, participated in this study. The Global Gait Graph Deviation Index (Global GGDI) and isometric muscle strength (hand-held dynamometry) were the primary outcome measures. Changes in spatiotemporal gait parameters, gross motor function and GMFCS level were secondarily examined. A significant improvement of Global GGDI was found (p < 0.05). The mean strength in hip flexors, extensors and adductors, knee extensors, and ankle dorsiflexors increased significantly (p < 0.05). Children improved significantly their GMFCS level and gross motor capacity (p < 0.05). SPML procedure combined with functional physiotherapy can improve gait function and lower-limb muscle strength.

Does stable sitting influence upper limb function in children with cerebral palsy?

Seyhan K, Kerem-Günel M. Does stable sitting influence upper limb function in children with cerebral palsy? Turk J Pediatr 2019; 61: 79-84. Bilateral spastic cerebral palsy (BSCP) patients frequently need to use various sitting devices for body control and function. The aim of this study was to investigate whether the use of a belt to position the pelvis in an adjustable chair would affect upper limb function in preschool children with BSCP. Fortyone children with BSCP [mean age 44 ±11, range 18-60 months] classified according to the Gross Motor Function Classification System (GMFCS), as level III (n=21) and level IV (n=20) were fitted with a hip-positioning belt. Upper limb functions were assessed by Quality of Upper Extremity Skills Test (QUEST). The median scores of the following upper extremity functions increased significantly by wearing the hip positioning belt: dissociated movements, grasping, weight bearing and protective extension. The total QUEST score increased from 56.7 (±46.3) to 66.1 (±39.2) (p < 0.001). The portable and adaptable hip-positioning belt may be used in daily life to improve upper limb activity in preschool children with moderate to severe BSCP.

Cerebral Palsy in North Indian Children: Clinico-etiological Profile and Comorbidities.

Aims and Objectives:Cerebral palsy (CP) is a common motor disability in children. This study aimed at elaborating various comorbidities and etiologies and also at correlating motor disability with other disabilities.Material and Methods:This hospital-based study was conducted in the outpatient department of a tertiary care hospital in Delhi on 160 children with CP in the age group 2–15 years. A detailed history taking and examination were conducted for each patient and appropriate investigations were performed.Results:Most patients, that is 64.4%, were younger than 5 years of age and 72.5% were males. Most common etiology was birth asphyxia (41.9%). Maximum patients were of bilateral spastic (spastic quadriplegic) CP accounting 43.1%. Intellectual disability was the most common comorbidity across all subtypes of CP followed by epilepsy. Comorbidities such as epilepsy and all visual problems except optic atrophy were more common in spastic quadriplegic CP. Hearing, speech impairment, and optic atrophy were more common in dyskinetic CP. Chewing, swallowing, and drooling problems were more common in spastic quadriplegic CP.Conclusion:Most common risk factor of CP is birth asphyxia; thus, by improving health care facilities, its incidence can be reduced. CP affects not only motor functions but also other important functions of body as well, and the more severe the motor disabilities, the more are other comorbidities and their intensity also increases with that of the intensity of brain insult.

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy.

To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.