Cerebral Palsy Children Research Articles

Comparative Efficacy of Therapeutic Panchkarma Procedures in Children with Cerebral Palsy

Introduction: Cerebral palsy (CP) continues to be one of the most common but challenging physical disabilities in children. It is named Balsanvardhan Vikruti as there is delayed growth and development due to brain damage. It accounts for nearly 15% of the child population (1 in 6). Objectives: To compare the efficacy of Brimhan (Anabolic) procedures Vs alternate Brimhan- Rukshan (Anabolic - Catabolic) Panchkarma procedures in the management of CP children of 2-8 years age group. Material and Methods: The study was carried out in the IPD of Kaumarbhritya, MGACHRC, Salod. Twenty patients fulfilling the diagnostic criteria were included and randomly distributed into two groups of 10 each. Group A was given Brimhan procedures like Talapothichil/Shiropichu, Annalepan, Pindswed, Tailadhara and MatraBasti for 3 days followed by Rukshan procedures like Talapothichil/Shirolepan, Udgharshan, Kwathdhara, Patrapottali and Niruh Basti for next 3 days alternate 5cycles starting and end with Brimhan in total 15 days and 15 days follow-up for 3 consecutive months. Group B received only Brimhan procedures for the same pattern and duration. Three such courses were administered to both Groups with an interval of 15 days along with necessary symptomatic treatment, physiotherapy and occupational therapy. Result: The study revealed that Group A patients showed more improvement (21%) than Group B (19%) in all parameters like gross motor, fine motor, language/speech, and personal social with enhancement in power and activities of daily living (Barthel index). Spasticity, convulsions were reduced and quality of life was increased in both the Groups. Conclusion: Multiple interventions are essential in the management of CP. Alternate Brimhan-Rukshan Panchkarma procedures are more beneficial with physiotherapy and occupational therapy as CP has Vata-Kapha Dosha dominance.

OUTCOME OF DEVELOPMENTAL THERAPY IN CHILDREN WITH CEREBRAL PALSY CHILDREN: A PROSPECTIVE COHORT

Introduction: Cerebral palsy (CP) is the non-progressive disorder of motor and posture with associated delayed development in areas of cognition, perception, behavior and sensation, due to insult to immature brain. Improvement in all developmental domains of CP patients depends upon early institution of rehabilitation programs involving all multidisciplinary approach. The portage early education program (PEEP) is a worldwide, effective and early interventional method, for developmentally delayed children. Objective: To determine the outcome of developmental therapy in children with CP by using PEEP. Study Design: Experimental research design (within group) Settings: The children hospital and the institute of child health Multan. Methodology: 156 patients of 2 to 10 years of age, both gender from January 2020 to December 2020, diagnosed as CP were enrolled for this study. All children were assessed by using PEEP and GMFM (Gross Motor Function Measure) twice 6 months apart. A trained clinical psychologist administered PEEP to all the children. All the Patients were advised regular weekly sessions at hospital by multidisciplinary team and at least 2 hours per day for continuation of these therapies at home. At the end of 6 months we found that all families had not followed this. The patient who visited >2times/month were considered compliant and those visited <2times/month were considered non-compliant. Data was analyzed by using SSPS version 16. Paired t test was used to compare the developmental outcome of compliant and non-compliant groups. Results: Out of 156 participants, 58(37%) were in compliant and 98(63%) non-compliant. Male subjects were prominent 42(72.41%) and 67(68.37%) respectively. Most of the participants belonged to 3-6 years of age in both groups28(48.29%) and 51(52.04%) respectively. Spastic quadriplegia (26(44.83%), 57 (58.16%)), and level 5 on GMFM 24(42.86) and 52(53.06%) respectively was commonly presents in both patient groups. The mean comparison of DQ of Compliant CP Children at initial stage and after six months in areas of GM, C, SH, S, L and GMFM was found statistically significant. Conclusion: CP children should be on regular follow up for developmental therapy for long time for better outcome. PEEP is an excellent system for the assessment, training and rehabilitation of children with delayed development.

Hearing and Visual Impairment in Children with Cerebral Palsy, A Study in Tertiary Level Hospital in Bangladesh

Background: Cerebral palsy (CP) is a diagnostic term used to describe a group of motor syndromes resulting from disorders of early brain development. CP remains unexplained in most cases and is typically diagnosed outside the neonatal period. Visual impairment decreases the quality of life and hearing impairment hampers linguistic development. This study aimed to observe the visual and hearing impairment of children with cerebral palsy associated with developmental disabilities. Material Methods: This is a cross-sectional observational descriptive study carried out in the department of Paediatric Neurology CMH Dhaka from March 2018 to February 2022. The participants (N=120) were from birth to 12 years of age. Detailed information was obtained in each case according to protocol. The pediatric neurologist based on the study definition crosschecked the diagnosis. The hearing assessment was done with the help of an Otolaryngologist in the department of Otolaryngology and the ophthalmological evaluation was done with the help of an ophthalmologist of the department of ophthalmology of CMH Dhaka. Hearing impairment, Ophthalmological motor disturbance, and developmental disabilities were correlated. A convenience sampling technique was used in this study. Relevant data were collected from hospital records. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded, and entered into the computer for statistical analysis by using SPSS 2021. Results: In this study, among the 120 children with CP, the mean age of the study was 5.57(SD±3.89) age range of 2-12 years Males were 82(68%) and females were 38(32%), male-female ratio (sex M: F 2.15: 1). Spastic quadriplegia constitutes the predominant group 59(49%), followed by Spastic diplegia 21(18%), Spastic hemiplegia 20(17.5%), dyskinetic CP 09(8%), 7(6%) were mixed CP and 4(3%) were hypotonic CP. Hearing impairment was found in 87 (72%) cases and visual impairment was detected in 92(76%). Among them, the child with Spastic Quadriplegic (83%) and diplegic CP (62%) children had a hearing impairment. Regarding vision, no fix and follow were observed in 69(57%) cases. Among the studied CP child (n=120) 16 children (13.33%) had normal eye finding and 104 (86%) had abnormal eye findings. Refractive error (32.5%) and Squint (19%) were the most common ocular defect among studied patients. Other ocular defect were nystagmus(10%), optic atrophy(12.5%), microphthalmia(10%), corneal opacity(3%), optic hypoplasia(4.1%), cataract(2.5%), pigmentary retinopathy(5%), retro-lental fibroplasias(3.3%) and ptosis(2.5%). In children with hypotonic (athetoid) and mixed CP, almost all (11 of 11) children had visual impairment. Spastic quadriplegic CP children (80%) and Spastic diplegic CP children (90%) had one or more domains of visual impairment. Conclusion: Cerebral Palsy is a non-progressive various form of neurological disorder in children. Early visual screening and hearing assessment can help CP children to minimize mental retardation, learning difficulties, and speech delay.

Preventive practices and parents' psychological health of children with disabilities after COVID‐19 lockdown in Pakistan

To find out differences in mental health outcomes between parents of children with different disabilities due to COVID-19 by determining the relationship between preventive practices, fear and stress in parents of disabled children. A sample of 213 parents, whose children with disabilities (age range 1-16 years) were previously on regular follow-up before pandemic but did not take therapy for 1 year or more during COVID-19 lockdown and resumed sessions after a gap period, was surveyed. Perceived stress scale, fear and adherence to preventive measures questionnaire (developed by researchers) were used to measure stress, fear response of parents due to COVID-19 and preventive measures practiced by disabled children respectively. Parents who had financial difficulties and believed their disabled children had more chance of getting COVID-19 were more stressed. Parents who received any help from community/government were less stressed. One-way analysis of variance showed parents of cerebral palsy (CP) children reported more stress of COVID-19 as compared to parents of autism spectrum disorder (ASD), global developmental delay (GDD) and intellectual disability (ID). Parents of ID children reported more stress than ASD. Parents of CP children had more fear of loss of family members or getting infected with COVID-19 than GDD parents. ASD, GDD and CP children adhered more to preventive measures than ID children; however, CP children adhered more to preventive measures than GDD children. COVID-19 lockdown has persisting impact on mental health of parents of disabled children. Those parents experienced increased levels of stress and fear but reported adherence to preventive measures depending on the child's disability.

Knowledge and Care Among Mothers Having Children with Cerebral Palsy

Cerebral palsy (CP) is a chronic, non-progressive, and incurable disorder that affects mobility and posture. Objective: To assess the Knowledge and Care among mothers having Children with Cerebral Palsy at Nishter hospital Multan. Methods: A cross sectional study designed was used. A sample of n=85 participants was recruited from Nishtar Hospital Multan Pakistan, through purposive sampling. The knowledge and care questionnaire were used for measurement of knowledge and care among mothers having children with cerebral palsy (CP). Filled questionnaires were entered and analyzed through SPSS version 21. Results: Findings revealed that 71.8% participants had poor knowledge regarding CP, 21.2% had fair knowledge and only 7% of participants had good knowledge regarding CP. Similarly, it was revealed that 50.6% participants had poor care, 41.2% had satisfactory care and only 8.2% were having good care for cerebral palsy children. Conclusions: Majority of the mothers of children with cerebral palsy in this study are unaware of the condition and show no concern for it. Support groups may be developed further to increase care giving' awareness of and concern with CP, which may aid them in finding the most suitable and timely interventions for their charges.

Pathologic external tibial torsion as one of the causes of knee joint dysfunction and formation of pronation deformity in children with cerebral palsy

Introduction. One of the complications of the clinical course of cerebral palsy in children is external torsion of the tibia. The issue of localization and the mechanism of its formation, as well as effective methods of its elimination, is debatable. Purpose - to study the mechanisms of the formation of pathological external torsion of the tibia in children with cerebral palsy, its effect on knee joint contracture and foot deformity, and effective methods of their correction. Materials and methods. The data obtained during the observation of 45 patients (90 cases) aged from 6 to 16 years with spastic diplegia, spastic tetraparesis and foot pronation were analyzed. To study the mechanisms of formation of external torsion of the lower leg and its correction, 2 groups of patients were selected. The Group I - 24 patients with internal rotation contractures of the hip joint (10 patients with internal rotation contractures of the hip joint; 10 patients - in combination with pathological antetorsion of the femoral neck; 4 patients - in combination with flexion contractures of the knee joints). The relationship between internal rotation contracture of the hip joint and external torsion of the tibia. The Group II consisted of 21 patients who were diagnosed with flexion contracture of the knee joints in combination with external torsion of the tibia. In order to study the effectiveness of operative treatment of knee flexion contracture and external torsion of the tibia in the Group II, 2 subgroups were distinguished: the subgroup IIA - 9 patients who underwent osteotomy of the tibial bone; the subgroup IIB - 12 patients who only underwent biceps femoris transposition. Results. Based on the study of clinical and radiological indicators, it was established that pathological torsion of the tibial bone is combined with flexion contracture of the knee joints. Proximal derotational osteotomy of the tibia has a positive effect on the results of correction of knee flexion contracture and foot position. Conclusions. The main reason for the formation of external torsion of the tibia is the imbalance of the flexor muscles of the knee joint and the supinator and pronator muscles of the foot. Proximal tibial derotation osteotomy eliminates not only pathological torsion, but also flexion contracture of the knee joints and excessive pronation of the foot. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of all institutions participating in the study. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Analysis of cerebral palsy gait based on movement primitives

BackgroundCerebral palsy is the most prevalent motor disorder among children. Despite extensive studies on motor modularity of gait of children with cerebral palsy, kinematic modularity of their gait has not been addressed which is the main goal of this study. MethodsThe kinematics of the gait of 13 typical development children and 188 children with cerebral palsy was captured and analyzed, where the cerebral palsy children were grouped into True, Jump, Apparent, and Crouch. Non-negative matrix factorization method was used to extract the kinematic modulus of each group, which were then clustered to find their characteristic movement primitives. The movement primitives of groups were then matched based on the similarity of their activation profiles. FindingsThe number of movement primitives was three for the Crouch group, four for the other cerebral palsy groups, and five for the typical development group. Compared to the typical development children, the kinematic modules and activations of the cerebral palsy groups involved higher variability and co-activation, respectively (P < 0.05). Three temporally matched movement primitives were shared by all groups, but with altered structures. InterpretationThe gait of children with cerebral palsy involved lower complexity and higher variability due to the reduced and inconsistent kinematic modularity. Three basic movement primitives were sufficient to prodcue the overall gait kinematics, as observed in the Crouch group. Other movement primitives, were responsible for providing smooth transitions between basic movement primitives, as seen in more complex gait patterns.

Increased muscle responses to balance perturbations in children with cerebral palsy can be explained by increased sensitivity to center of mass movement

BackgroundBalance impairments are common in children with cerebral palsy (CP). Muscle activity during perturbed standing is higher in children with CP than in typically developing (TD) children, but we know surprisingly little about how sensorimotor processes for balance control are altered in CP. Sensorimotor processing refers to how the nervous system translates incoming sensory information about body motion into motor commands to activate muscles. In healthy adults, muscle activity in response to backward support-surface translations during standing can be reconstructed by center of mass (CoM) feedback, i.e., by a linear combination of delayed (due to neural transmission times) CoM displacement, velocity, and acceleration. The level of muscle activity in relation to changes in CoM kinematics, i.e., the feedback gains, provides a metric of the sensitivity of the muscle response to CoM perturbations. Research questionCan CoM feedback explain reactive muscle activity in children with CP, yet with higher feedback gains than in TD children? MethodsWe perturbed standing balance by backward support-surface translations of different magnitudes in 20 children with CP and 20 age-matched TD children and investigated CoM feedback pathways underlying reactive muscle activity in the triceps surae and tibialis anterior. ResultsReactive muscle activity could be reconstructed by delayed feedback of CoM kinematics and hence similar sensorimotor pathways might underlie balance control in children with CP and TD children. However, sensitivities of both agonistic and antagonistic muscle activity to CoM displacement and velocity were higher in children with CP than in TD children. The increased sensitivity of balance correcting responses to CoM movement might explain the stiffer kinematic response, i.e., smaller CoM movement, observed in children with CP. SignificanceThe sensorimotor model used here provided unique insights into how CP affects neural processing underlying balance control. Sensorimotor sensitivities might be a useful metric to diagnose balance impairments.

Influence of socio- demographic factors on cerebral palsy among children

Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It is caused by damagethat occurs to the immature, developing brain, most often before birth. The present study investigated the influence ofsocio-demographic factors like family type, family size, socio-economic status, and religion on cerebral palsy amongchildren in Dharwad taluk during 2021-22. The sample size was 164 children of 6 to 16 years, on which 82 were cerebralpalsy and 82 were typical children matched with cerebral palsy children. A descriptive matched pair case control design wasused. Self- structured questionnaire and Agarwal’s socio-economic status scale was used for data collection. The result ofthe study revealed that, the incidence of cerebral palsy was high among males (67.10%) than females (32.90%) also firstborn (56.10%) had more risk than later born (43.90%). Majority of families were (84.10%) nuclear with medium size(56.90%). The incidence of cerebral palsy was high among low socio-economic status hence, found a strongassociationbetween cerebral palsy and socio-economic status. Risk factors for cerebral palsy among children when compared tomedium and high socio-economic status

Comparison of Priority Occupational Performance of Children with Cerebral Palsy from the Perspective of Children, Parents, and Occupational Therapists in Isfahan in 2021

Background: Cerebral palsy (CP) is a non-progressive complication of the developing brain that leads to movement problems and occupational performance limitations in the activities of daily living of children with CP. Therefore, getting a sense conception of the children, parents, and occupational therapists’ occupational performance priority to providing client-centered services in performing the activities of daily living of children with CP is extremely important. Objectives: This study aimed to determine the priorities of occupational performance from the perspective of children with CP, parents, and occupational therapists and compare their priorities with each other. Methods: This descriptive-analytical comparative study was conducted in Isfahan in 2021. The research population included 115 CP children aged 6 - 12 years, their parents, and occupational therapists in the occupational therapy department of rehabilitation clinics, rehabilitation centers, and occupational therapy department of hospitals in Isfahan city. Occupational performance priorities of children with CP, their parents, and occupational therapists were assessed through the valid and reliable Canadian occupational performance measurement (COPM). Results: In this research, 115 children with CP, their parents, and occupational therapists participated. Comparison of occupational performance priorities of children with CP from the perspective of children, parents, and occupational therapists showed that the most important occupational performance priority of children with CP from the perspective of these three groups is the same and related to self-care activities and includes activities, such as walking, going up and down the stairs, toileting, and going to the bathroom (P &lt; 0.05). Conclusions: Children with CP, their parents, and occupational therapists reported occupational performance priorities in similar performance dimensions in the age groups of 6 to 12 years for children with CP, which are mainly focused on self-care activities. The attention of occupational therapists to the priorities of children and parents can increase their participation in the rehabilitation process of these children.

Risk factors for 90-day readmission and prolonged length of stay after hip surgery in children with cerebral palsy

ObjectiveSpastic hip dysplasia is a common complication of cerebral palsy in children, and surgical intervention is usually warranted. While current literature has primarily analyzed single institution outcomes, this study utilized a national database to describe readmission rates and factors correlated with readmission for children with cerebral palsy undergoing hip surgery in order to treat this population more effectively. MethodsThis study queried the Nationwide Readmissions Database (2014–2018) for pediatric patients with cerebral palsy who underwent hip surgery. Patient demographics, pre-operative comorbidities, length of stay (LOS), treatment complications, and readmission data were collected for each patient and analyzed with inferential statistics. ResultsOf the 1225 patients included, the average age was 9.3 ± 3.8 years and 42.8% were female. Approximately 26.3% patients had a prolonged LOS (≥5 days) and 14.2% patients required readmission within 90-days of surgery. Medical complications, cardiac arrhythmias, and iron deficiency anemia were all significantly associated with elongated LOS as well as 90-day readmission. Patients with Medicaid were more frequently associated with an inpatient medical complication and the overall complication rate was 5.5%. ConclusionsWhile current literature has analyzed common risk factors and complications associated with hip surgery in the pediatric cerebral palsy patient, this study identifies a national readmission rate (14.2%) as well as preoperative comorbidities associated with readmission within 90-days and/or elongated LOS. Notably, complications are more frequently associated with patients using Medicaid. These results further exemplify the importance of equitable access to care and thorough selection of pediatric cerebral palsy patients appropriate for hip surgery.

STUDI AKSESIBILITAS DAN KUALITAS APLIKASI KORTIKO.EDU PADA ORANG TUA DENGAN ANAK CEREBRAL PALSY DI KOMUNITAS HAPPY CP FAMILY SURABAYA

Objective: Cerebral palsy (CP) is a disorder of movement and function due to permanent damage to brain cells during growth and development. One of the interventions that can be given is to do exercise therapy by a physiotherapist. However, 20 parents with CP children in the happy CP family Surabaya community had difficulty getting access to physiotherapy services in Surabaya, so the kortiko.edu application was created to provide education in the form of exercise therapy videos for CP children for these parents. Until now, the level of ease of access, clarity of images and sound and clarity of narration in video applications has not been known.Methods: 20 parents in the happy CP family community who have limited access to physiotherapy services participated in this study. The research began by conducting video calls between parents and child physiotherapists to carry out virtual assessments and examinations. Then select a number of videos on the kortiko.edu application that are suitable for learning and imitating the movements. Then parents were asked to rate the quality of the application in terms of ease of access and audio-visual quality by filling out a questionnaire.Results: out of 20 respondents stated that 100% was easy to download the application, 90% was easy to use the application, 65% stated that the sound of the video was clear, 50% stated that the video image was clear, 35% stated that the video explanation was easy to understand, and 60% stated that the movements in the video were easy done. Some parents suggest increasing the duration of the video and making videos with real CP children as subjects.Conclusion: the kortiko.edu application is very easy to access and use, but the quality of the application needs to be improved in terms of video duration and involving CP children as video models.

La rééducation pédiatrique de la paralysie cérébrale utilisant les niveaux d’évolution motrice répond-elle aux attendus actuels de pratique professionnelle en kinésithérapie ? Enquête par entretiens d’autoconfrontation

IntroductionCerebral palsy is the largest cause of motor deficiency in children. However their best practice recommendations for rehabilitation spark debate. The relevance of the work of “motor development milestone” is criticized in this regard. This study aims to identify the professional practice expectations and to observe whether invariants can be observed during care built on the work of “motor development milestone” for children with cerebral palsy (CP) in order to know whether they meet these expectations. MethodA literature review was conducted to identify the expectations of professional practice for the rehabilitation of CP children using qualitative analysis sorted by thematization to construct an analysis grid. An observational study of practice by a selfconfrontation interview with 3 independent physiotherapists was carried out. The interviews were analyzed using the grid in order to first identify possible invariants of practice and then, if necessary, to link them to the expectations of professional practice. ResultsForty-one “sub-headings” were identified to describe the professional practice expectations for the rehabilitation of CP children. Analysis of the self-confrontation interviews showed that 24 subheadings were common to all 3 observations. The subheadings most represented in the literature review were most often encountered during the sessions. Discussion/ConclusionThe results suggest that there are practice invariants in rehabilitation using NEM for CP children and that they partially meet practice expectations. The development of good practice guidelines, the EBP and patient expectations require justification of therapeutic choices and their performance. Their formalization must be developed in order to make them assessable according to validated scientific standards.

Reduction in Behavior Problems with Increase in Communication Skills Through Augmentative and Alternative Communication among Special Needs Children

Cerebral Palsy is one of the most prevalent physical handicaps in children. Sensory-motor problems such as communication and cognitive impairment are major symptoms of cerebral palsy. In Pakistan, lack of interventions for cerebral palsy children exists due to low health budget. Consequently, CP children are facing difficulty in having the treatment. The present study aims to implement an augmentative and alternative communication (AAC) approach among nonverbal children with cerebral palsy living in Pakistan. Past research evidence has revealed the co-morbidity of communication problems with behavioral issues among cerebral palsy children. Keeping in view, the present study also aims to examine the behavioral issues of nonverbal children with cerebral palsy. For the said purpose, a pilot study employed the interventional research design (pre and post assessment) which was conducted in Pakistan. 10 nonverbal cerebral palsy children were selected from three different special needs centers by using non-probability sampling technique. Repeated measures, pre and post assessment t-test analysis was conducted to assess the impact of augmentative and alternative communication (AAC) intervention on the communication skills and behavioral problems of the participants. The results showed that AAC intervention has significantly improved the communication skills (t = -11.09, P < .001) and reduced the behavioral problems (t = 2.55, P <.005) of the participants which were nonverbal children with cerebral palsy. Thematic analysis on the open-ended questions from Pragmatic profile reported that participants have started to enjoy indoor and outdoor activities. After the intervention, significant improvement in communication has been observed in participants when they present needs/desire. Thus, this study recommends that implementation of AAC on cerebral palsy population would be effective in improving communication skills and reducing their behavioral problems.

Long-Term Effect of Hyperbaric Oxygen Therapy on Gait and Functional Balance Skills in Cerebral Palsy Children—A Randomized Clinical Trial

This study aimed to explore the long-term effects of hyperbaric oxygen therapy on spatiotemporal gait parameters and functional balance in children with cerebral palsy. Thirty-nine children with hemiplegic cerebral palsy were randomly allocated to one of two groups: control or study. The children in both groups received traditional physical therapy three times per week for six months. In addition, the children in the study group received hyperbaric oxygen therapy five times/week for eight weeks. The GAITRite system and pediatric balance scale were used to assess spatiotemporal gait parameters and functional balance at baseline, post-intervention, and six months after the cessation of hyperbaric oxygen therapy. Post-intervention means of all measured parameters were significantly higher than pre-intervention means, but only for the study group (p < 0.05). However, both groups' means at the six-month follow up were significantly greater than those at pre-intervention (p < 0.05). At the post-intervention and follow-up evaluations, comparisons between groups revealed a statistically significant difference in all measured parameters for the study group against the control group (p < 0.05). It can be concluded that adding hyperbaric oxygen therapy to physical therapy rehabilitation could be effective in improving spatiotemporal gait parameters and functional balance in children with cerebral palsy.

Effects of Kinesthetic Training on the Perception Abilities of Cerebral Palsy Children

Cerebral palsy children are presented with the complaint of atypicalactivity in the muscle that leads to their poor perception abilities. The saidcondition may lead to poor perception abilities in these children. Thepresent research was conducted to measure the influence of kinestheticexercises on the perception abilities of cerebral palsy children. The studywas conducted in a physiotherapy center named DisAbilites in Faisalabad.The sample was composed of nine cerebral palsy children. The pretestposttest design was employed. The kinesthetic skills of the students wereassessed by using the perceptible abilities of the students suffering fromcerebral palsy. An intelligence test was used to measure the perceptionability of the cerebral palsy children before and after the intervention. Theintervention consisted of exercises performed by an experiencedphysiotherapist to enhance the kinesthetic skills of the children. Prior tothe intervention, the pretest was administered. After six weeks of theintervention, the posttest measured kinesthetic skills and perception abilityagain. Results indicated a statistically significant increase in thekinesthetic skills of cerebral palsy children. The increase in the score ofthe kinesthetic skills influences the perception abilities of the cerebralchildren positively.

The influence of wearing an ultrasound device on gait in children with cerebral palsy and typically developing children

BackgroundUltrasonography with motion analysis enables dynamic imaging of medial gastrocnemius (MG) muscles and tendons during gait. This revealed pathological muscle-tendon dynamics in children with spastic cerebral palsy (CP) compared to typically developing (TD) children. However, wearing an ultrasound probe on the lower leg could interfere with gait and bias muscle length changes observed with ultrasound. Research questionDoes wearing an ultrasound probe on the MG influence gait in children with CP and TD children? MethodsEighteen children with spastic CP and 16 age-matched TD children walked at comfortable walking speed on an instrumented treadmill. One baseline gait condition (BASE) and two conditions with an ultrasound probe and custom-made probe holder were measured: on the mid-muscle fascicles (FAS) and on the muscle-tendon junction (MTJ). The effect of condition and group on spatiotemporal parameters, hip, knee and ankle kinematics, ankle moment, ankle power, and modeled MG muscle-tendon unit (MTU) length was assessed using two-way repeated measures ANOVA’s. Statistical non-parametric mapping was applied for time-series. Post-hoc paired-samples t-tests were conducted, and the root mean square difference was calculated for significant parts. ResultsChildren took wider steps during FAS (CP, TD) and MTJ (TD) compared to BASE, and during FAS compared to MTJ (CP). Hip extension was lower (2.7°) during terminal stance for MTJ compared to FAS for TD only. There was less swing knee flexion (FAS 4.9°; MTJ 4.0°) and ankle plantarflexion around toe-off (FAS 3.0°; MTJ 2.4°) for both ultrasound placements, with no group effect. Power absorption during loading response was slightly increased for both ultrasound placements (0.12 W/kg), with no group effect. MTU shortened less in swing for both ultrasound placements (FAS 3.6 mm; MTJ 3.7 mm), with no group effect. SignificanceWearing an ultrasound probe causes minimal lower-limb gait alterations and MTU length changes that are mostly similar in CP and TD.

A big data approach to evaluate receipt of optimal care in childhood cerebral palsy

Purpose Through automated electronic health record (EHR) data extraction and analysis, this project systematically quantified actual care delivery for children with cerebral palsy (CP) and evaluated alignment with current evidence-based recommendations. Methods Utilizing EHR data for over 8000 children with CP, we developed an approach to define and quantify receipt of optimal care, and pursued proof-of-concept with two children with unilateral CP, Gross Motor Function Classification System (GMFCS) Level II. Optimal care was codified as a cluster of four components including physical medicine and rehabilitation (PMR) care, spasticity management, physical therapy (PT), and occupational therapy (OT). A Receipt of Care Score (ROCS) quantified the degree of adherence to recommendations and was compared with the Pediatric Outcomes Data Collection Instrument (PODCI) and Pediatric Quality of Life Inventory (PEDS QL). Results The two children (12 year old female, 13 year old male) had nearly identical PMR and spasticity component scores while PT and OT scores were more divergent. Functional outcomes were higher for the child who had higher adjusted ROCS. Conclusions ROCSs demonstrate variation in real-world care delivered over time and differentiate between components of care. ROCSs reflect overall function and quality of life. The ROCS methods developed are novel, robust, and scalable and will be tested in a larger sample. IMPLICATIONS FOR REHABILITATION Optimal practice, with an emphasis on integrated multidisciplinary care, can be defined and quantified utilizing evidence-based recommendations. Receipt of optimal care for childhood cerebral palsy can be scored using existing electronic health record data. Big Data approaches can contribute to the understanding of current care and inform approaches for improved care.

A RETROSPECTIVE STUDY IN VISAKHAPATNAM ON DELAYED CRY AT BIRTH: AN IMPORTANT PREDICTOR OF FUTURE NEURO DEVELOPMENTAL PROBLEM-ASSOCIATED FACTORS

Objectives: Cerebral palsy (CP) is a group of non-progressive neurological disorders caused by an injury to the area of the brain that controls muscle movement and posture. Physical and cognitive signs and symptoms that indicate CP vary widely, depending on which parts of the brain are affected, severity of the disease, and the age of the baby or child when symptoms first appear and one such symptom is delay in crying at birth. Methods: Data collected from the mothers of 177 children of CP children with history of delayed cry at birth, admitted or attended to Rani Chandramani Devi Government Hospital, Visakhapatnam from the period of 2014–2020. Results: The data collected retrospectively from the mothers of 177 CP children with history of delayed cry at birth were analyzed. Among them, 114 were male and 63 were female. Considering the age of the mother at the time of conception in the mothers of 177 CP children with delayed cry at birth, it was found that, more number of cases were reported in the maternal age between 19 and 30 years 106 (60%). The age of the mother at the time of conception, extremes of mother age both below 18 years and above 30 years, poses risk both to the mother and the fetus. In the present study, it was found to be 40%. Mothers with anemia were reported to be high 32.2% and act as a most prevalent antenatal factor of CP cases. By performing a student “t” test between the CP cases with associated factors and CP cases without associated factors, the results were highly significant p&lt;0.001. Conclusion: Delayed cry at birth should be taken as an early hint that the child might develop neurodevelopmental problems in the future. This should alert the parents and the family physicians and should be attended with appropriate consultation of a team of doctors to address any deviations observed at an early age for a better outcome.

CHALLENGES EXPERIENCED BY MOTHERS OF CHILDREN WITH CEREBRAL PALSY DURING THE MOVEMENT CONTROL ORDER (LOCKDOWN) IN MALAYSIA: A QUALITATIVE STUDY

Background and Purpose: Following the global coronavirus (COVID-19) outbreak and the recent spike in COVID-19 cases in Malaysia, the Malaysian government had imposed a Movement Control Order (MCO) on 16 March 2020 as a measure to curb the outbreak. Consequently, all non-essential affairs were suspended and operated fully on a work-from-home basis, when schools were temporarily closed, and citizens were urged to stay at home. Despite a high number of studies on the negative impacts of MCO to various sectors, there is a little concern noted for the potential impacts on vulnerable populations, including parents with special kids such as cerebral palsy (CP). The purpose of this qualitative study was to investigate the burdens and difficulties associated with the experience of caring for children with CP during the MCO&#x0D; &#x0D; Methodology: This study was designed as qualitative research. Twenty-six participants were selected using a purposive sampling method to involve in in-depth interviews. They were the parents who joined the Cerebral Palsy Support Group in Terengganu, Malaysia. The interview responses were thematically analyzed using a content analysis method.&#x0D; &#x0D; Findings: Four main themes were revealed from the thematic analysis, namely emotional distress, worry over postponement of therapy and medical consultation, burn out due to work from home, and conditions of the CP children themselves. The findings indicated that both mothers, either working or housewife, experienced depression and deterioration in physical health and psychosocial emotions.&#x0D; Contributions: Interventions in the forms of financial aids, guidance for CP children self-therapy at home, and emotional supports are urgently needed to ensure mothers and their CP children maintain their quality of life despite the MCO. &#x0D; &#x0D; Keywords: Movement control order, challenges, parents, cerebral palsy, financial distress, emotional distress.&#x0D; &#x0D; Cite as: Wan Abdul Ghapar, W. R. G., Ahmad, M. F., &amp; Yahya, N. (2023). Challenges experienced by mothers of children with cerebral palsy during the movement control order (lockdown) in Malaysia: A qualitative study. Journal of Nusantara Studies, 8(1), 246-269. http://dx.doi.org/10.24200/jonus.vol8iss1pp246-269