Cerebral Palsy Group Research Articles

On the clinical interpretation of overground gait stability indices in children with cerebral palsy

Several indices have been devised to quantify a person’s stability from its gait pattern during overground walking. However, clinical interpretation of the indices is difficult because the link between being stable and adopting a mechanically stable gait pattern may not be straightforward. This is particularly true for one of these indices, the margin of stability, for which opposite interpretations are available in the literature. We collected overground walking data in two groups of 20 children, with unilateral cerebral palsy (CP) and typically developing (TD), for two conditions, on flat and on uneven grounds (UG). We postulated that TD children were more stable during gait than children with CP and that both groups were more stable on flat compared to UG. We explored the coherent association between several indices and the two postulates to clarify clinical interpretation. Our results showed that increased margin of stability, increased amplitude of the whole-body angular momentum, decreased duration of single limb support, increased variability (gait kinematics, step length, and step width) were associated with reduced stability for both postulates. However, results for the margin of stability were paradoxical between the sides in the CP group where small margin of stability was indicative of a fall forward strategy on the affected side rather than improved stability. Whole-body angular momentum and duration of single limb support appeared as the most sensitive indices. However, walking speed influenced these and would need to be considered when comparing groups of different walking speed.

Effects of multicomponent exercise intervention on cardiometabolic risk factors in children and young adults with cerebral palsy: a multiple-baseline trial.

Adults with cerebral palsy (CP) have a high risk of cardiometabolic diseases. It is unknown whether this risk is elevated in young people with CP and whether exercise can reduce this risk. Therefore, we investigated the effects of the EXErcise for Cerebral Palsy (EXECP) intervention on cardiometabolic risk in children and young adults with CP and compared this risk to typically developing children and young adults (TDs). Ambulatory male and female participants with spastic CP, aged 9-24 years, and age- and sex-matched TDs without musculoskeletal disorders were recruited. Participants with CP were measured at baseline, after a three-month control period manifesting normal development, and after the three-month strength, gait, and flexibility training intervention. TDs were measured at baseline and after the control period. They did not attend the intervention. Cardiometabolic risk factors included body weight, body fat percentage, and skeletal muscle mass index assessed with bioimpedance; resting systolic and diastolic blood pressure and aortic pulse wave velocity assessed with a non-invasive oscillometric device; fasting plasma high-density and low-density lipoprotein cholesterol, triglyceride, and glucose levels. Data were analyzed with independent samples t-tests and linear mixed-effects models adjusted for sex and age. The study involved 18 participants with CP (13 males, 9-22year, mean 14.2 ± 4.4) and 17 TDs (12 males, 9-22year, mean 14.6 ± 4.3). At baseline, participants with CP had a 1.0 (95% confidence interval (CI) [-2.0, -0.0]) kg/m2 lower skeletal muscle mass index than TDs. During the control period, no statistically significant between-group differences were observed in the change of any outcome. In the CP group, body weight (β = 1.87, 95% CI [1.04, 2.70]), fat percentage (β = 1.22 [0.07, 2.37], and blood glucose (β = 0.19, 95% CI [0.01, 0.37]) increased, while diastolic blood pressure (β=-2.31, 95% CI [-4.55, -0.06]) and pulse wave velocity (β=-0.44, 95% CI [-0.73, -0.16]) decreased. In the TD group, only body weight increased (β = 0.85, 95% CI [0.01, 1.68]) statistically significantly. In the CP group, no changes were observed during the intervention. Young people with and without CP do not exhibit significant differences in most cardiometabolic risk factors. EXECP intervention may attenuate some adverse development trajectories occurring without the intervention but greater volume and intensity of aerobic exercise may be needed to reduce cardiometabolic risk. ISRCTN69044459; Registration date 21/04/2017.

Exploration of the triceps surae muscle in ambulatory children with cerebral palsy using instrumented measurements of stiffness and diffusion tensor magnetic resonance imaging for muscle architecture

BackgroundMusculoskeletal alterations causing reduced range of motion of the ankle joint are common in children with cerebral palsy (CP). Objective measurements of passive joint resistance and three-dimensional skeletal muscle volume and muscle architecture can lead to a comprehensive understanding of which factors influence joint range of motion.Research questionTo investigate the relation between the passive dorsiflexion of the ankle joint, biomechanical contributing factors to the passive joint resistance, and muscular architectural properties of the triceps surae muscle in children with CP.MethodsIn this cross-sectional observational study, 14 children with spastic CP (bilateral: 5, unilateral: 9, Gross Motor Function Classification System (GMFCS) level I:11, II:3) naïve to intramuscular tone reducing treatment, and 14 TD children were included. The passive dorsiflexion of the ankle was measured with a goniometer. Passive joint resistance and related parameters were estimated based on a biomechanical model and measurements using a motorized device, the Neuroflexor. Three-dimensional muscle architecture was quantified with diffusion tensor magnetic resonance imaging (DT-MRI).ResultsIn the CP group, the median [min, max] passive dorsiflexion was decreased in the most affected leg (MAL) compared to the less affected leg (LAL) (2.5° [-25°, 20°] vs. 12.5° [5°, 30°], p = 0.001). The stiffness coefficient (Nm/rad) in the MAL was significantly higher in children with CP compared to TD children (7.10 [3.39, 62.00] vs. 2.82 [1.24, 10.46], p = 0.015). Muscle architecture properties did not differ between CP and TD, except for pennation angle in the medial gastrocnemius (MG) of the MAL (CP 17.64° (2.29) vs. TD 21.46° (3.20), p = 0.017). The stiffness coefficient, in the MAL, correlated negatively to passive dorsiflexion (rs=-0.638) and pennation angle in medial gastrocnemius (rs=-0.964), and the non-linear coefficient (Non-linear 1) correlated negatively to the fascicle length of the medial gastrocnemius (rs=-0.857).ConclusionThis study shows that stiffness of the plantarflexors is related to decreased passive dorsiflexion of the ankle and muscle structure of the MG in high-functioning children with spastic CP. Assessments of how dynamic components as well as microscopic muscle alterations contribute to joint stiffness in the plantarflexors in individuals with CP are warranted.Trial registrationRetrospectively registered in ClinicalTrials.gov, NCT05447299. Observational study. Study start: 2019-01-15, register date: 2022-07-01.

The relationship between pneumonia and dental visits in patients with cerebral palsy: A nationwide registry-based cohort study in Taiwan

Background/purposeIn general, improving oral health can reduce the risk of pneumonia. The purpose of this retrospective cohort study was to investigate the risk of pneumonia between cerebral palsy (CP) cohort and non-CP cohort as well as the association of pneumonia with the number of dental visits in CP patients in Taiwan. Materials and methodsWe identified 10,544 patients who were diagnosed with CP between 2010 and 2019 from the Taiwan National Health Insurance Research Database. 63,264 individuals who had never been diagnosed with CP were captured and matched in a 6:1 ratio. Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between CP cohort and non-CP cohort. ResultsOur findings demonstrated that CP cohort had 2.619-fold risk for pneumonia as compared with non-CP cohort after adjustment (95 % CI = 2.574–2.813, P < 0.0001). Cox regression analysis indicated that the CP group had significantly higher incidence risk of pneumonia (log rank P < 0.0001). Higher risks of pneumonia in CP patients were associated with younger age, and lower urbanization level. Some comorbidities as well as history of pneumonia had the higher aHR for pneumonia within 180 days prior to index date. In addition, there was a positive association with the more than two dental visits for the decrease 0.887-fold incidence of pneumonia in CP-cohort as compared with no dental visit (95 % CI: 0.799–0.984). ConclusionTaken together, CP patients had a higher risk of pneumonia. Dental visits are beneficial for preventing the risk of pneumonia in CP patients. The patients with CP should receive regular dental checkup.

Strategies for unplanned gait termination at comfortable and fast walking speeds in children with cerebral palsy

Collision avoidance while walking is necessary for safe living, and faster walking speeds tend to increase collision risk. However, gait termination strategies for patients with cerebral palsy (CP), from comfortable to faster speed, remain unexplored. This study aimed to analyze these strategies in children with CP compared to typically developing (TD) children at two different speeds. Study participants included 10 children with CP (mean age, 12.5; five females; mean height, 147.8 cm; mean weight, 41.7 kg) and 10 TD children (mean age, 11.4; nine females; mean height, 142.0 cm; mean weight, 38.1 kg). Effects of walking speed on spatial, force, and temporal parameters were assessed at 100 % (WS1) and 125 % (WS2) speeds of comfortable walking. The TD group exerted a more pronounced braking force at the first step after the stop line appeared on the floor until the contralateral step at both WS1 (P = 0.006) and WS2 (P = 0.019); however, the CP group exerted a more potent force after the second step (WS1: P = 0.026, WS2: P = 0.023) in the anterior-posterior (AP) direction. Additionally, an increase in the center of mass (COM)-center of pressure (COP) divergence in the AP direction (P = 0.032), which decreased in the mediolateral (ML) direction (P = 0.036) at faster walking speeds, influenced the kinetic characteristics of the CP group from WS1 to WS2. The complex adaptations, such as unique braking forces and changes in the COM-COP divergence, suggest that gait interventions should consider the distinctive forces and adopt dynamic balancing strategies to avoid collisions during walking.

Impairment of Multi-Finger Force Control in Adult Patients with Dyskinetic Cerebral Palsy

PURPOSE: This study aimed to investigate the impact of cerebral palsy (CP) on motor control strategies, with a focus on understanding the altered capability of multi-finger force control in adult patients with dyskinetic CP.METHODS: Eight adults with dyskinetic CP and ten age- and sex-matched healthy controls participated in this study. The participants performed three force production tasks using four fingers of the dominant hand under isometric conditions: maximum voluntary contraction (MVC) to assess maximum force production, a ramp task to evaluate finger interdependency (enslaving), and a pulse task to examine the ability to rapidly and precisely adjust force. The co-contraction index (CCI) of finger flexor and extensor was also determined during steady state and pulse force production.RESULTS: Patients with dyskinetic CP demonstrated significant impairments in finger force control compared to healthy controls. Specifically, the accuracy and consistency of force production were reduced in the CP group, and they exhibited a longer time to peak pulse force. The CP group also showed increased finger interdependency and elevated CCI during pulse force production, suggesting a greater reliance on co-contraction and less efficient motor control strategies.CONCLUSIONS: This study highlights the distinct motor control deficits in individuals with dyskinetic CP, particularly in tasks requiring rapid and precise finger force adjustment. These results have important implications for the functional rehabilitation of patients with CP. Therapies aimed at reducing excessive co-contraction and decreasing finger interdependency may be beneficial for improving muscle coordination and overall motor function.

Markers of Intestinal Permeability and Inflammation in Enterally Fed Children with Cerebral Palsy.

Cerebral palsy (CP) results in non-progressive damage to the central nervous system, leading to functional disorders of the gastrointestinal tract and requiring enteral nutrition via gastrostomy in some patients. The aim of the study was to assess the impact of enteral nutrition on intestinal inflammation expressed by stool calprotectin and intestinal permeability determined by fecal zonulin and IFABP, and to determine whether CP affects these parameters. The study group consisted of 30 children with CP, fed enterally (Cerebral Palsy Enteral Nutrition-CPEN), and two reference groups: 24 children with CP, fed orally with a standard diet (CPC-Cerebral Palsy Controls) and 24 healthy children (HC-healthy controls). The differences between these groups and between the combined CP groups (CPG and CPEN + CPC) and HC were analyzed. Fecal zonulin, calprotectin, and intestinal fatty acid-binding protein 2 (IFABP2) levels were determined by ELISA. The concentrations of fecal calprotectin and zonulin were significantly higher in the CPEN group than in the CPC group (p = 0.012, p = 0.025). When comparing the CPG (n = 53) with the HC group (n = 24), statistically significant differences were observed for calprotectin (p = 0.000018, higher in the CPG) and IFABP (p = 0.021, higher in HC). Enteral nutrition was associated in our cohort with increased fecal calprotectin and zonulin. Children with cerebral palsy presented with increased fecal calprotectin but not increased intestinal permeability expressed by stool zonulin.

The Impact of Cerebral Visual Impairment on Social Skills and Sensory Processing.

Limited evidence exists on the impact of cerebral visual impairment (CVI) on developmental domains in toddlers. This study investigated whether CVI influences social skills and sensory processing in toddlers with cerebral palsy (CP). The study included toddlers with CP, with or without CVI, and typically developing (TD) toddlers. All parents completed the demographic information form. Social skills were assessed by the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Sensory processing was evaluated by the Infant/Toddler Sensory Profile (ITSP). Analysis of covariance was employed to assess the disparity in BITSEA and ITSP scores. Toddlers with CP and CVI group demonstrated lower social competence than the other groups (p < .05). Having CVI did not cause a statistically significant difference in sensory processing among toddlers with CP (p > .05). CVI significantly affects social competence in toddlers with CP but does not affect sensory processing.

Association between Cognitive Abilities before the Age of 3 Years and Those at Least 1 Year Later in Children with Developmental Delay.

This study investigated whether early cognitive assessment in children with developmental delay (DD) predicts cognitive development. We investigated the correlation between cognitive and language development in children with DD, cerebral palsy (CP), and autism spectrum disorder (ASD). Data were collected from children diagnosed with DD who visited the hospital between 2015 and 2023. The assessments included the Korean Bayley Scales of Infant and Toddler Development Second Edition (K-BSID-II) and the Korean Wechsler Preschool Primary Scale of Intelligence Fourth Edition (K-WPPSI-IV). Language development was evaluated using the Sequenced Language Scale for Infants (SELSI) and Preschool Receptive-Expressive Language Scale (PRES). The statistical analysis involved a correlation analysis. Among 95 children in the study, a significant correlation was discovered between early cognitive assessments (the Mental Developmental Index from the K-BSID-II) and later cognitive development (the Full-Scale Intelligence Quotient from the K-WPPSI-IV) in the DD and CP groups, but not in the ASD group. The DD and CP groups exhibited significant correlations in language development between the SELSI and PRES, whereas the ASD group did not. Early cognitive assessments can predict later cognitive development in children with DD and CP, but not in those with ASD, according to this study. There was a strong correlation between language and cognitive development in the DD and CP groups, highlighting the importance of early intervention and assessment for these children. Further investigation is necessary to address these limitations and refine demographic data.

Quantitative ultrasound of submental and masticatory muscles in children with cerebral palsy.

Quantitative muscle ultrasound (QMUS) is potentially valuable as a diagnostic tool in central neurological disorders, as it provides information about changes in muscle architecture. This study aimed to investigate whether ultrasound images of the submental and masticatory muscles in children with spastic cerebral palsy (CP) differ from those obtained in a reference group, and whether observed ultrasound abnormalities differ between subgroups of children with different Eating and Drinking Ability Classification System (EDACS) levels to support its construct validity. A prospective cohort study was conducted in 25 children with spastic CP aged 3-18 years. QMUS of selected muscles was performed. Muscle thickness and echogenicity in the CP group were compared to previously collected reference values, and between different EDACS levels within the CP group. Median echogenicity of all muscles was significantly higher in children with CP than in healthy controls. The temporalis muscle was significantly thinner in the CP group. There were no differences in muscle thickness or echogenicity between EDACS levels. QMUS is able to detect abnormal architecture of submental and masticatory muscles in children with spastic CP, but the interpretation of abnormalities in relation to the severity of mastication and swallowing problems needs further investigation.

Periodic limb movements during sleep in children with neuromuscular disease or cerebral palsy – An important potential contributor to sleep-related morbidity

ObjectivesPoor sleep is frequently reported in children with neuromuscular diseases (NMD) and cerebral palsy (CP) however breathing disorders during sleep are often the clinical focus. Periodic limb movements (PLMs) have an increased prevalence in adults with NMD and may contribute to sleep disturbance in this population. We assessed the prevalence of PLMs in children with NMD or CP. MethodsRetrospective review of polysomnography (PSG) with leg electromyography in children age 1–18 years with NMD (including Duchenne muscular dystrophy, myotonic dystrophy, spinal muscular atrophy) or CP performed at a paediatric sleep centre 2004–2022. ResultsLeg electromyography was available in at least 1 PSG in 239 children (125 NMD, 114 CP), and in 2 PSGs in 105 children (73 NMD, 32 CP). At initial PSG, 72 (30 %) were female with a median age 9y and respiratory disturbance index 3.5/h (interquartile range 1.3–9.9/h). Elevated PLM index (PLMI; >5/h) occurred in 9.6 % of each of the CP and NMD groups, quantified by initial PSG. Overall, PLMI increased from baseline (median 0, maximum 33/h) to follow-up (median 0, maximum 55.8/h; p < 0.05). In those with an elevated PLMI, arousal percentage attributable to PLMs was up to 25 % (median 7.5 %). ConclusionsElevated PLMI occurred at a higher prevalence in children with NMD and CP than reported in other clinic-referred paediatric populations. It is important that PLMs are not overlooked as identification and treatment may help improve sleep outcomes. Further research is required to understand the pathophysiology and consequences of PLMs specifically in this population.

The applicability of markerless motion capture for clinical gait analysis in children with cerebral palsy

The aim of this comparative, cross-sectional study was to determine whether markerless motion capture can track deviating gait patterns in children with cerebral palsy (CP) to a similar extent as marker-based motion capturing. Clinical gait analysis (CGA) was performed for 30 children with spastic CP and 15 typically developing (TD) children. Marker data were processed with the Human Body Model and video files with Theia3D markerless software, to calculate joint angles for both systems. Statistical parametric mapping paired t-tests were used to compare the trunk, pelvis, hip, knee and ankle joint angles, for both TD and CP, as well as for the deviation from the norm in the CP group. Individual differences were quantified using mean absolute differences. Markerless motion capture was able to track frontal plane angles and sagittal plane knee and ankle angles well, but individual deviations in pelvic tilt and transverse hip rotation as present in CP were not captured by the system. Markerless motion capture is a promising new method for CGA in children with CP, but requires improvement to better capture several clinically relevant deviations especially in pelvic tilt and transverse hip rotation.

A Comparison of the Functioning and Disability Levels of Children With Hemiplegic and Diplegic Cerebral Palsy Based on ICF-CY Components.

We compared children with hemiplegic and diplegic cerebral palsy (CP) using the conceptual framework of the International Classification of Functioning, Disability and Health: Child and Youth version (ICF-CY). We enrolled 42 children with CP aged 5 - 13 years old (M age = 9.57, SD = 2.8 years). We assessed their trunk control and dynamic balance with the Trunk Control Measurement Scale (TCMS) and the Timed Up and Go test (TUG), and we used ABILHAND-Kids and Assessment of Life Habits (Life-H) to assess their manual ability and participation with activities of daily living. We administered the European Child Environment Questionnaire (ECEQ) to identify relevant environmental factors. We employed structural equation modeling (SEM) to identify specific factors contributing to potential differences between these CP groups. Children with hemiplegic CP demonstrated significantly better outcomes in terms of trunk control, dynamic balance, and environmental factors compared to those with diplegic CP (p < .05). In contrast, children with diplegic CP demonstrated superior outcomes regarding manual ability, compared to those with hemiplegic CP (p < .001). In our structural equation models, trunk control strongly predicted both dynamic balance (0.75) and environmental factors (0.74). Moreover, the relationships between trunk control and participation in daily and social activities were 0.54 and 0.47, respectively. Impaired trunk control and dynamic balance were significant contributors to increased activity restrictions and environmental barriers in children with diplegic CP. This suggests that improving disability and functioning in children with diplegic CP requires a focus on trunk control training and dynamic balance exercises.

Increased Upper Extremity Muscle Mass in Ambulatory Children with Cerebral Palsy.

To compare muscle mass in the upper and lower extremities between ambulatory children with cerebral palsy (CP) and typically developing (TD) children. A total of 21 children aged 2 to 12 years with CP and a Gross Motor Function Classification System (GMFCS) level of I, II, or III were matched with 21 TD children for age, sex, and body mass index. The lean body mass (LBM) of each extremity was calculated from whole-body dual-energy X-ray absorptiometry. The LBM of the upper extremities was greater in children with CP compared to TD children, and the difference was significant in the GMFCS level II group (1340.6 g vs. 1004.2 g, p = 0.027). There was no significant difference in the LBM of the lower extremities between the CP and TD groups (p = 0.190). The ratio of lower extremity LBM to total extremity LBM was lower in children with CP, while the ratio of upper extremity LBM to total extremity LBM was higher in children with CP (73.2% vs. 78.5% [p < 0.001] and 26.7% vs. 21.5% [p < 0.001], respectively). Ambulatory children with CP, especially in the GMFCS level II group, exhibit greater muscle mass in the upper extremities compared to TD children.

Children with bilateral cerebral palsy use their hip joint to complete a step-up task.

Performance in stair-climbing is largely associated with disruptions to mobility and community participation in children with cerebral palsy (CP). It is important to understand the nature of motor impairments responsible for making stairs a challenge in children with bilateral CP to clarify underlying causes of impaired mobility. In pediatric clinical populations, sensitive measurements of movement quality can be captured during the initial step of stair ascent. Thus, the purpose of this study was to quantify the lower limb joint moments of children with bilateral CP during the stance phases of a step-up task. Participants performed multiple stepping trials in a university gait laboratory. Outcome measures included extensor support moments (the sum of hip, knee, and ankle sagittal plane moments), hip abduction moments, and their timing. We recruited seven participants per group. We found that peak support and hip abduction moments were similar in the bilateral CP group compared to the typical development (TD) group. We also found that children with bilateral CP timed their peak moments closer together and increasingly depended on the hip joint to complete the task, especially in their more affected (MA) lower limb. Our investigation highlights some underlying causes that may make stair climbing a challenge for the CP population, including a loss of selective voluntary motor control (SVMC), and provides a possible treatment approach to strengthen lower limb muscles.

Comparison of the prevalence of malocclusion and oral habits between children with cerebral palsy and healthy children

BackgroundCerebral palsy (CP) represents for children an important problem of health and affects roughly 2 per 1000 live births and is the most common pediatric developmental motor disability. Therefore, the purpose of this study was to determine the prevalence, type and severity of malocclusion and oral habits in children with Cerebral Palsy (CP) and to compare them with a control group of healthy children in Sana’a city.Materials and methodsA prospective, case–control study was made of two groups, a cerebral palsy and a control group. The study population consisted of 60 children who had CP, and a control group of 60 matched children with no physical or mental disabilities. Data were collected using a questionnaire and assessment for malocclusion was done clinically. The patients were compared with equal number of age-matched controls. The inclusion criteria were individuals aged over 6 years; absence of previous orthodontic treatment; no missing permanent first molars.ResultsResults showed an increased prevalence of malocclusion in children with cerebral palsy. Molar class II relationship was statistically higher in cerebral palsy children than healthy control (P = 0.001). Cerebral palsied children are likely to have a significantly increased protrusion of the anterior teeth (P < 0.001) when compared with normal children. Mouth breathing and Tongue thrust. Habits were significantly higher in the CP group (p = 0.0001) when compared with normal children.ConclusionThe prevalence of malocclusion was higher in children with Cerebral palsy than in normal children, and the present study concludes that in children with Cerebral Palsy, more oral Habits problems due to oral motor dysfunctions are common and problems of mouth breathing and Tongue thrust produce different malocclusion and poor oral hygiene complications in these children.

A new methodological approach to characterize selective motor control in children with cerebral palsy.

Despite being a primary impairment in individuals with cerebral palsy (CP), selective motor control (SMC) is not routinely measured. Personalized treatment approaches in CP will be unattainable without the ability to precisely characterize the types and degrees of impairments in motor control. The objective of this study is to report the development and feasibility of a new methodological approach measuring muscle activation patterns during single-joint tasks to characterize obligatory muscle co-activation patterns that may underly impaired SMC. Muscle activation patterns were recorded during sub-maximal voluntary isometric contraction (sub-MVIC) tasks at the hip, knee, and ankle with an interactive feedback game to standardize effort across participants. We calculated indices of co-activation, synergistic movement, mirror movement, and overflow (indices range 0-2, greater scores equal to greater impairment in SMC) for each isolated joint task in 15 children - 8 with typical development (TD) (mean age 4.7 ± 1.0 SD years) and 7 with CP (mean age 5.8 ± 0.7 SD years). Indices were compared with Mann-Whitney tests. The relationships between the indices and gross motor function (GMFM-66) were examined with Pearson's r. Mean indices were higher in the CP vs. the TD group for each of the six tasks, with mean differences ranging from 0.05 (abduction and plantarflexion) to 0.44 (dorsiflexion). There was great inter-subject variability in the CP group such that significant group differences were detected for knee flexion mirroring (p = 0.029), dorsiflexion coactivation (p = 0.021), and dorsiflexion overflow (p = 0.014). Significant negative linear relations to gross motor function were found in all four indices for knee extension (r = -0.56 to -0.75), three of the indices for ankle dorsiflexion (r = -0.68 to -0.78) and in two of the indices for knee flexion (r = -0.66 to -0.67), and ankle plantarflexion (r = -0.53 to -0.60). Indices of coactivation, mirror movement, synergy, and overflow during single-joint lower limb tasks may quantify the type and degree of impairment in SMC. Preliminary concurrent validity between several of the indices of SMC and gross motor function was observed. Our findings established the feasibility of a new methodological approach that quantifies muscle activation patterns using electromyography paired with biofeedback during single-joint movement.

Detection and quantification of pathogens in saliva of adolescents with cerebral palsy: a cross-sectional study

BackgroundElevated levels of inflammatory mediators in saliva have been described in individuals with cerebral palsy (CP).ObjectiveThe aim of this study was to detect and quantify the pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Prevotella intermedia in the saliva of adolescents with CP.MethodsThis is a cross-sectional study with adolescents with CP to detect periodontopathogens from saliva samples. Initially, saliva was collected from the CP (n = 34) and control groups (n = 31), followed by the gingival index (GI) for distribution of the groups of individuals with CP and control with gingivitis (bleeding on probing ≥ 10%) and without gingivitis. Bacterial DNA was extracted from saliva samples for detection of periodontopathogens by quantitative PCR (q-PCR). Data were analyzed by Mann–Whitney and Kruskal–Wallis tests, analysis of variance t-test (ANOVA) with Tukey–Kramer post-hoc tests (p &amp;lt; 0.05).ResultsThe quantification of DNA of periodontopathogens in saliva samples showed that adolescents with CP present a variability (22.93–39.56) in the detection of P. gingivalis and that some subjects with CP and gingivitis (n = 4) present high quantification of P. gingivalis (ranging 39.56–37.65), although no significant difference was found between the groups (p &amp;gt; 0.05). A significant contrast was observed for the pathogen P. intermedia when comparing the difference in the control group (p = 0.0396). No major differences were detected in the quantification of periodontopathogens evaluated between the control group and CP.ConclusionAdolescents with CP showed variability in the detection of DNA of periodontopathogens, especially a great variation in the detection of P gingivalis in saliva of CP with gingivitis.

The effect of uneven surfaces on inter-joint coordination during walking in children with cerebral palsy

Clinical gait analysis on uneven surfaces contributes to the ecological assessment of gait deviations of children with spastic cerebral palsy (CP). Walking on uneven surfaces requires specific motor strategies, which can be assessed by lower-limb kinematic and inter-joint coordination analyses. This study aimed to assess and compare kinematics and inter-joint coordination between children with CP and their typically developing (TD) peers when walking on even and two levels of uneven surfaces (medium and high). A total of 17 children with CP and 17 TD children (11.5 ± 3.5 and 10.4 ± 4.5 years old, respectively) were asked to complete 6–8 gait trials on a 4-m walkway of each surface (n = 3) in randomized blocks while fit with retro-reflective markers on their lower-limbs. Children with CP showed proximal gait adaptations (i.e., hip and knee) on uneven surfaces. Compared with the TD group, the CP group showed decreased hip extension during late stance (49–63%, d = 0.549, p < 0.001), and a more in-phase knee-hip coordination strategy during swing phase (75–84% of gait cycle, d = 1.035, p = 0.029 and 92–100%, d = 1.091, p = 0.030) when walking on an uneven (high), compared to even surface. This study provides a better understanding of kinematic strategies employed by children with spastic CP when facing typical daily life gait challenges. Further studies are needed to evaluate the benefits of integrating uneven surfaces in rehabilitation care.

Muscle coactivation during gait in children with and without cerebral palsy

BackgroundChildren with Cerebral Palsy (CP) walk with an uncoordinated gait compared to Typically Developing (TD) children. This behavior may reflect greater muscle co-activation in the lower limb; however, findings are inconsistent, and the determinants of this construct are unclear. Research objectives(i) Compare lower-limb muscle co-activation during gait in children with, and without CP, and (ii) determine the extent to which muscle co-activation is influenced by electromyography normalization procedures and Gross Motor Function Classification System (GMFCS) class. MethodsAn electromyography system measured muscle activity in the rectus femoris, semitendinosus, gastrocnemius, and tibialis anterior muscles during walking in 46 children (19 CP, 27 TD). Muscle co-activation was calculated for the tibialis anterior-gastrocnemius (TA-G), rectus femoris-gastrocnemius (RF-G), and rectus femoris-semitendinosus (RF-S) pairings, both using root mean squared (RMS)-averaged and dynamically normalized data, during stance and swing. Mann-Whitney U and independent t-tests examined differences in muscle co-activation by group (CP vs. TD) and GMFCS class (CP only), while mean difference 95% bootstrapped confidence intervals compared electromyography normalization procedures. ResultsUsing dynamically normalized data, the CP group had greater muscle co-activation for the TA-G and RF-G pairs during stance (p < 0.01). Using RMS-averaged data, the CP group had greater muscle co-activation for TA-G (stance and swing, p < 0.01), RF-G (stance, p < 0.05), and RF-S (swing, p < 0.01) pairings. Muscle co-activation calculated with dynamically normalized, compared to RMS-averaged data, were larger in the RF-S and RF-G (stance) pairs, but smaller during swing (RF-G). Children with CP classified as GMFCS II had greater muscle co-activation during stance in the TA-G pair (p < 0.05). SignificanceGreater muscle co-activation observed in children with CP during stance may reflect a less robust gait strategy. Although data normalization procedures influence muscle co-activation ratios, this behavior was observed independent of normalization technique.