Cerebral Palsy Group Research Articles

Degraded Synergistic Recruitment of sEMG Oscillations for Cerebral Palsy Infants Crawling.

Background: Synergistic recruitment of muscular activities is a generally accepted mechanism for motor function control, and motor dysfunction, such as cerebral palsy (CP), destroyed the synergistic electromyography activities of muscle group for limb movement. However, very little is known how motor dysfunction of CP affects the organization of the myoelectric frequency components due to the abnormal motor unit recruiting patterns.Objectives: Exploring whether the myoelectric activity can be represented with synergistic recruitment of surface electromyography (sEMG) frequency components; evaluating the effect of CP motor dysfunction on the synergistic recruitment of sEMG oscillations.Methods: Twelve CP infants and 17 typically developed (TD) infants are recruited for self-paced crawling on hands and knees. sEMG signals have been recorded from bilateral biceps brachii (BB) and triceps brachii (TB) muscles. Multi-scale oscillations are extracted via multivariate empirical mode decomposition (MEMD), and non-negative matrix factorization (NMF) method is employed to obtain synergistic pattern of these sEMG oscillations. The coefficient curve of sEMG oscillation synergies are adopted to quantify the time-varying recruitment of BB and TB myoelectric activity during infants crawling.Results: Three patterns of sEMG oscillation synergies with specific frequency ranges are extracted in BB and TB of CP or TD infants. The contribution of low-frequency oscillation synergy of BB in CP group is significantly less than that in TD group (p < 0.05) during forward swing phase for slow contraction; however, this low-frequency oscillation synergy keep higher level during the backward swing phase crawling. For the myoelectric activities of TB, there is not enough high-frequency oscillation recruitment of sEMG for the fast contraction in propulsive phase of CP infants crawling.Conclusion: Our results reveal that, the myoelectric activities of a muscle can be manifested as sEMG oscillation synergies, and motor dysfunction of CP degrade the synergistic recruitment of sEMG oscillations due to the impaired CNS regulation and destroyed MU/muscle fiber. Our preliminary work suggests that time-varying coefficient curve of sEMG oscillation synergies is a potential index to evaluate the abnormal recruitment of electromyography activities affected by CP disorders.

Day/night melatonin content in cerebral palsy

Changes in the sleep-wake cycle are frequent and may impair quality of life in individuals with cerebral palsy (CP). To investigate if a lack of a day/night variation of melatonin content could be related with sleep disorders (SD), the SD were evaluated with a Sleep Questionnaire and the melatonin content using ELISA in 33 individuals with CP and 24 controls. The indicative of SD were present in 47% of CP group, and the most frequent was the indicative of sleep breathing disorder. The CP group showed higher diurnal and lower nocturnal melatonin content than controls. Individuals with CP that had indicative of SD showed lower nocturnal content of melatonin than those without SD. These results showed that the lack of the day/night variation of melatonin was related to SD in individuals with CP.

Bipedal and unipedal stance in Brazilian football 7-a-side athletes with cerebral palsy

ABSTRACT To compare postural control between Football 7-a-side players with cerebral palsy (CP) and active non-athletes without neurologic impairments, 28 individuals (15 to 35 years old) were selected and divided into the Non-Athletes Group (NAG), consisting of 14 individuals without neurologic or musculoskeletal injury; and the CP Group (CPG), composed of 14 athletes from the regional football team. A force platform was used to measure anteroposterior displacement of center of pressure (COPap), velocity (COPvel), mediolateral displacement (COPml), and 95% confidence ellipse area (AREA95) on bipedal and unipedal stance. On bipedal stance, there was no difference between groups in anteroposterior displacement of center of pressure (COPap) and velocity (COPvel). On unipedal stance with the dominant leg, the NAG presented better postural control, statistically significant in mediolateral displacement (COPml), 95% confidence ellipse area (AREA95) and COPap (p = 0.003; p = 0.001; p = 0.018, respectively). Our results showed that both groups have similar postural control on bipedal stance, but NAG demonstrated better postural control with unipedal stance than Football 7-a-side players with CP.

Self-reported upper limb functioning of pupils with cerebral palsy by the International Classification of Functioning, Disability, and Health.

International Classification of Functioning, Disability, and Health: Children and Youth Version has shown an increasing role in the assessment of children with cerebral palsy (CP), but just a few researchers use it for individuals' self-assessment. In this study, we present the self-assessment of functioning of students with CP and changes by the end of a school year. Thirty-seven pupils with spastic CP involving upper limbs, 24 pupils with typical development, and 20 pupils with speech and language disorders were studied by International Classification of Functioning, Disability, and Health core sets for CP. The CP group reported limitations in sensory functions (P<0.05), movement-related functions (P<0.001), and mobility (P<0.001) as well as products and technology and support and relationships as supportive (P<0.05). Correlation between expert and self-evaluation was weak to moderate. The CP core set may appropriately serve in the self-assessment of pupils' functioning in longitudinal studies.

Use of 3D gait analysis as predictor of Achilles tendon lengthening surgery outcomes in children with cerebral palsy.

In children with spastic cerebral palsy (CP), the treatment of equinus foot with Achilles tendon lengthening (ATL) surgery is associated with high incidence of overcorrection, which may result in crouch gait. We aimed to assess if gait pattern in preoperative time could be a predictor of the surgery outcome. Cross-sectional retrospective study. Movement Analysis Lab of IRCCS San Raffaele Pisana Hospital in Rome (Italy). Eighteen children (mean age 9.6±4.7 years) with spastic diplegia CP who underwent bilateral ATL surgery to correct equinus foot were involved. Participants underwent 3D gait analysis before and approximately 12 months after surgery. Primary measures were spatiotemporal, kinematic (summarized by Gait Variable Scores, GVSs) and kinetic parameters. The gait patterns for each leg was defined from kinematic data, using a quantitative classification: plantar flexor knee extension (PFKE) index. The CP group was split into true equinus and jump gait. The equinus foot was successfully corrected as demonstrated by the improvement of GVS ankle dorsi-plantarflexion. However, there was a high rate of overcorrection in the true equinus, characterized by increases in knee flexion-extension GVS (8.7° pre vs. 16.7° post P<0.05) and knee flexion angle at initial contact (5.2° vs. 20.6° P<0.05) and by a decrease in the maximum ankle power generated at push-off (1.49 vs. 0.83 W/kg P<0.05). Assessment of motor phenotype in preoperative time are good predictors of the results of ATL surgery. In children with true equinus gait, the increase of knee flexion subsequent to ATL is an early indicator that this technique will lead to crouch gait. These results show the influence of true equinus and jump gait patterns on the outcomes of the ATL. Therefore, we propose that this approach could have clinical value to evaluate and prescribe rehabilitation in children with CP disease, proposing different solutions depending on motor phenotype.

Cerebellar peduncle injury predicts motor impairments in preterm infants: A quantitative tractography study at term-equivalent age

PurposeCerebellar injury is well established as an important finding in preterm infants with cerebral palsy (CP). In this study, we investigated associations between injury to the cerebellar peduncles and motor impairments in preterm infants using quantitative tractography at term-equivalent age, which represents an early phase before the onset of motor impairments. MethodsWe studied 64 preterm infants who were born at <33 weeks gestational age. These infants were divided into three groups: CP, Non-CP (defined as infants with periventricular leukomalacia but having normal motor function), and a Normal group. Diffusion tensor imaging was performed at term-equivalent age and motor function was assessed no earlier than a corrected age of 2 years. Using tractography, we measured fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the superior cerebellar peduncles (SCP) and middle cerebellar peduncles (MCP), as well as the motor/sensory tracts. ResultsThe infants in the CP group had significantly lower FA of the SCP and sensory tract than those in the other groups. There was no significant difference in FA and ADC of the motor tract among the three groups. Severity of CP had a significant correlation with FA of the MCP, but not with the FA of other white matter tracts. ConclusionOur results suggested that the infants with CP had injuries of the ascending tracts (e.g. the SCP and sensory tract), and that additional MCP injury might increase the severity of CP. Quantitative tractography assessment at term-equivalent age may be useful for screening preterm infants for prediction of future motor impairments.

Visual perception, visual-spatial cognition and mathematics: Associations and predictions in children with cerebral palsy

BackgroundPrevious research suggests that children with cerebral palsy (CP) have impairments in visual-spatial and mathematics abilities, although we know very little about the association between these two domains. AimsTo investigate the extent of visual-spatial and mathematical impairments in children with CP and the associations between these two domains. Method and ProcedureThirty-two children with predominantly quadriplegic spastic and/or athetoid (dyskinetic) CP (13 years 7 months) and a group of typically developing (TD) children (8 years 6 months) matched by receptive vocabulary were given a battery of visual-spatial and mathematics tasks. Visual-spatial assessments ranged from simple tests of perception to complex reasoning about these stimuli. A standardised test of mathematics ability was administered to both groups. Outcomes and ResultsThe children with CP had significantly poorer mathematical and visual-spatial abilities than the TD group. For the TD group age was the best predictor of mathematical ability, in the CP group receptive vocabulary and visual perception abilities were the best predictors of mathematical ability. Conclusion and ImplicationsThe CP group had extensive difficulties with visual perception; visual short-term memory; visual reasoning; and mental rotation all of which were associated with their mathematical abilities. These findings have implications for the teaching of visual perception and visual memory skills in young children with CP as these may help the development of mathematical abilities.

Findings regarding relationships between ambulation capability and some bone structure, respectively related metabolic parameters in pubertal and adolescent patients - Preliminary results

Children with cerebral palsy (CP) who cannot walk seem more prone to have low bone density than ambulatory ones and respectively, walking non-neurologic (scoliosis) patients, of the same age category. Yet, such relationships may be more complex; therefore we aimed to perform a preliminary analysis of them. We evaluated 58 children, 11–18 years old, divided in 3 groups: non-ambulatory CP (15), ambulatory CP (21) and with scoliosis (22) in the NRNCCNRC. To discriminate ambulation/non-ambulation capability in patients within this study we used a Functional Ambulation Categories inspired paradigm: non-ambulatory patients assimilated to 0 score and the ambulatory children would have achieved either independent or in different degrees of personal and/or device assisted, gait. Bone paraclinic parameters assessed: DEXA (Z-Scores), total serum Calcium and 25-OH vitamin D. Descriptive statistical analysis, ANOVA, medians test and Chi 2 tests, were performed using SPSS v.24. Regarding DEXA, concerning Z-Scores distribution, the 3 diagnosis groups differed both in averages and in medians, respectively values of low bone density showed significant differences only between the scoliosis and the non-ambulatory CP groups (more cases in the latter, P = 0.004). For total serum calcium and 25-OH vitamin D concentrations there were not distribution differences between the diagnosis groups. As for total serum calcium, most of our patients had normal values corresponding to their age, except: –4 with hypocalcaemia (1 with scoliosis, 3 ambulatory CP); –2 with hypercalcaemia (1 with scoliosis and 1 non-ambulatory CP). For 25-OH vitamin D serum concentrations, around 60% of the patients were deficient in each group (not sufficient available data to draw genuine statistical objectifications of differences in between). DEXA findings confirm significant differences between non-ambulatory CP children and ambulatory, and scoliosis ones; for the other paraclinic parameters larger groups are needed for enhanced statistical power.

Trunk Control in Children with Cerebral Palsy and its Association with Upper Extremity Functions

This study investigated the upper extremity functions of children with Cerebral Palsy (CP) and the association between upper extremity function and trunk control. Thirty children with unilateral CP and 32 children with bilateral CP between the ages of 5 and 12 years were included in this study. The Trunk Control Measurement Scale (TCMS) was used to assess trunk control, and the Quality of Upper Extremity Skills Test was used to assess upper extremity functions (QUEST) (QUEST consists of four subscales: Dissociated Movements Scale, Grasp Scale, Weight Bearing Scale, and Protective Extension Scale). There was a significant difference between the unilateral and bilateral CP groups, with unilateral CP favored in terms of trunk control. There was no difference in QUEST total scores between the unilateral and bilateral CP groups (p < 0.05). In both groups, there was a significant correlation between the total TCMS score and the Dissociated Movements Scale, Grasp Scale, Weight Bearing Scale and QUEST total score (p < 0.05). There was a significant positive correlation between trunk control and upper extremity functions in children with CP. This relationship must be considered for the effective implementation of physiotherapy assessment and intervention.

Epigenetic machine learning: utilizing DNA methylation patterns to predict spastic cerebral palsy

BackgroundSpastic cerebral palsy (CP) is a leading cause of physical disability. Most people with spastic CP are born with it, but early diagnosis is challenging, and no current biomarker platform readily identifies affected individuals. The aim of this study was to evaluate epigenetic profiles as biomarkers for spastic CP. A novel analysis pipeline was employed to assess DNA methylation patterns between peripheral blood cells of adolescent subjects (14.9 ± 0.3 years old) with spastic CP and controls at single CpG site resolution.ResultsSignificantly hypo- and hyper-methylated CpG sites associated with spastic CP were identified. Nonmetric multidimensional scaling fully discriminated the CP group from the controls. Machine learning based classification modeling indicated a high potential for a diagnostic model, and 252 sets of 40 or fewer CpG sites achieved near-perfect accuracy within our adolescent cohorts. A pilot test on significantly younger subjects (4.0 ± 1.5 years old) identified subjects with 73% accuracy.ConclusionsAdolescent patients with spastic CP can be distinguished from a non-CP cohort based on DNA methylation patterns in peripheral blood cells. A clinical diagnostic test utilizing a panel of CpG sites may be possible using a simulated classification model. A pilot validation test on patients that were more than 10 years younger than the main adolescent cohorts indicated that distinguishing methylation patterns are present earlier in life. This study is the first to report an epigenetic assay capable of distinguishing a CP cohort.

Causes of Cerebral Palsy in Sulaimani

Background and objectives:Cerebral palsy is a common neurodevelopmental condition encountered by pediatricians The condition may present itself in many different clinical spectra. The etiological and risk factors are many and an awareness of the interplay of multiple factors in the causation of cerebral palsy is crucial. The aim of the study is to evaluate the risk factors of cerebral palsy in Sulaimani city. A better understanding of the etiology of cerebral palsy is necessary for preventive strategies and treatments to be developed. Methods:This is a retrospective case control study including 100 cerebral palsy patients; data were taken from the records of rehabilitation center in Sulaimani city from 1st Jan 2017 up to 1st- Sep 2017and 100 control group of the same age admitted in our hospital. Results: One hundred cases of CP (52% male) and (48% female) were collected ,their mean age was 1.64 years and standard deviation (.52262) ,the risk factors of the cerebral palsy were birth asphyxia , prematurity , unknown cause ,and jaun- dice were (31 % , 26 %, 17%, 11% ,) respectively. There was a significant difference between control and cerebral palsy groups regarding (birth asphyxia, prematurity, pregnancy induced hypertension and jaundice). Conclusions: Birth asphyxia was identified as a major cause of cerebral palsy in Sulaimani city according to our study followed by prematurity as a second risk factor of cerebral palsy.

Corpus callosum and cerebellar vermis size in very preterm infants: Relationship to long-term neurodevelopmental outcome

The neonatal changes of corpus callosum or cerebellar volume in preterm infants have been shown to link with abnormal mentality and motor disability in early childhood. This study aims to predict the long-term neurological outcomes by measuring these changes on neonatal brain ultrasound in preterm infants. Our cohort consisted of infants aged below 32 weeks' gestation with very low birth body weights who completed neuro-assessments at 5 years of age. Corpus callosum or cerebellar vermis were measured at 28-30 weeks and at 37-40 weeks gestational age in premature infants with cerebral palsy (CP), mental retardation (MR) and normal control premature infants. There are 12 patients in MR group, 12 in CP group and 27 patients as controls for final analysis. There was no significant difference in other factors between study groups except lower gestational age (P=0.043) in CP group. Respiratory distress syndrome was more common in MR group (P=0.037) and cystic periventricular leukomalacia was more common in CP group (P<0.001) than controls. After adjusting for sex and birth body weight, the MR group had smaller cerebellar vermis area at 37-40 gestational weeks (P=0.002) than controls. They also reduced the growth of corpus callosum area (difference=-0.12±0.16, P=0.029) and cerebellar vermis area (difference=1.10±0.44, P=0.020) from 28 to 30 gestational weeks to 37-40 gestational weeks compared with controls (difference=0.03±0.15, 1.92±0.70, respectively). In contrast, the CP group had reduced the growth of corpus callosum body (difference=-0.02±0.18, P=0.034) compared with controls (difference=0.03±0.04). They subsequently had smaller body thickness of corpus callosum (0.10±0.02, P=0.015) at 37-40 gestational weeks than controls (0.14±0.04). Serial monitoring corpus callosum and cerebellar vermis size in early life of very preterm babies may predict the motor or mentality neurological outcome at 5 years of age.

Influence of functional mobility and manual function on play in preschool children with cerebral palsy

IntroductionThis study analysed the differences in play performance between preschool children with cerebral palsy and those with typical development and investigated the factors influencing functional mobility and manual dexterity on play in children with cerebral palsy.MethodSixty preschool children (30 with cerebral palsy; 30 with typical development), were assessed by the revised Knox Preschool Play Scale, being that children with cerebral palsy were also classified according to their functional mobility and manual dexterity.ResultsOn average, all measures were significantly smaller in the cerebral palsy group than the typical development group (p≤ .002). Manual function and functional mobility were negatively correlated with material (r = −.456, p = .011; r = −.487, p = .006) and space (r = −.494, p = .006; r = −.784, p = .000). Also the results pointed out a significant correlation with topography and manual function (r = .404, p = .027) and functional mobility (r = .718, p = .000). Pretend play and participation showed no correlation with topography (r = −.051, p = .788; r = −.312, p = .093), manual function (r = −.019, p = .921; r = −.322, p = .083) and functional mobility (r = −.085, p = .657; r = −.308, p = .097).ConclusionPlay performance of children with typical development was superior to those with cerebral palsy. The degree of impairment of functional mobility and manual function negatively was negatively associated with play exploration but did not relate to pretend play or social interaction in play.

Microvascularization is not a limiting factor for exercise in adults with cerebral palsy.

Muscle contractures are a common complication in patients with central nervous system (CNS) lesions which limit range of movement and cause joint deformities. Furthermore, it has previously been shown that muscles with contractures have a reduced number of capillaries, indicating decreased tissue vascularization. The aim of the present study was to investigate the microvascular volume (MV) at rest and after acute exercise in the muscle tissue of individuals with cerebral palsy (CP) and healthy control individuals. Contrast-enhanced ultrasound (CEUS) was used before and after 30 min of walking or running on a treadmill in 10 healthy control participants and 10 individuals with CP to detect MV of their skeletal muscle tissue. A significant increase in the MV was observed after exercise both in the adult CP group (21-53 yr) and in the control group (21-52 yr) (1.8 ± 0.8 ΔdB to 3.1 ± 0.9 ΔdB or 42.9% and 1.5 ± 0.6 ΔdB to 2.5 ± 0.9 ΔdB or 39.0%, respectively). Furthermore, a difference in the resting MV was observed between the most severe cases of CP [gross motor function classification scale (GMFCS) 3 and 4] (2.3 ± 0.5 ΔdB) and the less severe cases (GMFCS 1 and 2) (1.5 ± 0.2 ΔdB). When the CP group was walking (3.4 km/h), the lactate levels, Borg score, and heart rate matched the level of controls when they were running (9.8 km/h). In conclusion, individuals with CP become exhausted at much lower exercise intensities than healthy individuals. This is not explained by impaired microvascularization, since the MV of the individuals with CP respond normally to increased O2 demand during acute exercise. NEW & NOTEWORTHY Cerebral palsy (CP) patients were less physically active compared with typically developed individuals. This may affect the microvascularization. We observed that the CP group became exhausted at much lower exercise intensities compared with healthy individuals. However, impaired microvascularization was not the reason for the decreased physical activity as the CP group responded normally to increased O2 demand during acute exercise. These results indicate that walking may be recommended as an intervention to train and maintain skeletal muscle tissue in individuals with CP.

Effects of scalp electroacupuncture on the PI3K/Akt signalling pathway and apoptosis of hippocampal neurons in a rat model of cerebral palsy.

Background Substantial evidence from clinical reports has established that most cerebral palsy (CP) patients benefit from a comprehensive rehabilitation exercise training programme. Such advances are enhanced when scalp electroacupuncture (EA), applied at a location corresponding to the projection of the motor area, is combined with rehabilitation exercise training. However, little information exists regarding the mechanistic basis for these effects. Objective To examine whether EA stimulation within the scalp projection location of the motor area can inhibit apoptosis of hippocampal neurons by regulating the PI3k/Akt signalling pathway in a rat model of CP. Methods Fifty male Sprague-Dawley rats underwent surgical modelling of CP. Five were used to confirm successful establishment of the model and the remaining 45 rats were randomly divided into one of three groups that remained untreated (CP group, n=15) or received EA treatment alone (CP+EA group, n=15) or EA in combination with a PI3K/Akt inhibitor (CP+EA+LY294002 group, n=15)). An otherwise healthy negative control group of rats undergoing sham surgery was also included (Control group, n=15). In the CP+EA and CP+EA+LY294002 groups, EA was applied to the scalp surface at alocation corresponding to the projection of the motor area. Basso, Beattie and Bresnahan (BBB) locomotor scores, hippocampal protein expression of Akt and p-Akt (by Western blot analysis) and neuronal apoptosis in hippocampal tissue (by histopathology) were assessed at 7, 14 and 21 days post-CP induction. Results CP rats receiving scalp EA treatment demonstrated improved behavioural scores, less hippocampal neuronal apoptosis and higher expression levels of Akt and p-Akt (p<0.05) at all time points studied compared with untreated CP rats. There were no significant differences observed between CP+EA+LY294002 and untreated CP model groups. Conclusions The effects of scalp EA on the PI3K/ Akt signalling pathway may represent one of the mechanisms involved in the inhibition of hippocampal neuronal apoptosis and improvement of deficits associated with CP in a rat model.

Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia.

Perioperative bleeding requiring blood transfusion is a known complication of hip dysplasia (HD) surgery. Here we examine rates of, risk factors for, and postoperative complications associated with transfusion during HD surgery. The National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients treated by an orthopaedist from 2012 to 2013. HD cases were categorized by Current Procedural Terminology codes into femoral osteotomies, acetabular osteotomies, combined femoral/acetabular osteotomies, and open reductions. Patients were grouped by comorbidities: neuromuscular (NM) disease (eg, cerebral palsy) group, non-NM with other comorbidity (Other) group, and no known comorbidity (NL) group. Patients were stratified by weight-normalized transfusion volume. Multivariate regression analysis of transfusion association with procedures, demographics, comorbidities, preoperative laboratory values, and 30-day complications was performed. A total of 1184 HD cases were included. Transfusion rates for the NL, Other, and NM groups, respectively, were 44/451 (9.8%), 61/216 (28.2%), and 161/517 (31.1%). Transfusion volumes (mean±SD) for the NL, Other, and NM groups, respectively, were 8.4±5.4, 13.9±8.8, and 15.5±10.0 mL/kg (P<0.001). Combined osteotomies had the highest transfusion rates in the NM and Other groups (35.7% and 45.8%, respectively), whereas acetabular osteotomies had the highest rate in the NL group (15.8%). Open reductions had the lowest transfusion rate (all groups). Longer operations were independently associated with transfusion (all groups, per hour increase, OR>1.5, P<0.001). Independent patient risk factors included preoperative hematocrit <31% (NM group, OR=18.42, P=0.013), female sex (NL group, OR=3.55, P=0.008), developmental delay (NM group, OR=2.37, P=0.004), pulmonary comorbidity (NM group, OR=1.73, P=0.032), and older age (NL group, per year increase: OR=1.29, P<0.001). In all groups, transfusion was associated with longer hospitalization (P<0.001). We observed a volume-dependent increase in overall complication rate within the Other group for transfusion volumes >15 mL/kg (25.0% vs. 5.4% for <15 mL/kg, P=0.048). We identified several risk factors for transfusion in HD surgery. The incidence of transfusion in HD surgery and its association with adverse outcomes warrants development of appropriate patient management guidelines. Level III-prognostic.

Documenting an epidemic of suffering: low health-related quality of life among transgender youth.

To quantify HRQOL of TGN patients using the PedsQL 4.0 generic core scales, and to compare reported HRQOL of TGN adolescents with published data from comparison populations. Transgender children and adolescents (N = 142; 68% natal females) ages 6-23years (M = 15.9, SD = 3.7) attending an outpatient clinic for TGN care at an academic pediatric hospital and caregivers of children and adolescents (N = 95) completed the PedsQL 4.0 generic core scales. Scores were compared with published scores for healthy adolescents and adolescents with 10 chronic diseases. TGN youth reported significantly lower overall HRQOL (more than twice the clinically meaningful difference) compared to youth without chronic disease. Total self-reported TGN HRQOL (M(SD), 65.72(17.40)) was lower than all chronic disease comparison groups except for rheumatology and cerebral palsy. TGN youth reported physical functioning (M(SD), 75.33(22.87)) lower than or similar to chronically ill comparisons, but higher than rheumatology and cerebral palsy groups. Psychosocial functioning (M(SD), 59.87(17.83)) was lower than all comparison samples and similar to youth with cerebral palsy. Results were similar for parent proxy-reports of TGN youth HRQOL (LS means: 68.75; 95% CI 65.87-71.61 vs 66.16; 95% CI 62.87-69.45; p = 0.12). TGN youth reported low HRQOL across all domains; most were significantly lower than healthy peers or peers with chronic diseases. Clinicians should understand the magnitude of TGN youth's low HRQOL and offer them and their caregivers resources to maximize their ability to achieve their full potential for healthy and productive lives.

Developmental Features of Corpus Callosum in Children Revealed by MRI

With the wide use of magnetic resonance imaging (MRI) in clinical practice, more attention is paid to corpus callosum hypoplasia in children with various central nervous system diseases, including the cerebral palsy. We compared the areas of corpus callosum segments on the mid-sagittal MR images of the children with cerebral palsy and a control group; full-term infants and preterm infants. During the postnatal development, overall callosum area naturally increases, but single segments change differently in both absolute and relative values. In the control group, the relative area of the splenium grew insignificantly, whereas for the genu, it was stable. Children with cerebral palsy also show age-specific growth, but the area of corpus callosum is smaller compared with equal age children in the control group. We found an increased relative area of corpus callosum genu and a decrease of anterior body and splenium in the cerebral palsy group compared with the control group. The kCC index shows higher values in the control group than in any age subgroup of children with cerebral palsy. Mean values for the control group steadily increase with age, whereas in the cerebral palsy group, they remain the same. For every age-specific group, the difference of kCC was statistically significant. Mean kCC index values depend on gestational age and are statistically lower in preterm infants compared with full-term infants. Selective corpus callosum hypoplasia found in the current research could be due to Wallerian degeneration or a decreased number of axons in some of its segments. This could be explained by the disruption of neurogenesis in certain cortical areas. The morphometric index kCC can be used to detect deviations in the corpus callosum structure associated with prematurity and cerebral palsy.

Comparison of Morphological Characteristics of the Subaxial Cervical Spine between Athetoid Cerebral Palsy and Normal Control.

ObjectiveTo compare the morphometry of subaxial cervical spine between cerebral palsy (CP) and normal control.MethodsWe retrospectively analyzed 72 patients with CP, as well as 72 patients from normal population. The two groups were matched for age, sex, and body mass index. Pedicle, lateral mass (LM), and vertebral foramen were evaluated using computed tomography (CT) imaging. Pedicle diameter, LM height, thickness, width and vertebral foramen asymmetry (VFA) were measured and compared between the two groups. Cervical dynamic motion, disc and facet joint degeneration were investigated. Additionally, we compared the morphology of LM between convex side and concave side with cervical scoliotic CP patients.ResultsLM height was smaller in CP group. LM thickness and width were larger in CP group at mid-cervical level. In 40 CP patients with cervical scoliosis, there were no height and width differences between convex and concave side. Pedicle outer diameter was not statistically different between two groups. Pedicle inner diameter was significantly smaller in CP group. Pedicle sclerosis was more frequent in CP patients. VFA was larger in CP group at C3, C4, and C5. Disc/facet degeneration grade was higher in the CP group. Cervical motion of CP group was smaller than those of the control group.ConclusionLM morphology of CP patients was different from normal population. Sclerotic pedicles and vertebral foramen asymmetry were more commonly identified in CP patients. CP patients were more likely to demonstrate progressive disc/facet degeneration. This data may provide useful information on cervical posterior instrumentation in CP patients.

Quantification of Muscle Tissue Properties by Modeling the Statistics of Ultrasound Image Intensities Using a Mixture of Gamma Distributions in Children With and Without Cerebral Palsy.

To investigate whether quantitative ultrasound (US) imaging, based on the envelope statistics of the backscattered US signal, can describe muscle properties in typically developing children and those with cerebral palsy (CP). Radiofrequency US data were acquired from the rectus femoris muscle of children with CP (n = 22) and an age-matched cohort without CP (n = 14) at rest and during maximal voluntary isometric contraction. A mixture of gamma distributions was used to model the histogram of the echo intensities within a region of interest in the muscle. Muscle in CP had a heterogeneous echo texture that was significantly different from that in healthy controls (P < .001), with larger deviations from Rayleigh scattering. A mixture of 2 gamma distributions showed an excellent fit to the US intensity, and the shape and rate parameters were significantly different between CP and control groups (P < .05). The rate parameters for both the single gamma distribution and mixture of gamma distributions were significantly higher for contracted muscles compared to resting muscles, but there was no significant interaction between these factors (CP and muscle contraction) for a mixed-model analysis of variance. Ultrasound tissue characterization indicates a more disorganized architecture and increased echogenicity in muscles in CP, consistent with previously documented increases in fibrous infiltration and connective tissue changes in this population. Our results indicate that quantitative US can be used to objectively differentiate muscle architecture and tissue properties.