Cerebral Palsy Patients Research Articles

Translation and Validation Scale for Assessment and Rating of Ataxia in Urdu Language for Cerebral Palsy Patients

Aim: To translate the Scale for assessment and rating of Ataxia from English to Urdu language Methods: The study employed a linguistic validation study design with a non-random sample approach and was done at different clinical setups of Lahore. Parents of children with ataxic cerebral palsy with children aged 2 to 15 years old who speak Urdu should contact us. Sara's English version was translated into Urdu by two translators, one with a medical background and the other with a technical background in Urdu, both proficient in Urdu and English. Two individuals with medical and technology backgrounds who are competent in Urdu to English translation reverse translated the translated versions of SARA-Urdu I and SARA-Urdu II into English. The re-translated versions of SARA-Urdu I and SARA-Urdu II were translated back into English (SARA English III and SARA English IV). The translated versions were compared and generated a new Urdu version SARA Urdu-V. The data was entered into the SPSS version 23 application, which was also used to analyze it. Results: The translated version of the SARA scale has a Cronbach's alpha of 0.883. The inter-item correlation between the total SARA score and the eight domains of gait, stance, sitting, speech disturbance, finger chase, nose finger test, fast alternating hand movements, and heel shin slide was 0.131, 0.046, 0.159, 0.188, 0.136, 0.400, 0.698, and 0.450, respectively, after the translation of the Urdu version of SARA. For test retest reliability, the Pearson correlation value varied from 0.400 to 0.842. Conclusion: The Urdu version of SARA has appropriate internal consistency and fair inter-item correlation, and hence may be utilized by Urdu speakers. Keywords: Cerebral palsy, Cerebellar ataxia, Scale for assessment and rating of Ataxia

Combination of standard physical therapy with partial body weight supported treadmill training in children with spastic diplegic cerebral palsy

Standard physical therapy (SPT) with ground gait training is well recognized to improve the motor skill in cerebral palsy (CP) disease. Confirmation is required on achieving better gross motor function with partial body weight supported treadmill training (PBWSTT). The objective of the study is to analyze combination of SPT with PBWSTT for gross motor function children with spastic diplegic CP who able to walk. A prospective design was conducted in CP patients 2-7 years of age with Gross Motor Function Classification System (GMFCS) I-III and received physical therapy 2 times per week, 20 minutes per session, a total of 20 sessions. The treatment group is continued by PBWSTT for 20 minutes per session. Gross Motor Function Measure (GMFM)-66 of walking, running, and jumping (dimension E) is measured in pre and post-physical therapy. Data were analyzed descriptively. There were 10 subjects and divided into 5 subjects in the control and the rest in the treatment group. The mean age was 48.4 months and 63.4 months respectively. The Average score of GMFM-66 dimension E pre and post-SPT were 63.54 and 65.24, the difference is 1.7 (2.67%) from the initial score.

Metabolic assessment of cerebral palsy with normal clinical MRI using 18F-FDG PET imaging: A preliminary report.

To explore the cerebral metabolic patterns of cerebral palsy (CP) patients without structural abnormalities by brain magnetic resonance imaging (MRI) scans, we evaluated 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) imaging features in patients. Thirty-one children with CP [Gross Motor Function Classification System (GMFCS) levels II-V] showing no structural abnormalities by MRI were enrolled in this study. Regional glucose metabolic activity values were calculated using Scenium software and compared between the right and left cerebral hemispheres. These comparisons revealed asymmetric metabolic reductions in the central region, cerebellum, frontal lobe, and parietal lobe (p < 0.01). We next determined whether averaged brain metabolic activity values in different brain regions correlated with GMFCS levels. The metabolic activity values of basal ganglia, left temporal lobe, and cerebellum correlated negatively with GMFCS scores (all p < 0.05). This method was applied to the left cerebellum, which showed higher metabolic activity values than those in the right cerebellum in most patients (83.8%), and these values also correlated negatively with GMFCS scores (Spearman's r = −0.36, p = 0.01). Differential cortical glucose metabolism by 18F-FDG PET, may help to distinguish between different CP diagnoses that are not detected by MRI.

Early Intervention and Parent Counseling Give Positive Impact in Cerebral Palsy Child: A Case Report

Cerebral palsy is a neuro-development disorder, management of which requires awareness of risk factors and regular developmental assessments. Committed routine follow up is necessary for cerebral palsy patient along with parental adequate knowledge.Effective timely intervention with professional guidance along with medication could significantly improve the overall condition of cerebral palsy patient and therefore would make their living relatively meaningful.Early intervention starts withinfirst 6 months after term age. Intervention should be performed daily in home consideringthe importance of parent child relationship, training and counseling by professionalguidance. In fact, Parental knowledge of their child’s cerebral palsy is inadequate. If professionals give early intervention to the child and improve parental knowledge about cerebral palsy will empower them to help their children to overcome this chronic lifelong disorder. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 926-930

Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study.

The study's aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0-18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery.

Design of Virtual Reality-Based Hippotherapy Simulator Exergaming Software and Its Controller for Rehabilitation of Children with Cerebral Palsy in Indonesia: An Engineering Concept

Horse riding exercise, also known as hippotherapy is a popular treatment for children with cerebral palsy (CP). However, the need for trained therapist, massive land use, and expensive maintenance of the horse ranch makes hippotherapy not affordable or even available for most patients in Indonesia. This problem motivates us to consider mechanical horse riding simulator machines to replace actual horse hippotherapy. However, most patients are children and are easily bored when asked to do monotonous activities for an extended period. The room setting also does not give the patient visual inputs that usually help motivates the children in real-horse hippotherapy activities. To solve this problem, we designed an exercise game (exergaming) software which we named Sirkus Apel, providing the patients with fun activities while doing the therapy. We also design an inertial sensor-based controller that lets the patients control the in-game horse by their back movements, which also benefits CP patients. To make the visual input enjoyable to the user while also considering the user’s safety, we built a convex mirror-based dome virtual reality to provide an immersive 3-D experience. We then project the game content to the dome to provide an immersive experience to the patients making it as if they are riding a real horse inside the game.

Hip Imaging in Children With Cerebral Palsy: Estimation and Intrapatient Comparison of Patient-Specific Radiation Doses of Low-Dose CT and Radiography.

Hip displacement is the second most common orthopedic problem affecting children with cerebral palsy (CP). Routine radiographic hip surveillance typically involves an anteroposterior (AP) pelvis radiograph. Unfortunately, this imaging protocol is limited by its projectional technique and the positioning challenges in children with CP. Alternatively, hip low-dose computed tomography (LDCT) has been advocated as a more accurate strategy for imaging surveillance as it provides biofidelic details of the hip that is independent of patient positioning. However, the tradeoff is the (presumed) higher radiation dose to the patient. The goal of this study is to estimate patient-specific radiation doses of hip LDCTs and AP pelvis radiographs in CP patients, and perform an intrapatient dose comparison. A search of our imaging database was performed to identify children with CP who underwent hip LDCT and AP pelvis radiograph within 6 months of each other. The LDCTs were performed using weight-adjusted kVp and tube current modulation, whereas the radiographs were obtained with age-/size-adjusted kVp/mAs. The patient-specific organ and effective doses for LDCT were estimated by matching the patients to a nonreference pediatric phantom library from the National Cancer Institute Dosimetry System for Computed Tomography database with Monte Carlo-based dosimetry. The patient-specific organ and effective doses for radiograph were estimated using the National Cancer Institute Dosimetry System for Radiography and Fluoroscopy with Monte Carlo-based dose calculation. Dose conversion k-factors of dose area product for radiography and dose length product for LDCT were adapted, and the estimation results were compared with patient-specific dosimetry. Our study cohort consisted of 70 paired imaging studies from 67 children (age, 9.1 ± 3.3 years). The patient-specific and dose length product-based effective doses for LDCT were 0.42 ± 0.21 mSv and 0.59 ± 0.28 mSv, respectively. The patient-specific and dose area product-based effective doses for radiography were 0.14 ± 0.09 mSv and 0.08 ± 0.06 mSv, respectively. The radiation dose for a hip LDCT is ~4 times higher than pelvis radiograph, but it is still very low and poses minimal risk to the patient.

Pelvic radiography as a non-invasive screening tool for hiatal hernia in children with cerebral palsy.

The diagnosis of hiatal hernia (HH), causing severe gastroesophageal reflux disease and complications in children with cerebral palsy (CP) is cumbersome because invasive investigations are required for diagnosis. Hip displacement, one of the most common complications in children with CP, can be diagnosed with a simple pelvic radiograph. This study aimed to evaluate the association between the severity of hip displacement and HH and the diagnostic accuracy of Reimers’ hip migration percentage (MP) on pelvic radiography in assessing the presence of HH. A total of 52 children with CP (27 boys, 25 girls; mean age, 6.3 years; range, 0.6–17.4 years) who underwent esophagogastroduodenoscopy, upper gastrointestinal series and pelvic radiography between March 2013 and February 2020 were recruited. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were evaluated and statistically analyzed. HH was defined as ≥ 2 cm proximal displacement of the gastroesophageal junction identified in esophagogastroduodenoscopy or upper gastrointestinal series, and MP was calculated by evaluating the pelvic radiograph. Of the 52 children enrolled in this study, HH was diagnosed in 18 children (34.6%). When the patients were classified and analyzed according to the MP result, HH was observed in 10%, 26.7%, and 70.6% in MP <33%, MP 33%–39%, and MP > 40% groups, respectively (P < .001). The optimal MP cutoff of 36.5% distinguished pediatric CP patients with HH from those without HH with a sensitivity of 78%, specificity of 68%, a positive predictive value of 56.0%, and a negative predictive value of 85.2%, respectively. The application of MP and the severity of hip displacement, which can be easily measured by simple radiography, may be useful and reliable in screening for detecting HH in children with CP. Retrospectively registered. This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2007-627-106).

Measuring the knowledge level of cerebral palsy patients' parents about the complications of the disease

Measuring the knowledge level of cerebral palsy patients' parents about the complications of the disease

Live births with cerebral palsy at a tertiary maternity hospital: incidence and associated risk factors over a 17-year period

The aim of this retrospective study was to establish the incidence and associated risk factors for cerebral palsy (CP) at a tertiary maternity hospital in the UK between 2000–2016. We identified CP patients from our electronic coding system using ICD codes. Multiple independent variables for all live births born during this period were included in a univariate and multivariate logistic regression (LR) to identify associations between these and CP. We identified 130 CP children out of 87318 live births. Univariate LR determined male sex, birth weight <2500 g, gestational age of ≤36 weeks, Small-for-gestational-age, 1-and 5-minute Apgar score <9, neonatal intensive care unit (NICU) admission, multiple births, breech, emergency Caesarean section and delivery between 16.00–20.00 as significant risk factors. In the multivariate LG male sex, 1-minute Apgar <9, 5-minute Apgar <5 and admission to NICU remained as significant risk factors. The risk for delivery between 16.00–19.59 was nearly significant. There was a significant association between NICU admission and moderate-severe CP. Our CP incidence of 0.149% is at the lower end of the incidence spectrum of international comparisons. Impact Statement What is already known on this subject? The historic reported incidence of cerebral palsy (CP) ranges from 1.1 to 3.6 cases per 1000 live births, with birth weight <2500g, birth <28 weeks of gestation, Apgar scores ≤4 and male sex having been associated with an increased incidence. What do the results of this study add? This is a large series of live births from a tertiary maternity hospital with a comparative low CP incidence of 0.149%, despite the hospital dealing with many complex pregnancies and deliveries. We identified that already an Apgar score of <9 at 1 minute (significant) and births between 16.00–20.00 (non-significant) were associated with an increased risk to develop CP but not with a specific day of the week. What are the implications of these findings for clinical practice and/or future research? Our significant association between a 1-minute Apgar score of <9 and CP stresses the importance of immediate efficient resuscitation already for babies with a 1-minute score as high as 8. The increased CP risk for deliveries between 16.00–19.59 may be linked to staffing issues and needs further exploration. What this paper adds New data from a single maternity hospital Analysis of risk factors GMFCS distribution

Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications.

Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched, and all clinical studies focusing on THA in patients with CP from inception through March 2020 were included. The methodological quality was assessed with Guo et al.'s quality appraisal checklist for case series and case-control studies, while cohort and prospective studies were evaluated with a modified version of the Downs and Black's quality assessment checklist. The initial search returned 69 studies out of which 15, including 2732 THAs, met the inclusion criteria. The most frequent indication for THA was dislocated painful hip for which previous non-operative treatment had failed. Complications presented in 10 to 45% of cases. The most frequently reported complication was dislocation (1-20%), followed by component loosening (0.74-20%). Aseptic component loosening was the most frequent cause of revision surgery, followed by dislocation and periprosthetic fracture. Mean implant survival at ten years was 84% (range 81-86%). The available literature suggests that although THA is a beneficial procedure in CP patients, it has a higher rate of complications and worse implant survival than the general population.

Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy.

In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options. The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes. Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified. Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.

Analysis of Joint Power and Work During Gait in Children With and Without Cerebral Palsy

PurposeTo compare joint work in the lower limb joints during different sub-phases of the gait cycle between Cerebral Palsy (CP) and healthy children.MethodsEighteen CP and 20 healthy children’s gait data were collected. The CP group included orthoses, intra-muscular injection of botulinum toxin and surgery groups. A motion capture system was used to collect gait data. Joint work was calculated as positive and negative components in six subphases during gait and normalised by speed when comparing the groups.ResultsThe CP group had a slower walking speed, smaller stride length and longer stance phase than the healthy group. Hip max positive work was 0.12 ± 0.02 Jkg−1/ms−1 for the CP group in pre-mid-stance but 0.07 ± 0.01 Jkg−1/ms−1 for the healthy group during the terminal phase. In terminal stance, ankle positive work was significantly lower in the CP group (0.12 ± 0.01) than in the healthy group (0.18 ± 0.01). The knee showed a similar distribution of positive work in the stance phase for the two groups. In the ankle and hip, the CP group had energy generation mainly in midstance while the healthy group was mainly in terminal stance. In the ankle, the CP group had larger energy absorption in mid-stance than the healthy children group, while the CP group showed lower energy generation in the terminal stance phase than seen in the healthy group.ConclusionThe qualitative and quantitative analysis of joint work provides useful information for clinicians in the treatment and rehabilitation of CP patients.

Fate of hips complicated by avascular necrosis of the femoral head following reconstructive surgery in nonambulatory patients with cerebral palsy

The purpose of this study was to evaluate the influence of avascular necrosis of the femoral head (AVN) following hip reconstructions on the future hip development of cerebral palsy (CP) patients. A retrospective study of 394 hips in 205 nonambulatory patients with spastic CP who underwent reconstructive hip surgery was performed. The mean age at surgery was 7.3 ± 2.4 years. The mean follow-up duration was 5.6 ± 2.7 years, and the mean age at the latest follow-up was 12.8 ± 3.4 years. AVN was classified in terms of its severity and location. Femoral head remodelling was assessed by the spherical index and the Mose circle. An unsatisfactory radiological outcome was defined as having a migration percentage of more than 30% at the final follow-up. AVN was observed in 169 (42.9%) hips. Older age at the time of surgery, higher preoperative migration percentage, and open reduction procedures were predictors for the development of AVN. Hips with AVN confined to the lateral epiphysis, and AVN involving the entire epiphysis with preserved height experienced successful remodelling. 27 (65.9%) of the 41 hips with unsatisfactory outcomes experienced AVN. Younger age, higher postoperative migration percentage, and occurrence of AVN were related to unsatisfactory outcomes. The highest incidence of failed remodelling and unsatisfactory outcomes were observed in hips with entire epiphyseal involvement and more than 50% loss of its height. AVN following hip reconstructions is not necessarily associated with poor hip development, however, depending on the severity and location, it is a prognostic factor for unsatisfactory radiological outcomes.

Analysis of kinematic and kinetic parameters of pace in cerebral palsy patients with internal torsion hip deformity

Literature data on the correlation between femoral torsion during clinical examination and during walking are different. Aim of the study was to compare kinetics and kinematics in cerebral palsy patients with iatrogenic crouch gait pattern with and without clinically diagnosed internal femoral torsion. Material and methods . Comparative analysis of clinical examination and three-dimensional gait analysis (3DGA) was performed in 61 subjects (122 limbs), GMFCS II with iatrogenic crouch gait pattern. The average age was 14.5 ± 2.5 years. This sample was formed in 2018 – 2021. Kinetic and kinematic data were recorded by Qualisys 7+ optical cameras (8 cameras) with passive marker video capture technology, synchronized with six KISTLER dyno platforms (Switzerland). The analysis was performed in the QTM (Qualisys) and Visual3D (C-Motion) programs with automated calculation of values. Based on the clinical data, all the patients were divided as follows: I – no clinically detected internal femoral torsion – 50 limbs, II – clinically detected internal femoral torsion – 68 limbs. Results . Comparison of the values of kinematics and kinetics in groups of patients according to the criterion of clinically detected/not detected had statistically significant differences in kinematics – the maximum and minimum values of femur and tibia torsion relative to the norm. Differential diagnosis of compensated/decompensated internal femoral torsion was represented by multidirectional values of the angle of foot positioning relative to the motion vector. The kinetic parameters in the groups were statistically doubtful, because they depended on the walking speed of patients, their ability to move. Conclusions . The values of maximum femoral torsion angle up to 22° were not clinically interpreted as internal femoral torsion, those from 22° to 28° can be interpreted both with clinically revealed femoral torsion (68 %) and with the absence of femoral torsion (22 %), which corresponds to the risk group, those more than 28° fell into the group of clinically diagnosed internal femoral torsion.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Sep 2022This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002822AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Awake Intravesical Botulinum Toxin in Pediatric Neurogenic Bladder Many pharmacological agents are derived from natural products. What started out as reports of poison-tipped arrows and blowgun darts led to interest about the paralytic properties of curare. The medical benefits of paralysis led to research into the mechanism of action and commercially available sources with reliable dosages and effects.1 One of the earliest motivations was to try to limit the effects on severe muscle contractions during electroconvulsive therapy. These efforts led to its role in general anesthesia as the paralytic agent tubocurarine.2 While other agents such as pancuronium have become more commonly used,3 the precedent was set. Botulinum toxin (Botox®) is the neurotoxin produced by Clostridium botulinum bacteria. It affects the acetylcholine receptors at the neuromuscular junction, leading to flaccid paralysis. It is a potent lethal naturally occurring toxin and has led to medical interest in much the same fashion as curare was developed into a therapeutic.4 Commercial botulinum toxin has been shown to help with muscle spasticity and to improve storage pressures in neurogenic bladder patients when injected intravesically. These treatments are usually carried out under general anesthesia. Overland et al (page 702) from San Francisco, California discuss the use of botulinum neurotoxin in an awake setting.5 They note that physiatrists have been injecting intramuscular botulinum toxin without general anesthesia or sedation in their cerebral palsy and spasticity patients. They present a small series of patients (sensate and nonsensate) who received bladder botulinum toxin injection without general anesthesia but with support standing by if needed. They had good results, with only 2 patients requiring conversion to general anesthesia or sedation, and mitigating factors such general anxiety and communication issues were present. Because botulinum toxin effects are limited and repeat injections are often necessary, performing the procedure without repeated general anesthesia not only is economical and conserves operating room time, but also helps limit anesthesia exposure. Do New Complications Develop during Puberty after Hypospadias Repair? We are currently in a period of reassessment of hypospadias methods and the reporting of complications and reoperations.6 An experienced pediatric urologist once noted that “everyone’s repair looks good at the time of surgery; tell me what it looks like at 1 year.”7 This concern about late-presenting issues has led many to advocate long-term followup through puberty. While logical, given the many anecdotal reports of late-presenting fistulas, or perhaps more accurately, late-reported fistulas, more is needed to be known about late effects, particularly in those patients who had more complex procedures. Do the growth of the penis during puberty, erections and onset of sexual activity risk greater complications later in life, when many of these patients may be transitioning out of pediatric urology care? Snodgrass and Bush (page 696) from Dallas, Texas report on their experience with patients who presented with late complications.8 All were peripubertal or postpubertal. They found in their retrospective review that 86% recalled complications occurring before puberty. They noted a bimodal presentation, with most being reported before puberty and a few developing later into adulthood, usually related to obstruction and stenosis. Selection and recall bias clearly can affect these findings, because one can only report on patients who are unhappy enough to present, and recall of exact onset can be difficult in some to pin down. Adolescents and young men who might not have relished recurrent operations on their penis as a child may not have the most reliable recall of exact onset of complications. This bimodal presentation supports the finding of Barbagli et al.9 An initial group will have issues attributed to evaluation, surgical technique and approach, and postoperative care. The later group are those older men who have had good early results but who develop late strictures and stenosis; this is believed due to neourethras created out of skin and lack of a natural corporal spongiosum support. Followup through puberty seems warranted, and patients who present later in life with a prior history of hypospadias repair deserve further investigation despite making it through adolescence doing well.

Comparison of baseline characteristics and postoperative complications in neuromuscular, syndromic and congenital scoliosis.

Nonidiopathic scoliosis encompasses a group of diagnoses, including neuromuscular scoliosis, syndromic scoliosis and congenital scoliosis. The objective of this study was to compare the preoperative and postoperative clinical differences in pediatric nonidiopathic scoliosis patients with neuromuscular scoliosis vs. syndromic scoliosis/congenital scoliosis. This is a single-center retrospective review of all pediatric patients undergoing spinal instrumentation for nonidiopathic scoliosis during a 5-year period. Neuromuscular scoliosis patients ( n = 144), syndromic scoliosis patients ( n = 44) and congenital scoliosis patients ( n = 52) were compared. Demographics, patient characteristics and outcomes were compared. Neuromuscular scoliosis patients had lower BMI z-scores and were more likely to have pulmonary disease, technology dependence and seizure disorder. Additionally, neuromuscular scoliosis patients underwent bigger procedures with more levels fused and a higher rate of pelvis fixation. By direct comparison, neuromuscular scoliosis patients tended to have more complications including deep surgical site infections, readmission in 30 days, return to operating room in 90 days and emergency care visits in 90 days. When controlling for the differences in their preexisting conditions and surgical procedure, we found that pelvic fixation was a major confounding factor, whereas the others had no effect. We further subanalyzed cerebral palsy patients and found this group to exhibit no difference in complications compared to other neuromuscular scoliosis subtypes. Neuromuscular scoliosis patients have different characteristics and subsequent postoperative complications than those with syndromic scoliosis and congenital scoliosis. The difference in complication profile is mainly due to differences in surgical procedure and a higher rate of pelvic fixation. This should be considered when planning nonidiopathic scoliosis surgery among multidisciplinary teams.

Defining Equinus Foot in Cerebral Palsy.

Background: Equinus foot is the deformity most frequently observed in patients with cerebral palsy (CP). While there is widespread agreement on the treatment of equinus foot, a clear clinical definition has been lacking. Therefore, we conducted this study to evaluate functional changes in gait analysis in relation to maximum possible dorsiflexion (0°, 5°, 10° and 15°) and in two subgroups of CP patients (unilateral and bilateral). Methods: In this retrospective study, CP patients with different degrees of clinically measured maximum dorsiflexion were included. We further subdivided patients into unilaterally and bilaterally affected individuals and also included a healthy control group. All participants underwent a 3D gait analysis. Our goal was to determine the degree of maximum clinical dorsiflexion where the functional changes in range of motion (ROM) and ankle moment and power during gait were most evident. Then, a subgroup analysis was performed according to the affected side. Results: In all, 71 and 84 limbs were analyzed in unilaterally and bilaterally affected subgroups. The clinically 0° dorsiflexion group barely reached a plantigrade position in the 3D gait analysis. Differences in ROM were observed between subgroups. Ankle moment was quite similar between different subgroups but to a lower extent in the unilateral group. All CP patients had reduced ankle power compared to controls. Conclusions: A cutoff value of clinical ≤ 5° dorsiflexion is the recommended value for defining a functionally relevant equinus foot in CP patients.

Grice extra-articular subtalar fusion for spastic pes planovalgus.

A pes planovalgus deformity, an unstable foot deformity, affects the gait of children with cerebral palsy (CP). Treatments, including subtalar fusion, were proposed. The Grice procedure maintains foot stability, but bone graft non-union poses a challenge. This study aimed to identify the rate and factors related to post-operative bone graft non-union. Thirty-one paediatric CP patients (age, 8.9 ± 1.8 years) who underwent the Grice procedure (53 feet) using ipsilateral tibial bone grafts were reviewed. Pre-operative gross motor function classification system (GMFCS) classes were class 1 in five, 2 in five, 3 in 14, and 4 in seven patients. Standing foot radiographs were assessed for signs of non-union, and parameters (talocalcaneal and talar declination angles and talar head uncovering index) measured pre-operatively, post-operatively, and at the most recent evaluation were compared. Factors associated with bone graft non-union were analysed by regression analysis. P < 0.05 was considered statistically significant. Degenerative changes in hindfoot joints were evaluated by Bargon's criteria. At the average follow-up evaluation at 5.4 ± 4.3 years, the GMFCS class was improved or was maintained in 29/31 patients. Post-operative radiographic measurements were restored and were maintained over the follow-up period (P < 0.001). A total of 14/53 feet (26%) had non-union. The pre-operative lateral talocalcaneal angle (OR 1.08, p = 0.04) and follow-up duration (OR 1.18, p = 0.03) were identified in univariate analysis as potential factors related to non-union but were not confirmed in a multivariate model. Hindfoot joints in most feet showed mild degenerative changes. Grice subtalar fusion in patients with a higher pre-operative lateral talocalcaneal angle might lead to bone graft non-union.

A retrospective cohort study about hip luxation in non-ambulatory cerebral palsy patients: The point of no return.

Purpose:The migration percentage is a widely used criterion for surgery in displaced hips. Literature suggests that no hip can spontaneously improve if the migration percentage exceeds 45%, in a mixed population of cerebral palsy children. The aim of the present article was to identify the point of no return of the migration percentage in a selected sample of non-ambulatory cerebral palsy children, being the most exposed to hip luxation.Methods:This single-center retrospective cohort study included patients with spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV or V, age 0–18, having at least three pelvic radiographies, excluding radiographies relative to hips having previously undergone surgery. The following information was collected: sex, cerebral palsy subtype, Gross Motor Function Classification System level, presence of drug-resistant epilepsy, migration percentage, age at assessment, use of walking or standing assistive devices, previous botulinum injection, oral or intrathecal baclofen, and hip pain. Data were analyzed at the level of the individual hips. Descriptive statistics were presented. Receiver operating characteristic curve analysis was conducted to investigate which value of the migration percentage could be adopted as the “point of no return”: that is, the cutoff value beyond which no migration percentage reduction, by more than 5%, could be expected.Results:The optimal cutoff value was identified as migration percentage ≥50%, with a sensitivity of 84.5% and a specificity of 100% (p-value <0.001).Conclusion:Based on the present study, migration percentage ≥50% is the “point of no return” for Gross Motor Function Classification System IV-V cerebral palsy patients, representing the cutoff value beyond which no spontaneous cerebral palsy reduction may be expected, unless addressing surgery.Level of evidence:level II—retrospective study.