Cerebral Palsy Subjects Research Articles

Évaluation de la fiabilité de l’examen clinique de la hanche de l’enfant paralysé cérébral

The incidence of cerebromotor disorders of cerebral palsied subjects on their orthopedic state is a constant: excess contractions leading to misalignments, muscular and periarticular retractions, displacements of mobility sectors, bone deformations These orthopedic consequences are correlated to the degree motor impairment. Rehabilitation, orthopaedic, medical and surgical treatments find their relevance all the more so if the factors of the disorders are correctly identified, evaluated qualitatively and quantitatively. The contributions of clinical and paraclinical examinations complement each other to provide professionals with the richest range possible. In 1991, Dr Alain Lespargot described a clinical examination allowing to define the sectors of mobility where the hip is in a situation of satisfactory centering or on the contrary, of less centering. This article studies the interest of this examination in addition to radiography. This is a first step to show that this clinical examination effectively accounts for the centering situation of the hips flexed around 90°. It is reliable and reproducible. However, it requires some practice and repetition, like many of our other professional gestures.

De l’évolution des représentations du handicap à l’évolution des modèles de conception des appareillages

The device occupies an important place in the therapeutic arsenal used in cerebral palsy. The molded seat (or seat corset), the pelvic-pedal splints for verticalization, the night splints represent the daily life of a large number of cerebral palsy subjects. Unfortunately, it is a source of pain or discomfort, which limits its use when the initial objectives seemed relevant. The tools allowing the development of the specifications of these devices have evolved in connection with the representation that we have of disability and of the person with a disability. This evolution opens up new perspectives in the representation and design of the device: This would no longer be only a tool for compensating for a deficiency but that of an adaptive and enabling tool.

A deep-learning approach for automatically detecting gait-events based on foot-marker kinematics in children with cerebral palsy-Which markers work best for which gait patterns?

Neuromotor pathologies often cause motor deficits and deviations from typical locomotion, reducing the quality of life. Clinical gait analysis is used to effectively classify these motor deficits to gain deeper insights into resulting walking behaviours. To allow the ensemble averaging of spatio-temporal metrics across individuals during walking, gait events, such as initial contact (IC) or toe-off (TO), are extracted through either manual annotation based on video data, or through force thresholds using force plates. This study developed a deep-learning long short-term memory (LSTM) approach to detect IC and TO automatically based on foot-marker kinematics of 363 cerebral palsy subjects (age: 11.8 ± 3.2). These foot-marker kinematics, including 3D positions and velocities of the markers located on the hallux (HLX), calcaneus (HEE), distal second metatarsal (TOE), and proximal fifth metatarsal (PMT5), were extracted retrospectively from standard barefoot gait analysis sessions. Different input combinations of these four foot-markers were evaluated across three gait subgroups (IC with the heel, midfoot, or forefoot). For the overall group, our approach detected 89.7% of ICs within 16ms of the true event with a 18.5% false alarm rate. For TOs, only 71.6% of events were detected with a 33.8% false alarm rate. While the TOE|HEE marker combination performed well across all subgroups for IC detection, optimal performance for TO detection required different input markers per subgroup with performance differences of 5-10%. Thus, deep-learning LSTM based detection of IC events using the TOE|HEE markers offers an automated alternative to avoid operator-dependent and laborious manual annotation, as well as the limited step coverage and inability to measure assisted walking for force plate-based detection of IC events.

An Intention Prediction Based Shared Control System for Point-to-Point Navigation of a Robotic Wheelchair

Shared control approaches for robotic wheelchairs aim to provide navigation assistance to humans by utilizing robot’s intelligence in environment perception and motion planning. They can be broadly classified into two categories based on human intention prediction. Without human intention prediction, control authority lies with humans and assistance is provided only to avoid collisions. This can cause difficulty in cases where fine motor control is required, such as when entering narrow doorways, especially for users with severe upper limb disability. Intention prediction based approaches are able to better assist with such tasks but do not give enough control authority to the user as possible user intentions are pre-defined. In this work, we present an intention prediction based shared control system for point-to-point navigation of wheelchair which gives control authority to the user and also assists in fine motor control tasks. We compute various possible user intentions online using generalized Voronoi diagram, link them across time steps using their <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">homotopy class</i> and thus are able to calculate their probability given user input history. A shared local path planner then steers user towards the most likely path. This allows the user to follow any path. Our simulation experiments with 18 healthy subjects and both simulation and real wheelchair experiments, with 2 Cerebral Palsy (CP) subjects, show that our system can improve navigation outcome for people with disability and in general leads to around 10% faster completion of the task for even healthy people as compared to a local obstacle avoidance system while allowing users to follow their desired path with similar accuracy.

Brachial plexus birth injury and cerebral palsy lead to a common contracture phenotype characterized by reduced functional muscle length and strength.

IntroductionBrachial plexus birth injury (BPBI) and cerebral palsy (CP) both cause disabling contractures for which no curative treatments exist, largely because contracture pathophysiology is incompletely understood. The distinct neurologic nature of BPBI and CP suggest different potential contracture etiologies, although imbalanced muscle strength and insufficient muscle length have been variably implicated. The current study directly compares the muscle phenotype of elbow flexion contractures in human subjects with BPBI and CP to test the hypothesis that both conditions cause contractures characterized by a deficit in muscle length rather than an excess in muscle strength.MethodsSubjects over 6 years of age with unilateral BPBI or hemiplegic CP, and with elbow flexion contractures greater than 10 degrees on the affected side, underwent bilateral elbow flexion isokinetic strength testing to identify peak torque and impulse, or area under the torque-angle curve. Subjects then underwent needle microendoscopic sarcomere length measurement of bilateral biceps brachii muscles at symmetric joint angles.ResultsIn five subjects with unilateral BPBI and five with hemiplegic CP, peak torque and impulse were significantly lower on the affected versus unaffected sides, with no differences between BPBI and CP subjects in the percent reduction of either strength measurement. In both BPBI and CP, the percent reduction of impulse was significantly greater than that of peak torque, consistent with functionally shorter muscles. Similarly, in both conditions, affected muscles had significantly longer sarcomeres than unaffected muscles at symmetric joint angles, indicating fewer sarcomeres in series, with no differences between BPBI and CP subjects in relative sarcomere overstretch.DiscussionThe current study reveals a common phenotype of muscle contracture in BPBI and CP, with contractures in both conditions characterized by a similar deficit in muscle length rather than an excess in muscle strength. These findings support contracture treatments that lengthen rather than weaken affected muscles. Moreover, the discovery of a common contracture phenotype between CP and BPBI challenges the presumed dichotomy between upper and lower motor neuron lesions in contracture pathogenesis, instead revealing the broader concept of “myobrevopathy”, or disorder of short muscle, warranting increased investigation into the poorly understood mechanisms regulating muscle length.

Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.

COMPARATIVE STUDY OF EFFICACY OF CRYOTHERAPY AND MYOFASCIAL RELEASE TECHNIQUE IN CALF MUSCLE SPASTICITY IN SPASTIC DIPLEGIC CEREBRAL PALSY CHILDREN

The greatest substantial consequence of juvenile impairment is cerebral palsy (CP). Spasticity of numerous muscle groupings is common after Central Nervous System damage. Spasticity causes functioning issues. For individuals suffering from CP ankle anomalies seem strongly tied to workable limits. Spastic CP is highest frequent type of CP, which limits child's responsive status and prohibits them from participating in communal activities. Soft tissue mobilisation procedures would be used in variety ways. Cryotherapy is interventional method for stiffness in neurological patients that has narrow advantage. MFR can potentially utilised against spasticity. The focus of this investigation is to evaluate Cryotherapy and MFR influence over calf muscle stiffness in participants who have Spastic Diplegic CP. The survey's goal is to determine efficacy of Cryotherapy and MFR in calf muscle spasticity in Spastic diplegic CP subjects. Thirty individuals suffering spastic diplegic CP were chosen using randomized sampling procedure. The subjects was categorised onto 3 subgroups, each of ten individuals. Cryotherapy was applied to Group A, MFR was applied to B and C Group was applied with combination of cryotherapy and MFR. Both before and after therapy, MAS and goniometry are used to assess calf muscle spasticity and ankle PROM. Overall validity of MAS and PROM comparing before and after in subgroup was determined using Tukey Test. Spasticity was reduced and range of motion was improved (p&lt;0.05) in intra group comparison. Cumulative influence of cryotherapy and MFR is beneficial in reducing calf muscle stiffness in spastic diplegic CP children, as per this investigation.

Changes in intersegmental stability during gait in patients with spastic cerebral palsy.

Dysfunction in peripheral and neural structure with spastic cerebral palsy (CP) causes impaired performance and stability of various behaviors. Recent progress of quantification methods for the stability properties, which is based on the uncontrolled manifold hypothesis, has been applied to various neurological disorders. A prior study revealed that the ability for purposeful regulation of stability properties is weakened with CP during finger and hand actions. Successive regulation of stability properties is crucial for human locomotion; therefore, it is imperative to quantify the changes in the intersegmental coordination as to the stable performance in CP individuals during gait. We hypothesized that (1) Spastic CP group will show smaller step length and gait velocity with larger variability, and (2) Spastic CP group will show no changes in average stability indices for both the COM and head position stabilization, while the smaller difference between stable and unstable posture during the gait cycle. Whole-body kinematic data during walking were collected from CP and control subjects. Step length, velocity, and coefficient of variation (CV) were calculated as spatiotemporal parameters. We quantified the intersegmental stability index in time-series during gait for the stabilization of the whole-body COM and head position. The CP subjects showed smaller step length and velocity with larger CV than the controls. However, the CP group showed a significantly less difference in the stability indices between the single- and double-limb support phases as compared to the controls for both the COM and head position stabilization. Present study is the first to document the quantification of changing intersegmental stability in the spastic CP during locomotion. The dysfunction of intentional modulation of stability properties in CP individuals may be a more common problem, which is not limited to a specific body effector.

Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values

This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.

Whole genome methylation and transcriptome analyses to identify risk for cerebral palsy (CP) in extremely low gestational age neonates (ELGAN)

Preterm birth remains the leading identifiable risk factor for cerebral palsy (CP), a devastating form of motor impairment due to developmental brain injury occurring around the time of birth. We performed genome wide methylation and whole transcriptome analyses to elucidate the early pathogenesis of CP in extremely low gestational age neonates (ELGANs). We evaluated peripheral blood cell specimens collected during a randomized trial of erythropoietin for neuroprotection in the ELGAN (PENUT Trial, NCT# 01378273). DNA methylation data were generated from 94 PENUT subjects (n = 47 CP vs. n = 47 Control) on day 1 and 14 of life. Gene expression data were generated from a subset of 56 subjects. Only one differentially methylated region was identified for the day 1 to 14 change between CP versus no CP, without evidence for differential gene expression of the associated gene RNA Pseudouridine Synthase Domain Containing 2. iPathwayGuide meta-analyses identified a relevant upregulation of JAK1 expression in the setting of decreased methylation that was observed in control subjects but not CP subjects. Evaluation of whole transcriptome data identified several top pathways of potential clinical relevance including thermogenesis, ferroptossis, ribosomal activity and other neurodegenerative conditions that differentiated CP from controls.

The Impact of Oral-Gut Inflammation in Cerebral Palsy.

Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy.Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis.Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292).Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.

Gene expressions in cerebral palsy subjects reveal structural and functional changes in the gastrocnemius muscle that are closely associated with passive muscle stiffness.

Cerebral palsy (CP) is a non-progressive motor disorder that affects posture and gait due to contracture development. The purpose of this study is to analyze a possible relation between muscle stiffness and gene expression levels in muscle tissue of children with CP. Next-generation sequencing (NGS) of gene transcripts was carried out in muscle biopsies from gastrocnemius muscle (n=13 children with CP and n=13 typical developed (TD) children). Passive stiffness of the ankle plantarflexors was measured. Structural changes of the basement membranes and the sarcomere length were measured. Twelve pre-defined gene target sub-categories of muscle function, structure and metabolism showed significant differences between muscle tissue of CP and TD children. Passive stiffness was significantly correlated to gene expression levels of HSPG2 (p=0.02; R2=0.67), PRELP (p=0.002; R2=0.84), RYR3 (p=0.04; R2=0.66), C COL5A3 (p=0.0007; R2=0.88), ASPH (p=0.002; R2=0.82) and COL4A6 (p=0.03; R2=0.97). Morphological differences in the basement membrane were observed between children with CP and TD children. The sarcomere length was significantly increased in children with CP when compared with TD (p=0.04). These findings show that gene targets in the categories: calcium handling, basement membrane and collagens, were significantly correlated to passive muscle stiffness. A Reactome pathway analysis showed that pathways involved in DNA repair, ECM proteoglycans and ion homeostasis were amongst the most upregulated pathways in CP, while pathways involved in collagen fibril crosslinking, collagen fibril assembly and collagen turnover were amongst the most downregulated pathways when compared with TD children. These results underline that contracture formation and motor impairment in CP is an interplay between multiple factors.

A Study to Evaluate the Effect of Proprioceptive Neuromuscular Facilitation Stretching on Balance and Gait in Spastic Diplegic Cerebral Palsy: An Interventional Study

Background: Cerebral Palsy is a static, non-progressive disorder that results from brain insult or injury during any of the prenatal, perinatal and postnatal stages. Proprioceptive neuromuscular facilitation integration pattern stimulates the proprioceptors with in the muscle and tendon to enhance the performance, flexibility and balance. It is generally effective in maintaining the reaction of exercise unit by increasing the co-ordination which react to the stimulation in muscular strength and flexibility. AIM: To evaluate the effect of Proprioceptive neuromuscular facilitation Stretching on balance and gait in spastic diplegic cerebral palsy. Method: Total 30 Spastic diplegic cerebral palsy subjects were assessed as per Selection criteria of the study. Consent form taken from children’s parents. They were randomly divided into group-A (n=15) and group-B (n=15). spastic diplegic cerebral palsy were assessed for baseline outcome measures Pediatric berg balance, WeeFIM scale ,10 Meter walk test on day 1 and after 4 week. Group-A was given conventional treatment and Propioceptive neuromuscular facilitation stretching which include hold -relax and contract- relax for 6-second hold and 10 repetitions for 5 days/week for 4 weeks. Group-B was given conventional treatment. Statistical analysis was done using SPSS Software. Conclusion: Neuromuscular facilitation stretching along with conventional therapy is more effective to improve the balance and gait in spastic diplegic cerebral palsy.

Mechanisms of reduced plantarflexor function in Cerebral palsy: smaller triceps surae moment arm and reduced muscle force

Both muscle forces, and moment arm (MA) could contribute to reduced muscle moment in people with Cerebral Palsy (CP). Current reports in CP are conflicting. The tendon travel method of estimating MA requires constant force, but passive force is high and variable in CP, and range of motion is limited. Therefore, the purpose of this study was to examine triceps surae muscle MA in 12 subjects with mild to moderate CP (15–32 years) and 10 typically developing peers (TD, 17–26 years) by tendon travel and by visually measuring the apparent MA. MA was calculated at 90° and at a reference angle (∼106°) with zero net passive moment. The tendon travel (28.8 ± 5.6 mm) and visual methods (29.1 ± 5.5 mm) yielded similar MA in CP (p = 0.94) at the reference angle. TD had significantly larger triceps surae muscle MA than CP subjects (p = 0.002), 35.4 ± 4.1 mm at the reference angle for tendon travel and 35.4 ± 3.6 mm by the visual method. Test/retest revealed less bias (0.8 mm) using the visual method. Calculated active peak isometric force was significantly less in CP (1983.8 ± 887.0 N) than TD (4104.9 ± 1154.9 N, p < 0.001). There are challenges in estimating MA in CP, but the visual method is more reliable. Although a shorter moment arm would reduce the joint moment, joint angular velocity for a given velocity of muscle shortening would be enhanced. Strength training may mitigate the effects of the smaller moment arm and reduced joint moment generated in those with CP.

Concurrent Validity and Reliability of an Inertial Measurement Unit for the Assessment of Craniocervical Range of Motion in Subjects with Cerebral Palsy.

Objective: This study aimed to determine the validity and reliability of Inertial Measurement Units (IMUs) for the assessment of craniocervical range of motion (ROM) in patients with cerebral palsy (CP). Methods: twenty-three subjects with CP and 23 controls, aged between 4 and 14 years, were evaluated on two occasions, separated by 3 to 5 days. An IMU and a Cervical Range of Motion device (CROM) were used to assess craniocervical ROM in the three spatial planes. Validity was assessed by comparing IMU and CROM data using the Pearson correlation coefficient, the paired t-test and Bland–Altman plots. Intra-day and inter-day relative reliability were determined using the Intraclass Correlation Coefficient (ICC). The Standard Error of Measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90) were obtained for absolute reliability. Results: High correlations were detected between methods in both groups on the sagittal and frontal planes (r > 0.9), although this was reduced in the case of the transverse plane. Bland–Altman plots indicated bias below 5º, although for the range of cervical rotation in the CP group, this was 8.2º. The distance between the limits of agreement was over 23.5º in both groups, except for the range of flexion-extension in the control group. ICCs were higher than 0.8 for both comparisons and groups, except for inter-day comparisons of rotational range in the CP group. Absolute reliability showed high variability, with most SEM below 8.5º, although with worse inter-day results, mainly in CP subjects, with the MDC90 of rotational range achieving more than 20º. Conclusions: IMU application is highly correlated with CROM for the assessment of craniocervical movement in CP and healthy subjects; however, both methods are not interchangeable. The IMU error of measurement can be considered clinically acceptable; however, caution should be taken when this is used as a reference measure for interventions.

Effects of spastic cerebral palsy on multi-finger coordination during isometric force production tasks.

In this study, we quantified changes in finger interdependence (enslaving), multi-finger synergies, and feedforward modulation of synergy properties (i.e., anticipatory synergy adjustment) during single- and multi-finger force production tasks in individuals with cerebral palsy (CP). Spastic diplegic CP and healthy control subjects performed sets of finger force production tasks by each of the hands, including maximal force production and submaximal quick pulse force production in an isometric condition. The framework of the uncontrolled manifold hypothesis was used to quantify the indices of multi-finger synergies and the anticipatory synergy adjustment (ASA). The CP group showed lower maximal forces and higher indices of finger interdependence (enslaving), while the indices of multi-finger synergies stabilizing total finger forces during stable force production were not different significantly compared to the controls. Further, the time of ASA for the CP group was not delayed. The CP group showed a significantly less drop in the synergy indices during the anticipatory and quick pulse phase compared to the control group, which was accompanied by larger co-contraction indices of the forearm muscles. These findings suggest that the function of assembling motor synergies for stable force production is not affected by CP, while the ability to modulate synergy properties may be impaired with CP partially due to spasticity. The spasticity presumably hampers the purposeful feedforward destabilization of the performance. The results suggest that quantification of multi-digit synergies may provide an alternative tool for quantitative assessment of impaired coordination in the CP individuals.

Comment vieillit-on en institution avec une scoliose ? Impact de l’arthrodèse vertébrale sur la qualité de vie des paralysés cérébraux adultes

IntroductionQuality of life is now part of the discussion, when considering spinal arthrodesis in children and teenagers with severe cerebral palsy and scoliosis. From the subjective point of view of close caregivers, quality of life is significantly improved two to five years after surgery. Nevertheless information relevant to the long-term evolution of those patients, most of them institutionalized, is lacking. In this study the quality of life of 45 adult cerebral palsy subjects with scoliosis (20 with arthrodesis and 25 without), classified IV or V on the Gross Motor Classification System and living in institutions was questioned. Material and methodFour items: daily care, pain/comfort, sitting position and communication, were proposed to evaluation by professional caregivers, blind to the final goal of the study and asked to answer along a Lickert scale (−2 to +2). ResultsResults show that professional caregivers dont make any difference between operated and non operated patients when considering easiness of daily care, pain/comfort of the resident or ability to communicate, but judge sitting position to be slightly better for those with spinal arthrodesis. Satisfaction with sitting posture depends for one part on the degree of scoliotic curve but other factors (hip and knee rigidity, quality of the sitting orthosis) also seem to be relevant. ConclusionSpinal arthrodesis is beneficial for sitting posture, even in aging subjects with severe cerebral palsy and scoliosis living in institutions. But the study also points to the numerous other health challenges which negatively affect the quality of life of such patients.

Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control.Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations.Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review.Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies.Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.

The effect of feeding problems on the growth of children and adolescents with cerebral palsy

This cross sectional study determine the growth, feeding problems and nutrient intakes of cerebral palsy children and adolescents. A total of 153 subjects (68 females, 85 males) aged between 2 to 15 years old (mean 8.93 + 3.5) from community rehabilitation centers and spastic centers around Kuala Lumpur, Muar and Penang were recruited using convenience sampling method. 61% of subjects had feeding problems especially in the severe level group (72.9%) as compared to the mild (50.6%) [(χ 2 =7.890), p<0.05], whereby choking and swallowing were significantly associated with their severity levels [(χ 2 choking =7.183), p<0.05; (χ 2 swallowing =9.994), p<0.05]. Subjects with feeding problems have lower body weight, height, BMI, triceps skin fold and MUAC (p<0.05 for all parameters). 60% of cerebral palsy subjects had poor nutritional status, feeding problems and the presence of feeding problems significantly affects their growth.

Nutritional status in cerebral palsy: A Cross-sectional comparative survey of children in Kano, Nigeria

Cerebral palsy (CP) is a common neurodevelopmental motor disorder resulting from early childhood brain insult. Nutrition in children is very important for growth and development. This is more so in those with chronic illnesses such as CP. This study was conducted with the aim of assessing the anthropometry and anthropometric indices of CP children. This comparative, cross-sectional study recruited 150 children with CP matched for age and sex, with 150 children without CP (as controls). The participants' socio-demographic and CP-related data were collected using a pre-tested questionnaire designed for the study. The weight and height of the subjects were measured. Nutritional status was determined using the World Health Organization Z-scores. Overall prevalence of malnutrition in CP subjects was 86%. This was significantly higher than in controls, whose prevalence was 55.3% (χ2 = 34.027,P < 0.0001). The prevalence of stunting, wasting and underweight in CP subjects was 53.3%, 57.5% and 66.9%, respectively. These were also significantly higher than those of controls who had prevalence of stunting being 16.7%, wasting 8.5% and underweight 14.8%. This study found a high prevalence of malnutrition (especially under-nutrition) and therefore underscores the need for more emphases on nutritional assessment, counselling and management in CP patients.