Childrenwith Cerebral Palsy Research Articles

A SURGICAL CORRECTION OF THE TENDON - MUSCULAR APPARATUS IN EQUINO-FLAT-VALGUS FEET IN CHILDREN WITH CEREBRAL PALSY

Purpose. to analyze the effectiveness of soft tissue surgical correction of equine-flat-valgus-feet deformity in children with cerebral palsy. Material and methods. A retrospective analysis of clinical and X-ray findings of 47 patients (86 feet) with equino-flat-valgus deformity was performed. All patients were treated surgically. They were divided into two groups by age: Group I - 23 children (4-7 y.o.); Group II - 24 children (8-11 y.o.). The neurological status was examined in patients with the motor development of level I - III (by GMFCS classification) who had hemiparesis, diplegia and tetroparesis. A comparative analysis was made with a reference group which consisted of 30 children (56 feet), aged 4-11, who had exostotic chondrodysplasia or trauma of the ligamentous apparatus in one foot without neurological pathology and feet deformities. Results. One year after surgery, a significant improvement in clinical and radiological parameters comparing to preoperative findings was registered in patients of both studied groups. Most parameters were close to the established reference intervals. In Group I, three years later at the follow-up examination no significant difference was revealed in similar parameters obtained three years later and one year later after the surgery. However, in Group II three years later a negative dynamics was seen in most of studied parameters when compared with reference values and with results of the first postoperative year. Such outcomes demonstrate high efficiency of soft foot tissue surgery in children under 8. A significant decrease in clinical and radiological parameters after similar amount of surgical correction in children of primary school age (8-11 y.o.), which were under the long-term observation, may indicate the ineffectiveness of such techniques at this age. Evaluation of the functional status by the Gillette functional assessment scale three years after the surgery revealed the increased functional status in 78.26% of patients from Group I and in 41.66% from Group II. In some children from Group II (primary school age), there was a negative dynamics in their functional status. Conclusion. In generally, the obtained data indicate good prospects for improving the functional status in the postoperative period in children of both groups. However, the existing negative dynamics in children from Group II (8-11 y.o.) indicates a weak prospective for a long-term surgical deformity correction of the foot ligamentous apparatus because the coming period is a period of rapid growth and increased loading on the musculoskeletal system of a child with cerebral palsy.

Serum adipokine levels, bodyweight and functional status in children with cerebral palsy

ObjectiveThe incidence of obesity is increasing, including children with cerebral palsy (CCP). Purposes were to determine the association of serum adipokine levels, anthropometrics and biomarkers measurements with bodyweight and functional status in CCP. MethodsSeventy-two CCP (age 8.7 ± 1.9 years) were enrolled. They were classified by body mass index (BMI) into thinness, normal and overweight and were characterized by the Gross Motor Function Classification System (GMFCS). Serum levels of adipokines (leptin, adiponectin and resistin) were analyzed. A multivariate regression model was used to examine variables associated with BMI and GMFCS. Correlations between serum adipokines, BMI and GMFCS classifications were evaluated. ResultsThe CCP with overweight had the prevalence of 24% and had remarkably higher levels of serum leptin (p < 0.05). Strong relationships were observed between BMI and age, leptin, triceps skinfold thickness and hemoglobin (p < 0.05). Serum leptin levels were positively correlated (p < 0.001) with BMI. A negative association between BMI and serum adiponectin levels was observed (p = 0.03). In contrast, serum resistin levels did not associate with BMI. Serum adipokine concentrations did not correlate with the GMFCS classification. ConclusionsThe treatment for CCP should aim to control weight in order to balance adipokine and functional levels and reduce risks of subsequent metabolic disorders.

Functional abilities of children with cerebral palsy

Introduction. Cerebral palsy is one of the leading causes of neurological impairment in childhood. The dominant clinical sign is the impairment of gross motor functions; however, associated conditions may limit the child with cerebral palsy in daily activities as well. The aim of this study was to determine the functional status of children with cerebral palsy, its relationship with the types of cerebral palsy, and concomitant conditions. Material and Methods. The sample included 206 children with cerebral palsy. The data were obtained from medical records with clinical characteristics of cerebral palsy, and associated conditions. The clinical types of cerebral palsy were determined using the Surveillance of Cerebral Palsy in Europe registry and topographical categories. Gross motor function abilities were evaluated using the Gross Motor Function Classification System and manual abilities by the Manual Ability System Classification. Results. According to the Gross Motor Function Classification System, about two thirds of children with cerebral palsy (64.0%) had levels I, II or III of gross motor function impairment. A statistically significant difference was noted with respect to the distribution of various clinical types of cerebral palsy in relation to functional classification based on Gross Motor Function Classification System (p &lt; 0.001), as well as in the functional classification in terms of intellectual impairment (p &lt;0.001); children with severe forms of intellectual impairment were classified at a higher level of functional limitation. Epilepsy was more prevalent in children with higher level of functional limitation (p = 0.009). Conclusion. Two thirds of children with cerebral palsy could walk independently or with walking aids. Children with quadriplegia and dyskinetic type of cerebral palsy had the most limited functional abilities. Associated conditions were more prevalent in children with higher functional limitations.

Postural Control Influence on Upper Extremity Function among Children with Cerebral Palsy: A Literature Review

Performance of upper extremity function and movement sequence is influenced by postural control. Motor disorders lead to deficits in postural control, which subsequently may lead to postural instability of children with cerebral palsy (CWCP). This will limit their upper extremity activity performance. Management strategies help to support and enhance the CWCP’s upper extremity function so that they may engage with the activities of daily living. The purpose of this paper is to review previous literature on the influence of postural control towards upper extremity function. Literature searches were conducted in various electronic databases, including ProQuest, Science Direct, Springer Link, Sage, Wiley Online Library, and Google Scholar using specific key terms. Search terms included children with cerebral palsy; postural control; postural adjustments; upper extremity function; reaching and sitting and from references of retrieved articles. Nineteen journal articles published between 2000 and May 2015 were found. Most search results consisted of experimental studies, while others are reviews, case studies, and cross-sectional studies. Findings show that, postural control has a major influence on upper extremity function. In conclusion, it is necessary to highlight the importance of both factors to the CWCP parents or caregivers, as understanding and awareness on this matter is still inadequate in the community. Hence, a study is needed on the awareness of the postural control influence on upper extremity function among caregivers, as well as examining the implementation of management strategies in community settings. DOI : http://dx.doi.org./10.17576/jskm-2016-1402-02

Serum Leptin as a Nutritional Biomarker in Children with Cerebral Palsy.

Adequate nutrition is crucial for children with cerebral palsy (CCP). However, conventional nutritional assessments may be inadequate for defining undernourished CCP. Leptin, an adipocyte hormone controlling energy expenditure, could be a useful marker. Objectives of this cross-sectional analytic study were to explore correlations between serum leptin level and nutritional status, anthropometric measurements, and biochemical parameters in 86 CCP (aged 9 ± 2 years). Subscapular (SST) and triceps (TST) skinfold thicknesses, weight, and calculated height were obtained. Body mass index and weight-for-height (WH) Z-scores were calculated. Complete blood count and serum levels of leptin and albumin were collected. CCP were classified as undernourished if their WHZ was < -2 according to the World Health Organization criteria. Correlations between anthropometric measurements, biochemical data, and serum leptin levels were evaluated. From 86 CCP, 11 (12%) children were undernourished, and SST, hemoglobin, and hematocrit were significantly lower. Serum leptin levels of nourished and undernourished CCP were 5.4 ± 6.2 and 2.9 ± 1.6 ng/mL (p < 0.001), while the reported value from normal children was 4.9 ng/mL. Serum leptin levels demonstrated a significant correlation with SST and TST (r = 0.83 and 0.72; p < 0.001). Serum leptin was the only marker significantly correlated with WHZ (r = 0.45, p < 0.001) while adjusting for covariates. A serum leptin level of 2.2 ng/mL was the optimal cutoff point for defining adequate nutritional status (WHZ ≥ -2). The measurement of serum leptin should be included in a care scheme of CCP especially during surgical evaluation.

The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome.

The aims of the study were to evaluate the outcomes and predictive factors of the split anterior tibialis tendon transfer (SPLATT) procedure for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Forty-five ambulatory CCP with 68 equinovarus feet, positive for the flexor withdrawal reflex test, aged 8.1 ± 2.5 (range four to 15) years were enrolled. All feet underwent a soft tissue release procedure combined with the SPLATT procedure and were followed for at least 12 months after surgery. The functional outcome was rated using the criteria of Kling and co-workers. Pre-treatment gross motor functional classification system (GMFCS) levels were compared to the patients' latest evaluations. Factors associated with outcomes and success rate were assessed. At an average follow-up of 5.5 ± 3.3 (range 1.1-16) years, feet were rated as excellent in 48 cases (70 %), good in ten (15 %) and poor in ten (15 %), respectively. Thirty-four CCP showed an improvement for the GMFCS level, P < 0.001. The factor that could predict a poor outcome was the pre-treatment GMFCS levels 3-4 with an odds ratio (95 % CI) of 4.92 (0.96-25.2), P = 0.03. The ten years success rate of the SPLATT procedure between CCP with GMFCS levels 1-2 and levels 3-4 were not different with a mean ± SD (95 % CI) of 0.85 ± 0.1 (0.5-0.96) versus 0.6 ± 0.1 (0.3-0.8), P = 0.08, respectively. The SPLATT procedure provides a balanced function of the foot, thus improving the ambulatory ability in CCP and should be integrated into the surgical plan. Pre-treatment GMFCS levels 3-4 predicted unfavourable outcomes and should be addressed during pre-operative parental counselling.

Possibilities of applying the method of radiofrequency (RF)thermal destruction to correct spasticity in childrenwith cerebral palsy

For the treatment of focal spasticity in the TurnerInstitute we developed and applied the approach toreduce spasticity in children with cerebral palsy byapplying the method of radiofrequency thermal de-struction of peripheral nerves and muscle motorpoints. This method is based on the effect of heatrelease during the passage through biological tissueof radiofrequency currents. The procedure was totally performed in 112 patients aged 1,2 to 14 yearsold with a level of spasticity over 3 points on a scaleAshworth. In order to reduce hypertonia of femuradductors, the target for RF ablation was obturatornerve; we targeted on the motor point of the gastrocnemius muscle in equinus, to reduce forearm flexorhypertonia we targeted on the musculo-cutaneousnerve, flexor muscles of the hand we intervened on their motor points. A positive result was maintained at follow-up of 6 months to one year in all patients, maximum - 2 years. The obtained results are preliminary and subject to further statistical processing, but they are quite comparable with the results of the use of type A botulinum toxin preparations. The proposed method of treatment is minimally invasive, virtually devoid of the risk of postoperative complications, can cut one stage spasticity in the muscles of various motor segments in children with cerebral palsy of great age range, including children up to 2 years old.

The brain's sense of walking: a study on the intertwine between locomotor imagery and internal locomotor models in healthy adults, typically developing children and children with cerebral palsy.

Motor imagery and internal motor models have been deeply investigated in literature. It is well known that the development of motor imagery occurs during adolescence and it is limited in people affected by cerebral palsy. However, the roles of motor imagery and internal models in locomotion as well as their intertwine received poor attention. In this study we compared the performances of healthy adults (n = 8, 28.1 ± 5.1 years old), children with typical development (n = 8, 8.1 ± 3.8 years old) and children with cerebral palsy (CCP) (n = 12, 7.5 ± 2.9 years old), measured by an optoelectronic system and a trunk-mounted wireless inertial magnetic unit, during three different tasks. Subjects were asked to achieve a target located at 2 or 3 m in front of them simulating their walking by stepping in place, or actually walking blindfolded or normally walking with open eyes. Adults performed a not significantly different number of steps (p = 0.761) spending not significantly different time between tasks (p = 0.156). Children with typical development showed task-dependent differences both in terms of number of steps (p = 0.046) and movement time (p = 0.002). However, their performance in simulated and blindfolded walking (BW) were strictly correlated (R = 0.871 for steps, R = 0.673 for time). Further, their error in BW was in mean only of −2.2% of distance. Also CCP showed significant differences in number of steps (p = 0.022) and time (p < 0.001), but neither their number of steps nor their movement time recorded during simulated walking (SW) were found correlated with those of blindfolded and normal walking (NW). Adults used a unique strategy among different tasks. Children with typical development seemed to be less reliable on their motor predictions, using a task-dependent strategy probably more reliable on sensorial feedback. CCP showed less efficient performances, especially in SW, suggesting an altered locomotor imagery.

PO-0859 Diagnostic Assessment And Health Surveillance In Cerebral Palsy

Background and aims Cerebralpalsy is an umbrella term for a group of disorders affecting body movement, balance and posture. Attempt should be made to establish the underlying cause. Children should be monitored for comorbidities, so that early intervention could be undertaken. Method Retrospectivestudy of case notes of all children known to have cerebral palsy in Telford and Wrekin in UK. Results There were 36 children, aged 2 yrs 9 mths to 15 yrs 8 mths (at Sep 09) - 24 boys and 12 girls. Most children (91%) were given the diagnosis belowthe age of 24 mths (mean 16.3 mths). 11 (31%) were preterm, under 32 weeks gestation and 18 (50%) were born at term. 11 (31%) are in special schools. 32 (89%) were investigate dradiologically. There were radiological abnormalities in 69% of those scanned. The majority of children, 32 (89%) had SpasticCP of which- 14 (42%) had diplegia. 22 out of 36 children (61%) had co morbid problems. Screening for co morbidities was noted to beinconsistent. Conclusions Neuroimagingis recommended in the evaluation of cerebral palsy if the aetiology is notestablished. 1 Other investigations such as metabolic and genetic studies should be guided by the clinical presentation. A unified pathway with a checklist highlighting key points to identify co morbidities early is suggested to improve the quality of care. Reference 1 Ashwal S et al 2004 Practice Parameter :Diagnostic assessment of children withcerebral Palsy. Neurology 2004:62:851-863e. Attempt should be made to establish underlying cause

Does muscle strength influence standing ability in bilateral cerebral palsy?

Introductionandaim: In childrenwith cerebral palsy (CP)muscle strength is considered important formotor function, andmuscle strength training has been reported to improve gait function [1]. To our knowledge, however, the impact of muscle strength on standing ability has not been explored. To the current definition of CP have, beside the influence of disturbances in movement and posture, been added disturbances of sensation, perception and cognition [2]. In clinic we recognize childrenwith severe difficulties to achieve upright standing thatmay be referred to spatial perception problems [3]. The purpose of this study was to investigate whether muscle weakness was more pronounced in children needing support during standing vs those who stood independently. Patients and methods: Muscle strength in 25 children with bilateral cerebral palsy (BSCP) with ability to maintain standing with or without support for at least 30 s, was evaluated with a handheld dynamometer (Chatillon®) [1]. Muscle strength measurements were performed in a sitting position in hip flexors, kneeextensors, ankledorsiflexorsandplantarflexors. Childrenwith independent standing ability were designated Group A (n=13, median age 11.2 years, GMFCS levels 1–3) and children needing support to maintain standing were designated Group B (n=12, medianage10.9 years, GMFCS levels 2–4).Muscle strength (torque) was compared between the children in groups A and B. The maximum value of the strongest leg was chosen for analysis. The A and B groups were divided in subgroups based on age ( 13 years, n=9). Results: There were no differences in muscle strength in any muscle group between the children in groups A and B (Table 1). In age group 13 years there were no differences in muscle strength in any muscle group between Group A (n=4) and Group B (n=5). Discussion and conclusions: The results indicate that children with BSCP who needed support during standing did not present with more muscle weakness than those who stood independently. Results are preliminary andneed to benormalised according to age, weight and sex, and related to strength in typically developing children. Muscle strength alone does not seem to explain difficulties in standing ability. The measurements were performed in sitting position, thus no aspects of antigravity function was examined. Further examinations of factors other than muscle weakness assumed to influence standing must be explored. Reference

Spatio-temporal parameters of turning in healthy children

Introduction: Turning while walking is a crucial part of locomotion, however little is known about the biomechanics of turning maneuvers. The aim of this study was to identify the adaptations required for healthy children to navigate turns. Patients/materials and methods: Thirty-one healthy children performed barefoot walking in a straight line and 90◦ turns at self-selected veolcity. Seventeen children (12 girls, 12.6±2.3 years, height 1.6±0.1m, and leg length 0.8±0.1 m) independently chose to perform turning with both the inside (spin) and outside (step) foot, andwere retained for statistical analysis. Three turning phases were analyzed (approach, turn, and depart strides) while left and right trialswere pooled. Retroreflectivemarkerswere used to automatically detect foot strike and foot off events [1] required to compute spatio-temporal data [2]. Spatial data were normalized to leg length while absolute temporal variables were reported [3]. One-way repeated measures ANOVA with Bonferroni correction were performed on stride velocity, stance time, stride length, and stride width. Results: Half of all children turned utilizing only the spin strategy while no child solely attempted step turns. Statistical analysis revealed that both turning conditions were different from straight walking. Themain differences occurred between turning phases for step and spin conditions while only a few differences were found between turning types (Table 1). Mean [95% confidence interval]. Superscripts indicate statistical difference from straight (*), approach stride same condition (a), turn stride same condition (t), and between conditions for the same phase (s). Discussion and conclusions: The present cohort preferred turning using an inside foot strategy regardless of an increased risk of fall and increasedmuscular demand previously reported [4] and decreased stride width found here. However, it remains unclear how other populations, such as childrenwith cerebral palsy, would perform turning maneuvers. Investigation of turning may provide greater insight into the biomechanical adaptations required for independent ambulation and may lead to the development of more functional rehabilitative programs and improved surgical outcomes.

A Correlation Study of the Korean Assessment Methodfor Feeding Abilities and U-TAP in Children withCerebral Palsy

A Correlation Study of the Korean Assessment Methodfor Feeding Abilities and U-TAP in Children withCerebral Palsy

Investigation of quality of life in mothers of children withcerebral palsy in Iran: association with socio-economic status,marital satisfaction and fatigue

Purpose: This study aimed to compare the quality of life (QOL) of Mothers of Children with Cerebral Palsy (MCCPs) with mothers of Typically Developing (TD) children as a Control Group (CG). The association of the mediating variables including socio-economic status (SES), marital satisfaction and fatigue with maternal QOL was also evaluated. Method: The MCCPs group consisted of 120 mothers (mean age: 30.3 ± 5.5 years) of children with CP. The CG included 100 mothers (mean age: 29.9 ± 4.5 years) of TD children. Demographic characteristics of the participants were recorded and the data was collected by World Health Organization Quality of Life-BREF (WHOQOL-BREF), SES Questionnaire, Index of Marital Satisfaction (IMS) and Fatigue Severity Scale–Persian (FSS-P). Data analysis was done by SPSS version 16.0. Results: The QOL and SES were lower, while FSS-P and IMS were higher in MCCPs group than CG (p < 0.001). The SES, IMS and FSS-P associated with all domains of QOL in MCCPs group, while they did just with some domains of QOL in CG (p < 0.05). Conclusions: The lower QOL in MCCPs group is supposed to be mediated by the SES, marital satisfaction and fatigue so, maternal empowerment in terms of these mediators and family-centered approach are recommended.Implications for RehabilitationThe mothers of children with CP compared to mothers of typically developing children face particular challenges relating to rearing the child with disability.These tedious and chronic challenges influence on QOL, socio-economic status, marital satisfaction and perceived fatigue in mothers of children with CP.The QOL of mothers of children with CP seems to be exacerbated by factors such as lower SES, marital dissatisfaction and higher perceived fatigue.

Looking for best practice in caring for disabled children: a case of socialized foster care in China

This study focuses on the problems associated with caring for children with cerebral palsy (CWCP) in Chinese State Children's Welfare Institutions (SCWIs). It considers how to place these children with foster families and also provide them with the best rehabilitation services. In a pilot project, one SCWI trained foster parents as rehabilitators and provided services to CWCPs living with foster families in selected rural communities. The practice was very successful over the last decade, and more than 600 CWCPs in these communities are growing up happily. Hence, specialized foster care projects could be a solution for all SCWIs in China, where most of the institutionalized children are disabled.

Cerebral palsy and epilepsy

Cerebral palsy is the most common cause of physical disability in early childhood. Epilepsy is known to have a high association with cerebral palsy. All types of epileptic seizures can be seen in patients with cerebral palsy. Complex partial and secondary generalized ones are the most frequent seizure types. In persons with cerebral palsy and mental retardation, the diagnosis of epilepsy presents unique difficulties. Generally they are not able to describe the epileptic events themselves, parents are not able to describe them without fear and persons trained in epilepsy witness the events only rarely. Some syndromes, such as infantile spasms. West and Lennox-Gastaut syndrome, are particularly frequent, whereas children with cerebral palsy are rarely free of epilepsy. It has been observed that epileptic seizures in children with cerebral palsy tend to have an earlier onset; they often appear in children with cerebral palsy and mental retardation; they are more severe in patients with a more severe degree of cerebral palsy. The overall outcome of seizures in children with cerebral palsy is poor, requiring prolonged course of antiepileptic medications, polytherapy with higher incidence of refractory seizures and hospital admissions for status epilepticus. The presence of a neurological deficit, as well as cerebral palsy, does not necessarily mean a poor prognosis after the discontinuation of antiepileptic drugs, but the risk of a relapse in persons with cerebral palsy is high. The objective of the paper was to show the relationship between cerebral palsy and epilepsy and to determine the occurrence, associated factors, nature and prognosis of epilepsy in children with cerebral palsy.

Association between type of cerebral palsy and the cognitive levels

Background Cerebral palsy is the main cause of physical disabilityduring childhood. Assessment is necessary to acknowledge thelevel of intelligence of the patients and to prevent impairmentsin order to plan the prompt intervention.Objectives To evaluate the cognitive levels of cerebral palsy andassociation between cognitive levels and its types.Methods We conducted a cross-sectional study on subjectsfrom Sekolah Luar Biasa Negeri 3 Yogyakarta. Intelligence wasmeasured using the Stanford-Binet intelligence scales, whereasdiagnosis of cerebral palsy was based on criteria of the AmericanAcademy for Cerebral Palsy (AACP). Data were analyzed usingchi-square test.Results There were 35 subjects, comprising of 21 boys and 14girls aged 5-18 years. The results show that in general, childrenwith cerebral palsy had mental retardation in several cognitivelevels. Children with hemiplegia type (1 subject) had IQ level that equals to mental retardation. Children with spastic diplegia type (6 subjects) showed borderline IQ (1) and mental retardation (5). Children with quadriplegia type ( 15 subjects) had superior IQ (1), borderline (7) and mental retardation (7). Out of 13 subjects with athetoid type 2, had borderline IQ (2), and mental retardation (11). The statistical analysis with chi-square test resulted in P = 0.114 (P &lt; 0.05).Conclusion Our data showed that most patients with cerebral palsy had mental retardation of several cognitive level but there was no significant association between each type of cerebral palsy with cognitive levels.

CHANGES IN JOINT KINEMATICS IN CHILDREN WITH CEREBRAL PALSY WHILE WALKING WITH AND WITHOUT A FLOOR REACTION ANKLE–FOOT ORTHOSIS

The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 +/- 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15 masculine); Group II, with moderate limited extension (maximum knee extension between 15 masculine and 30 masculine) and Group III Crouch (maximum knee extension in stance more than 30 masculine). Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.

14.9 Postural adjustments during reaching in childrenwith cerebral palsy: Dysfunction or adaptation?

14.9 Postural adjustments during reaching in childrenwith cerebral palsy: Dysfunction or adaptation?

The psychologic evaluation of children withcerebral palsy and its implications in treatment: Preliminary report

Summary The intelligence distribution of 330 children with cerebral palsy studied over a five-year period was obtained. One-half of the children were mentally defective (I.Q. under 70) and three-fourths of them were below average intelligence (I.Q. below 90). There is no relationship between type of cerebral palsy and intelligence distribution. Of the 330 children, 56 per cent were under 4 years of age when first seen at the clinic. Of these, 53 per cent were mentally defective (I.Q. under 70), of whom 61 per cent were low grade defective (I.Q. below 40). Two specific disabilities, distractibility and visuomotor disturbances, were studied. Forty-four per cent of the spastics and 40 per cent of the athetoids were very distractible. However, only 8 per cent of the athetoids, in contrast to 39 per cent of the spastics, showed visuomotor disturbances. Implications of these findings are discussed. By fitting the treatment to the psychologic as well as the neuromuscular status of the individual child, aims of treatment would be more frequently fulfilled, and the tremendous parental emotional turmoil which unsuccessful and perhaps unindicated treatment engenders will be avoided.