Classification Of Cerebral Palsy Research Articles

A pose estimation for motion tracking of infants cerebral palsy

AbstractThe General Movements Analysis (GMA) has demonstrated noteworthy promise in the early detection of infantile Cerebral Palsy (CP). However, it is subjective and requires highly trained clinicians, making it costly and time-consuming. Automation of GMA could potentially enhance accessibility and further our comprehension of infants’ full-body movements. This paper investigates the feasibility of using 2D and 3D pose estimation strategies to observe and scrutinize the infant’s comprehensive body movement attributes to improve our perspective to consider joint movement and positions over time as an alternative to GMA for early CP prediction. The study includes comprehensive movement analysis from video recordings for accurate and efficient analysis of infant movement by computing various metrics such as angle orientations at different predicted joint locations, postural information, postural variability, movement velocity, movement variability, and left–right movement coordination. Along with antigravity movements are assessed and tracked as indicators of CP. We employed a variety Machine Learning (ML) algorithms for CP classification based on a series of robust features that have been developed to enhance the interpretability of the model. The proposed approach is assessed through experimentation using the MINI-RGBD and RVI-38 datasets with a classification accuracy of 92% and 97.37% respectively. These results substantiate the efficacy of employing pose estimation techniques for the precocious prediction of infantile CP, highlighting the importance of monitoring changes in joint angles over time for accurate diagnosis and treatment planning.

Baby Observational Selective Control AppRaisal (BabyOSCAR): Convergent and discriminant validity and reliability in infants with and without spastic cerebral palsy.

To describe the development of an observational measure of spontaneous independent joint motion in infants with spastic cerebral palsy (CP), the Baby Observational Selective Control AppRaisal (BabyOSCAR), and to test its convergent validity and reliability. A retrospective sample of 75 infants (45 with spastic CP and 30 without CP) at 3 months of age were scored with the BabyOSCAR and compared with diagnosis of spastic CP, limbs affected, and Gross Motor Function Classification level at 2 years of age or later for convergent validity using t-tests, Kruskal-Wallis tests, and Spearman's rank correlation coefficients. BabyOSCAR interrater and test-retest reliability was also evaluated using intraclass correlation coefficients. Infants with spastic CP had significantly lower BabyOSCAR scores than children without CP (p < 0.001) and scores were significantly correlated with Gross Motor Function Classification System levels (p < 0.001). Children with unilateral CP had significantly higher asymmetry scores than children with bilateral CP or no CP (p < 0.01). Interrater and test-retest reliabilities were good to excellent. Reductions in independent joint control measured in infancy are a hallmark of eventual diagnosis of spastic CP, and influence gross motor function later in childhood (with or without a diagnosis of CP).

Genetic determinism of epilepsy refractoriness in patients with congenital cerebral p

Background. In the phenotype of cerebral palsy, motor and mental disorders are often accompanied by epilepsy. Congenital epilepsy has been intensively researched in recent years. Special attention is drawn to epilepsy caused by congenital disturbance of the excitability of the neuronal membrane due to canalopathies.Aim. To analyze a large number of genes associated with the development of the cerebral palsy phenotype and distribute them according to determinable traits.Materials and methods. The results of clinical and genetic analysis of 136 cases of cerebral palsy with epilepsy are presented. The patients were divided into groups according to the syndromes according to the classification of cerebral palsy. Epileptic syndromes were divided into three groups: focal childhood epilepsy with structural brain changes and benign epileptiform discharges in electroencephalogram – 41 (30.1 %) cases, structural focal epilepsy – 37 (27.2 %) cases, epileptic encephalopathies – 58 (42.7 %) cases. Pathogenic variants in genes were confirmed by next generation sequencing Sanger methods of venous blood.Results. The performed risk analysis showed that in the presence of disorders in genes attributed to the group of regulation of the formation and functioning of the cytoskeleton, the risk of lack of remission is significantly lower than in other dominants, while abnormalities in genes attributed to the group of regulation of the function of the mitochondrial apparatus significantly increase the risks of failure to achieve remission and need in polytherapy.Conclusion. Probably, the violation of energy metabolism in the cell neutralizes the stabilization of the neuronal membrane under the action of anticonvulsants. The determinant of the formation and functioning of the cytoskeleton, according to our preliminary data, is largely associated with the formation of malformations of the brain. In this case, the refractoriness of epilepsy may be secondary and determined by the severity of structural changes in the brain

Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India

ObjectiveTo describe the comorbidities in children with cerebral palsy (CP) and determine the characteristics associated with different impairments.DesignCross-sectional study.SettingTertiary care referral centre in India.PatientsBetween April 2018 and May 2022, all...

A study of clinico etiological profile of children with cerebral palsy in a tertiary care centre

The clinical spectrum of Cerebral palsy (CP) can differ in various places depending upon the knowledge of the people and resources for prevention, diagnosis and management. Although studied extensively in high-resource countries, adequate data related to CP from resource-constraint settings are lacking.&#x0D; The aim: The present study is a descriptive study done on clinical profiles, aetiology, and comorbidities.&#x0D; Materials and methods: Present study is a hospital-based descriptive study of 80 children with Cerebral Palsy from January 2020 to June 2021 (18 months) admitted to Niloufer Hospital for Child Health, cases chosen as per inclusion criteria guided by "The Definition and classification of cerebral palsy, April 2006 International consensus". Clinical history and clinical examination and necessary investigations using a systematically designed proforma&#x0D; Results: The most common types were spastic type (78.9 %) and hypotonic type (12.5 %). Spastic quadriparesis (55 %) was the most common among subtypes. Males were more affected than females, with more rural than urban distribution. 48.8 % belonged to the lower middle and 37.5 % to the upper lower class of socio-economic status. Consanguinity was observed in 33 %, and 3 % had a similar family history. A high incidence (65 %) was seen in firstborn children. Term gestation was commonest at 87 % and prematurity at 13 %. 91.3 % of the cases were institutional deliveries. For causes of cerebral palsy, 45 % required resuscitation at birth, 2.5 % had neonatal sepsis, 1.25 % had a cerebral malformation, 7.5 % had an intracranial bleed, 7.5 % had post-meaning encephalitic sequelae, 1.3 % had TORCH infection. Comorbidities Like mental retardation were seen in 90 %, seizure disorder in 87.5 %, visual problems in 24.8 %, hearing problems in 13.75 %, 56.25 % of cases were malnourished.&#x0D; Conclusions: Comorbidities are significantly observed in cases of cerebral palsy. Appropriate screening and management of comorbidities, especially vision, hearing, speech, seizures, and nutrition, improve the overall prognosis in cases of Cerebral palsy.

Investigation of urinary disorders, functional independence, and quality of life in children with cerebral palsy.

The study aimed to investigate the relationship between voiding disorders, functional independence, and quality of life, according to the gross motor function classification system, in children with cerebral palsy (CP) aged 8-17. A total of 102 individuals (aged 8-17) with CP were included in the study. The Gross Motor Function Classification System (GMFCS), Dysfunctional Voiding and Incontinence Scoring System (DVISS), Wee Functional Independence Measure for Children (WeeFIM), and Pediatric Quality of Life Inventory (PedsQL) were used to evaluate the clinical parameters. There is a statistically significant difference in DVISS (p = 0.010), WeeFIM (p = 0.001), and PedsQL (p = 0.001) scores of individuals with CP regarding GMFCS. According to the CP classification, there is a statistically significant difference between WeeFIM (p = 0.001) and PedsQL (p = 0.020) scores. Besides, there is a significant difference between DVISS (p = 0.048), WeeFIM (p = 0.001) and PedsQL (p = 0.001) according to the ambulation status of individuals with CP. On the other hand, there is a positive moderate, statistically significant correlation between WeeFIM and PedsQL scores (ρ = 0.306, r = 0.002). A moderately negative statistically significant relationship exists between PedsQL and DVISS (ρ = -0.266, r = 0.007). A negative, moderate, statistically significant correlation was shown between DVISS and WeeFIM scores (ρ = -0.323, r = 0.001). As the gross motor functional level of individuals with CP increased, voiding dysfunction increased; on the other hand, functional independence and quality of life decreased.

Cerebral Palsy classification based on multi-feature analysis using machine learning

Cerebral Palsy (CP) is an umbrella name for disorders caused by abnormal brain development or damage to the developing brain. It affects the child's ability to move and maintain balance and posture. CP is the most common cause of motor disability in childhood. CP has various classification systems based on body structure and function, such as the topographic classification into quadriplegia, diplegia, and hemiplegia, or based on activities such as the gross motor function classification system (GMFCS). Classifying children with CP is challenging for clinicians due to the homogeneous nature of the clinical presentations of children with CP. Classifications of CP can guide the planning of services that enhance the quality of life of children and their families. There are a few studies about children with CP in Jordan. Data about children with CP in Jordan are also lacking. This study, therefore, aims to compile a comprehensive, concise, and fully annotated national dataset for Jordanian children with CP and to provide a benchmark for related studies in the field of pediatric rehabilitation medicine (PRM). This work presents the methodology implemented to compile and analyze the dataset and the experiments conducted on this dataset. We evaluated the dataset using a set of five commonly used machine learning classification algorithms, namely, K-Star, Multilayer Perceptron (MLP), Naïve Bayes (NB), Random Tree (RT), and Support Vector Machine (SVM). The MLP classifier successfully classified CP-type cases with an accuracy rate of 84% and GMFCS cases with an accuracy rate of 53%. The obtained results were promising and encouraging to put the compiled CP dataset into practice for clinicians, researchers, and policymakers working in the field of PRM.

Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register

Purpose To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. Methods We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. Results Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. Conclusions The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitation The first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children. The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning. Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.

A Review on Recent Advances of Cerebral Palsy

This narrative review summarizes the latest advances in cerebral palsy and identifies where more research is required. Several studies on cerebral palsy were analyzed to generate a general idea of the prevalence of, risk factors associated with, and classification of cerebral palsy (CP). Different classification systems used for the classification of CP on a functional basis were also analyzed. Diagnosis systems used along with the prevention techniques were discussed. State-of-the-art treatment strategies for CP were also analyzed. Statistical distribution was performed based on the selected studies. Prevalence was found to be 2-3/1000 lives; the factors that can be correlated are gestational age and birth weight. The risk factors identified were preconception, prenatal, perinatal, and postnatal categories. According to the evidence, CP is classified into spastic (80%), dyskinetic (15%), and ataxic (5%) forms. Diagnosis approaches were based on clinical investigation and neurological examinations that include magnetic resonance imaging (MRI), biomarkers, and cranial ultrasound. The treatment procedures found were medical and surgical interventions, physiotherapy, occupational therapy, umbilical milking, nanomedicine, and stem cell therapy. Technological advancements in CP were also discussed. CP is the most common neuromotor disability with a prevalence of 2-3/1000 lives. The highest contributing risk factor is prematurity and being underweight. Several preventions and diagnostic techniques like MRI and ultrasound were being used. Treatment like cord blood treatment nanomedicine and stem cell therapy needs to be investigated further in the future to apply in clinical practice. Future studies are indicated in the context of technological advancements among cerebral palsy children.

Association of Functional Ability with Nutritional Status Among Children with Cerebral Palsy

Cerebral palsy (CP) is the most common physical disability in childhood. Children with CP are particularly vulnerable to malnutrition. There is a paucity of studies among these individuals to find the association between functional ability with nutritional status. In this study our objective was to find out the association between functional ability (functional level measured by four functional classification systems) and nutritional status in children with cerebral palsy (CP) attending in a tertiary care hospital in Bangladesh. We performed a cross-sectional study on 127 children (aged 18 months to 12 years) with a diagnosis of CP who were attending outpatient and inpatient department of National Institute of Neurosciences & Hospital, Dhaka, Bangladesh (January 2020–December 2020). Functional ability was assessed by standard CP classification systems (GMFCS, MACS, CFCS, EDACS, Level I through level V). Nutritional status was evaluated and classified according to the WHO growth charts. To find out the association, Spearmann-rho correlation analysis were applied. Sixty five patients (51%) were found underweight, 86 (67.7%) were stunted and 40 (31.5%) were wasted. Among them, severe underweight, severe stunting and severe wasting were found in 21.3%, 41.7% and 11.8% cases respectively. Severe thinness measured by BMI was found in 81.1% cases. Forty one percent (41.1%), 40.2%, 11%, 7.9% patients were functionally leveled as severe in GMFCS, MACS, CFCS and EDACS, although CFCS and EDACS were not applicable for all ages (36.2%, 37.8%). A significant negative association was found between weight for height, weight for age, BMI and functional level measured by GMFCS, MACS, CFCS and EDACS (P value <0.05 to<0.001) but no significant negative association was found between height for age and functional level measured by GMFCS, MACS. Stunting and wasting are more common among pediatric patients with CP. In our study stunting was more prevalent. We found significant negative association between functional level and nutritional status as measured by scales applied in this study.

Physical activity and gait efficiency in children with cerebral palsy

Introduction. Correct classification of cerebral palsy is essential for the effective treatment and rehabilitation of affected patients. The most common form of assessing a patient is determining his gross motor functions. For patients who can walk, a 6-minute walk test can be used to evaluate their gait. Aim. The aim of this study was to examine the influence of physical activity on the gait efficiency in children with cerebral palsy. Materials and methods. The study involved 17 children aged 12-16 years old at 2nd level in GMFCS. Two 6-minute walk tests and a 72-hour measurement of physical activity using the McRoberts Dynaport MoveMonitor were performed. Results. Statistical analysis indicates important influence of physical activity on gait efficiency measured by 6-minute walk test (6MWT). Statistically significant deviations were observed between the distance covered in the 6MWT by the respondents and the normative values. Conclusion. Children with cerebral palsy at 2nd level in GMFCS, have lower gait efficiency than healthy children in the corresponding age range. Increased physical activity has a statistically significant effect on the change of the gait efficiency determined in the 6-minute walk test.

Virtual Reality-Incorporated Horse Riding Simulator to Improve Motor Function and Balance in Children with Cerebral Palsy: A Pilot Study.

The horse riding simulator (HRS) reportedly has a beneficial effect on motor function and balance in children with cerebral palsy (CP). However, by itself, the HRS is not a sufficient source of challenge and motivation for children. To address this issue, we combined the HRS with virtual reality (VR) to promote somatosensory stimulation and motivation. Sixteen children (ages: 5–17 years) with CP and presenting Gross Motor Function Classification System (GMFCS) levels I–IV were enrolled in the study. Using a head-mounted display and controllers, interventions were carried out over 30-min periods (two rides lasting 12 min each, along with a six-min rest period) twice a week over a period of eight weeks (16 sessions in aggregate). The Pediatric Balance Scale (PBS), Gross Motor Function measure (GMFM)-88, and GMFM-66 scores of each participant were measured before and after the interventions. Statistically significant improvements were observed in the PBS, GMFM-66, the total GMFM-88 scores, and those corresponding to dimensions D and E of GMFM-88 after the intervention (p < 0.05). This study demonstrates that VR-incorporated HRS is effective in improving motor function and balance in children with CP and that its incorporation in conventional PT programs could yield beneficial results.

Intrauterine drug exposure as a risk factor for cerebral palsy.

To determine whether infants with intrauterine drug exposure (IUDE) are similarly at risk for cerebral palsy (CP) as other high-risk populations, whether CP classification differs based on IUDE status, and describe the association of CP with specific substances among exposed infants. This was a retrospective analysis of infants in a high-risk follow-up program (n=5578) between January 2014 and February 2018 with a history of IUDE or who received a CP diagnosis. CP rates were compared using two-sample z-tests. CP classification was assessed using Fisher's exact, Cochran-Armitage, and Wilcoxon rank-sum tests. Models for CP risk were assessed using multivariable logistic regression. Among all infants with IUDE (n=1086), 53.8% were male with a mean (SD) birth gestational age of 36.8 (3.6) weeks. Among unexposed infants with CP (n=259), 54.4% were male with a mean (SD) birth gestational age of 29.9 (5.7) weeks. Opioids were the most common exposure (93.7%) of all infants with IUDE. The CP rate in the IUDE (5.2%) and unexposed (5.7%) high-risk populations were not significantly different (p=0.168), nor were there differences in CP typology, topography, or severity between exposed (n=57) and unexposed (n=259) infants (all p>0.05). In patients with IUDE and after controlling for established CP risk factors, the observed odds of CP varied among substances. We suggest that IUDE should be considered a 'newborn-detectable risk' in the guidelines for the early detection of CP.

Epidemiology of scoliosis in cerebral palsy: A population-based study at skeletal maturity.

AimThis study investigated the prevalence of scoliosis in a large, population‐based cohort of individuals with cerebral palsy (CP) at skeletal maturity to identify associated risk factors that may inform scoliosis surveillance.MethodsYoung people with CP born between 1990 and 1992 were reviewed through routine orthopaedic review or a transition clinic. Classification of CP was recorded by movement disorder, distribution, gross and fine motor function. Clinical examination was undertaken and those with clinical evidence of scoliosis or risk factors had radiographs of the spine. Scoliosis severity was measured and categorised by Cobb angle.ResultsTwo hundred and ninety‐two individuals were evaluated (78% of the birth cohort) at a mean age of 21 years, 4 months (range 16–29 years). Scoliosis (Cobb angle >10°) was found in 41%, with strong associations to the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS) and dystonic/mixed movement disorders. Those at GMFCS V were 23.4 times (95%CI 9.9–55.6) more likely to develop scoliosis than those at GMFCS I. Severe curves (Cobb >40°, 13% of the cohort) were found almost exclusively in those functioning at GMFCS IV and V, and were 18.2 times (95%CI 6.9–48.5) more likely to occur in those with dystonia than those with spasticity.ConclusionsScoliosis was very common in young people with CP, with prevalence and severity strongly associated with GMFCS and MACS level and dystonic movement disorder. Severe curves were almost exclusively found in non‐ambulant children. Clinical screening for scoliosis should occur for all children with CP, with radiographic surveillance focusing on those functioning at GMFCS IV and V.

Nutritional Status of Children with Cerebral Palsy in Gorkha, Nepal: Findings from the Nepal Cerebral Palsy Register.

Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome.

MRI combined with early clinical variables are excellent outcome predictors for newborn infants undergoing therapeutic hypothermia after perinatal asphyxia.

BackgroundBinary prediction-models for outcome [death, cognition, presence and severity of cerebral palsy (CP)], using MRI and early clinical data applicable for individual outcome prediction have not been developed.MethodsFrom Dec 1st 2006 until Dec 31st 2013, we recruited 178 infants into a population-based cohort with moderate or severe hypoxic-ischaemic encephalopathy (HIE) including postnatal collapse (PNC, n = 12) and additional diagnoses (n = 12) using CoolCap/TOBY-trial entry-criteria including depressed amplitude-integrated EEG (aEEG). Early clinical/biochemical variables and MRI scans (median day 8) were obtained in 168 infants. Injury severity was scored for cortex, basal ganglia/thalami (BGT), white matter (WM) and posterior limb of the internal capsule, summating to a total injury score (TIS, range 0–11). Outcome was categorized as adverse or favourable at 18–24 months from Bayley-III domains (cut-off 85) and neurological examination including CP classification.FindingsHIE and entry-aEEG severity were stable throughout the study. Outcome was favourable in 133/178 infants and adverse in 45/178: 17 died, 28 had low Cognition/Language scores, (including 9 with severe CP and 6 mild); seven had mild CP with favourable cognitive outcome. WMxBGT product scores and TIS were strong outcome predictors, and prediction improved when clinical/biochemical variables were added in binary logistic regression. The Positive Predictive Value for adverse outcome was 88%, increasing to 95% after excluding infants with PNC and additional diagnoses. Using WMxBGT in the regression predicted 8 of the 9 children with severe CP.InterpretationBinary logistic regression with WMxBGT or TIS and clinical variables gave excellent outcome prediction being 12% better than single variable cross-tabulation. Our MRI scoring and regression models are readily accessible and deserve investigation in other cohorts for group and individual prediction.FundingWe thank the National Health Service (NHS) and our Universities and funders in UK and Norway: SPARKS, The Moulton Foundation, The Norwegian Research Council, The Lærdal Foundation for Acute Medicine and charitable donations for their support for cooling therapy.

Somatosensory discrimination impairment in children with hemiplegic cerebral palsy as measured by the sense_assess© kids.

To characterise somatosensory discrimination impairment of the upper-limb across domains of tactile discrimination, limb position sense and haptic object recognition using the sense_assess© kids and examine associations with upper-limb motor performance in children with hemiplegic cerebral palsy (CP). The sense_assess© kids was administered at one timepoint to 28 children, aged 6-15.5years (M=10.1, SD=2.4), with hemiplegic CP (right hemiplegia n=15) and Manual Ability Classification System Levels I (n=11) and II (n=17). Unimanual motor performance was quantified using the Box and Block Test. Tactile discrimination was impaired in 18, limb position sense in 20, and haptic object recognition was impaired in 21 of 28 children. Over 80% (23/28) of children had impaired somatosensory discrimination in one or more domains. Low to moderate correlations were observed between each measure of somatosensory discrimination and motor performance. Manual ability classification was associated with limb position sense and haptic object recognition. A moderate inverse correlation (r=-.57, p<.01) exists between the number of somatosensory domains impaired and motor performance. The frequency of somatosensory impairment in the upper limb of children in our sample was high and associated with manual ability, suggesting a need for routine assessment of somatosensation in this population.

Neuroimaging Patterns and Function in Cerebral Palsy-Application of an MRI Classification.

Background: Cerebral palsy (CP) is a disorder of movement and posture and every child with CP has a unique composition of neurological symptoms, motor severity, and associated impairments, constituting the functional profile. Although not part of the CP definition, magnetic resonance imaging (MRI) sheds light on the localization, nature, and severity of brain compromise. The MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe (SCPE), describes typical MRI patterns associated with specific timing of vulnerability in different areas of the brain. The classification has proven to be reliable and easy to use.Aims: The aim of this study is to apply the MRICS on a large dataset and describe the functional profile associated with the different MRI patterns of the MRICS.Materials and Methods: Data on children with CP born in 1999–2009 with a post-neonatal MRI from 20 European registers in the JRC-SCPE Central Registry was included. The CP classification and the MRICS was applied, and The Gross Motor Function Classification (GMFCS) and the Bimanual Fine Motor Function (BFMF) classification were used. The following associated impairments were documented: intellectual impairment, active epilepsy, visual impairment, and hearing impairment. An impairment index was used to characterize severity of impairment load.Results: The study included 3,818 children with post-neonatal MRI. Distribution of CP type, motor, and associated impairments differed by neuroimaging patterns. Functional profiles associated with neuroimaging patterns were described, and the impairment index showed that bilateral findings were associated with a more severe outcome both regarding motor impairment and associated impairments than unilateral compromise. The results from this study, particularly the differences in functional severity regarding uni- and bilateral brain compromise, may support counseling and service planning of support of children with CP.

Deep Learning Algorithm for Classification of Cerebral Palsy from Functional Magnetic Resonance Imaging (fMRI)

Cerebral palsy is a disorder of neurology that may be caused by prenatal, perinatal or postnatal reasons that result in the failure of motor functioning in children besides mental well-being. Referring to the location of brain injury and the effect of it on the muscle tone, cerebral palsy is classified into subgroups namely spastic, non-spastic etc. Each type of palsy varies in symptoms and hence the therapy planning and rehabilitation are decided depending on the factors involved in each type. This urges the requirement of a suitable technique to classify the type of Palsy at the earlier stages to effectively plan therapy. Functional MRI of the neonatal brain helps in imaging and classification of cerebral palsy. The deep neural network is a subset of machine learning that is widely used in image classification applications. This technique is applied to the functional magnetic resonance brain images of infants to classify the type of cerebral palsy using a deep convolutional network of modified AlexNet architecture that helps the physician further in a planned rehabilitation to facilitate the lifestyle of the affected children.

Intrauterine cytomegalovirus infection: a possible risk for cerebral palsy and related to its clinical features, neuroimaging findings: a retrospective study

BackgroundAbundant clinical evidences indicate that the increased risk of cerebral palsy (CP) may be associated with the intrauterine exposure to maternal infection. Cytomegalovirus (CMV) is a common cause of CP. However, little is known about the relationship between the intrauterine exposure of the fetus to CMV infection and CP. This study aims to explore the relationships between intrauterine CMV infection and clinical symptoms, classification, intelligence development and brain neuroimaging findings in children with CP.MethodsIn this study, 147 children with CP in recent 6 years were retrospectively analyzed (average age: 14.76 ± 3.07months; sex (M/F): 103/44). 148 children had CMV IgG and IgM positive sera identified by TORCH examination were selected as the control group (average age: 15.10 ± 3.21months; sex (M/F): 102/46), which also undergo the examination of CMV-DNA in urine. The age and sex of children in the control group were matched with those in the CP group. CMV-DNA in urine was detected by CMV fluorescence quantitative PCR, and t-test was performed to analyze the number of copies. For the CP group, standardized rehabilitation treatment was performed and the function of gross motor was evaluated by GMFM scale before and after treatment. The Gesell developmental scale (GDS) was used to assess the level of intellectual development. The classification of CP was conducted and the results of magnetic resonance imaging were analyzed. Finally, the correlations between the copy number of CMV-DNA and the clinical characteristics of children with CP were evaluated by the method of Pearson and Spearman correlation analysis.ResultsThe level of CMV infection was negatively correlated with the developmental quotient (DQ) of children with CP. Negative association was found between the level of CMV infection and the level of the gross motor development. The level of CMV infection was positively related with the occurrence probability of spastic quadriplegia. However, no associations were found between the abnormalities of brain tissue and the number of CMV copies. Moreover, CMV infection might add the difficulty of the rehabilitation treatment.ConclusionsCMV infection is a risk factor for the occurrence of CP in children. Pregnancy examination should be strengthened. Early detection and control of CMV infection may contribute to the rehabilitation of children with CP and reduce the disability and social burden.