Clinical Diagnosis Of Cerebral Palsy Research Articles

MRCT and CT in the diagnosis of pediatric disease imaging: assessing imaging performance and clinical effects

ObjectiveThis study focused on analyzing the clinical value and effect of magnetic resonance imaging plus computed tomography (MRCT) and CT in the clinical diagnosis of cerebral palsy in children.MethodsFrom February 2021 to April 2023, 94 children diagnosed with cerebral palsy were selected from our hospital for study subjects. These patients were divided into CT and MRI groups, with CT examination given to the CT group and MRI examination given to the MRI group. The positive rate of the two examination methods in the diagnosis of cerebral palsy was compared, different imaging signs in two groups of children with cerebral palsy were compared, and the diagnostic test typing results between two groups were further analyzed.ResultsThe diagnostic positivity rate of the children in the MRI group was 91.49%, which was significantly higher than that of the children in the CT group (70.21%) (P < 0.05). In both groups, encephalomalacia, bilateral frontal subdural effusions, and gray-white matter atrophy of the brain were the main signs, and the difference in the proportion of these three imaging signs between the two groups was not significant (P > 0.05). Differences between the two groups examined for cerebral palsy subtypes were not significant (P > 0.05).ConclusionThe positive rate of pediatric cerebral palsy examined by MRI is higher than that of CT diagnosis, but the clinic should organically combine the two to further improve the detection validity and accuracy.

Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries.

Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models. Quantification of brain volumes in a group of patients with clinically determined cerebral palsy. In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared. Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype. This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype. This study demonstrates the value of integrating an artificial intelligence programme into the radiologists' armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.

CLINICAL PROFILE AND MRI FINDINGS IN CEREBRAL PALSY AND THEIR CORRELATION WITH TYPE OF CEREBRAL PALSY

Introduction: Cerebral palsy is well-dened as a cluster of permanent disorders of movement and posture causing activity limitations that are attributed to non-progressive damage in developing fetal or infant brain. Aim:To study the clinical prole and MRI ndings in cerebral palsy and their correlation with type of cerebral palsy. Material and Methods: This Hospital based prospective observational study was carried out in Department of Paediatrics at Maharishi Markandeshwar Institute of Medical Science And Research, Mullana (Ambala), Haryana in collaboration with Department of Radio-diagnosis, MMIMSR, Mullana (Ambala). Study was undertaken in 50 neonate, infants and children with clinical diagnosis of Cerebral Palsy. Results: The majority of patients were delivered term (58%) followed by preterm delivery (42%). The majority of patients had spastic quadriplegia type of cerebral palsy. Periventricular leukomalacia was the most common abnormality found on imaging. Abnormal radiological ndings were observed in 94% cases. Conclusion: To establish an aetiology and prognosis in children with cerebral palsy MRI neuroimaging is recommended as the initial investigation as MRI ndings closely relate to the type of CP, neurological decits and gestational age of patients with brain insults

Effectiveness of Vestibular Stimulation Training in Cerebral Palsy

Introduction: Various studies are carried out to improve posture and balance in children with cerebralpalsy by using different approaches. But the aspect of vestibular stimulation exercises on improving postureand balance in children with CP have not yet been studied. Hence this study is design to see the effect ofvestibular stimulation exercises on posture and balance in children with CP.Methodology: Thirty children with clinical diagnosis of Cerebral palsy, were randomly allocated into controlgroup and interventional group. Participants in control group were given Conventional Physiotherapy.Participants in intervention group were given Conventional Physiotherapy and vestibular stimulationexercises.Results: The result of the study found extreme significant effects of the conventional physiotherapy incontrol group and extreme significant effects of conventional physiotherapy and vestibular stimulationexercises on posture and balance in children with CP in intervention group according to the results of theGMFM-88 and PBS. There is significant difference in mean score of GMFM-88 and PBS in interventiongroup as compared to the control group.Conclusion: There will be significant effect of vestibular stimulation exercises on posture and balance inchildren with CP.

Caregivers' Perceptions Regarding Oral Health Status of Children and Adolescents with Cerebral Palsy.

Objectives: The aim of the present study was to compare the perception of caregivers regarding the oral health status of children and adolescents with cerebral palsy (CP) and those with typical development. Study Design: Study group (SG) was composed of 35 children and adolescents with a clinical diagnosis of CP and their caregivers. Control group (CG) was composed of 35 individuals with typical development (matched with the SG for age, sex and caries activity) and their caregivers. Questionnaire was administered to caregivers addressing the oral health of individuals under their care. Caries activity, dmft/DMFT index, visible plaque index (VPI) and occlusal characteristics were determined. Results: Statistically significant differences were found in the perceptions of dental problems (p = 0.004) and gingival bleeding (p = 0.013). Individuals in SG whose caregivers perceived dental problems had a higher mean VPI (50.84 ± 5.11%) than those in CG (27.97 ± 6.50%). The mean dmft/DMFT in the SG was 2.77 ± 3.20. Class II molar relationship, overjet and anterior open bite were more prevalent in the SG. Conclusion: Caregivers of children/adolescents with CP perceive more oral problems, such as visible plaque, gingival bleeding and malocclusion, than caregivers of children/ adolescents with typical development.

Safety and Feasibility of Transcranial Magnetic Stimulation as an Exploratory Assessment of Corticospinal Connectivity in Infants After Perinatal Brain Injury: An Observational Study.

Perinatal brain injuries often impact the corticospinal system, leading to motor impairment and cerebral palsy. Although transcranial magnetic stimulation (TMS) has been widely used to study corticospinal connectivity in adults and older children, similar studies of young infants are limited. The objective was to establish the safety and feasibility of advanced TMS assessments of the corticospinal connectivity of young infants with perinatal brain injury. This was a pilot, cross-sectional study of 3- to 12-month-old (corrected age) infants with perinatal stroke or intracranial hemorrhage. Six participants (2 term, 4 preterm) were assessed with stereotactic neuronavigation-guided TMS. Single-pulse TMS was applied to each hemisphere and responses were recorded simultaneously from both upper limbs. During data collection, vital signs and stress responses were measured to assess safety. Developmental motor outcomes were evaluated using the General Movements Assessment and Bayley Scales of Infant and Toddler Development (3rd edition). A clinical diagnosis of cerebral palsy was recorded, if available. No adverse events occurred during TMS testing. All sessions were well tolerated. Contralateral motor evoked responses were detected in 4 of 6 participants. Both contralateral and ipsilateral responses were observed in 2 of 6 participants. TMS responses were not obtained in all participants. This could be related to the location of brain injury or developmental stage of the corticospinal system controlling the wrist flexor muscle group from which responses were recorded. This study provides a summary of the framework for performing novel TMS assessments in infants with perinatal brain injury. Implementing this approach to measure corticospinal connectivity in hypothesis-driven studies in young infants appears to be justified. Such studies could inform the characterization of corticospinal development and the neural mechanisms driving recovery following early interventions.

Optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of neurological impairment, and children with suspected or confirmed cerebral palsy.

BackgroundNeurological impairment is a common sequelae of perinatal brain injury. Plasticity of the developing brain is due to a rich substrate of developing neurones, synaptic elements and extracellular matrix. Interventions supporting this inherent capacity for plasticity may improve the developmental outcome of infants following brain injury. Nutritional supplementation with combination docosahexaenoic acid, uridine and choline has been shown to increase synaptic elements, dendritic density and neurotransmitter release in rodents, improving performance on cognitive tests. It remains elusive whether such specific ‘neurotrophic’ supplementation enhances brain plasticity and repair after perinatal brain injury.Methods/DesignThis is a two year double-blind, randomised placebo controlled study with two cohorts to investigate whether nutritional intervention with a neurotrophic dietary supplement improves growth and neurodevelopmental outcomes in neonates at significant risk of neurological impairment (the D1 cohort), and infants with suspected or confirmed cerebral palsy (the D2 cohort).120 children will be randomised to receive dietetic and nutritional intervention, and either active supplement or placebo. Eligible D1 neonates are those born <30+6 weeks gestation with weight <9th centile, ≤30+6 weeks gestation and Grade II, III or IV Intra-Ventricular Haemorrhage or periventricular white matter injury, or those born at 31-40+28 weeks gestation, with Sarnat grade I or II or III Hypoxic Ischaemic Encephalopathy or neuroimaging changes compatible with perinatal brain injury. Eligible D2 infants are those aged 1-18 months with a suspected or confirmed clinical diagnosis of cerebral palsy. The primary outcome measure is composite cognitive score on the Bayley Scales of Infant and Toddler Development III at 24 months. Secondary outcomes include visuobehavioural and visual neurophysiological assessments, and growth parameters including weight, height, and head circumference.DiscussionThis is the first study to supplement neonates and infants with perinatal brain injury with the combination of factors required for healthy brain development, throughout the period of maximal brain growth. A further study strength is the comprehensive range of outcome measures employed. If beneficial, supplementation with brain phosphatide precursors could improve the quality of life of thousands of children with perinatal brain injury.Trial registrationCurrent Controlled trials: ISRCTN39264076 (registration assigned 09/11/2012), ISRCTN15239951 (registration assigned 23/04/2010).

Facilitation handlings induce increase in electromyographic activity of muscles involved in head control of cerebral palsy children.

This study aimed to investigate the electromyographic (EMG) activation of the main cervical muscles involved in the head control during two postures widely used for the facilitation of head control in children with Cerebral Palsy (CP). A crossover trial involving 31 children with clinical diagnosis of CP and spastic quadriplegia was conducted. Electromyography was used to measure muscular activity in randomized postures. Three positions were at rest: (a) lateral decubitus, (b) ventral decubitus on the floor and (c) ventral decubitus on the wedge. Handlings for facilitating the head control were performed using the hip joint as key point of control in two postures: (a) lateral decubitus and (b) ventral decubitus on wedge. All children underwent standardized handlings, performed by the same researcher with experience in the neurodevelopmental treatment. EMG signal was recorded from muscles involved in the head control (paraspinal and sternocleidomastoid muscles) in sagittal, frontal and transverse planes, at the fourth cervical vertebra (C4), tenth thoracic vertebra (T10) and sternocleidomastoid muscle (SCM) levels. The results showed a significant increase in muscle activation when handling was performed in the lateral decubitus at C4 (P<0.001), T10 (P<0.001) and SCM (P=0.02) levels. A significant higher muscle activation was observed when handling was performed in lateral decubitus when compared to ventral decubitus at C4 level (P<0.001). Handling in ventral decubitus also induced an increase in EMG activation at T10 (P=0.018) and SCM (P=0.004) levels but not at C4 level (P=0.38). In conclusion, handlings performed in both positions may induce the facilitation of head control, as evaluated by the activity of cervical and upper trunk muscles. Handling performed in lateral decubitus may induce a slightly better facilitation of head control. These findings contribute to evidence-based physiotherapy practice for the rehabilitation of severely spastic quadriplegic CP children.

Are clinical measurements linked to the Gait Deviation Index in cerebral palsy patients?

ObjectiveFrom a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy. DesignA retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009. PopulationOne hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study. MethodQuinlan's Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity). ResultsSeven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments. ConclusionThere is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation.

Cerebellar Injury in the Extremely Premature Infant: Newly Recognized but Relatively Common Outcome

Severe injury to the cerebellum as a complication of extreme prematurity with extremely low birthweight was recently described in 13 children with the clinical diagnosis of cerebral palsy. We report another 10 cases of this syndrome. The clinical features include striking motor impairment and variable degrees of ataxia and athetosis or dystonia, which represent a distinct clinical type of cerebral palsy. Most are severely damaged, with cognitive, language, and motor delays. All are microcephalic, except one with hydrocephalus. Neuroimaging studies demonstrate the absence of major portions of the cerebellum involving both the inferior vermis and hemispheres. Most also have injury of a less severe nature in the cerebrum. This report indicates that this is not an uncommon outcome of extremely low birthweight infants, and we hope to encourage further investigations into the relative frequency and likely etiologies of the condition.

Isolated 3-methylcrotonyl-CoA car☐ylase deficiency in a 15-year-old girl

A 15-year-old girl with a former clinical diagnosis of cerebral palsy was found to have isolated deficiency of 3-methylcrotonyl-CoA car☐ylase (MCC) on gas chromatography-mass spectrometry (GC/MS) analysis and enzyme determination. Her symptoms included marked growth retardation from birth, profound mental retardation, tonic seizures, rigospastic quadriplegia with opisthotonic dystonia, gastroesophageal reflux with poor esophageal peristalsis, and recurrent episodes of aspiration pneumonia. Brain MRI revealed marked brain atrophy, involving both the gray and white matter. Although she did not exhibit acute metabolic decompensation or acute encephalopathy, her neurological symptoms continuously worsened. This patient is the oldest among reported cases of MCC deficiency who had symptoms at birth, and this case may have the severest sequelae of the longest known natural course of this inborn error of metabolism.

Neurodevelopmental outcome of very low birth weight children requiring chest compressions immediately after birth. † 1160

There is a small body of literature documenting the outcome of premature infants surviving neonatal resuscitation much of which is pessimistic. We investigated the outcome of very low birth weight infants who had chest compressions (CC) in the delivery room compared to infants of similar characteristics who did not require that level of initial intervention. Methods: A search of the computerised Newborn Follow Up database identified all infants meeting the following criteria: born at the Health Sciences Centre in 1992-94, birth weight < 1250g; no evidence of congenital anomalies or maternal substance abuse likely to affect neurodevelopmental outcome; a minimum of 12 months follow up. Chest compressions were initiated following established guidelines for neonatal resuscitation. The study group consisted of survivors of CC in the delivery room. The control group consisted of all other infants meeting the above criteria. The data base contains antenatal and perinatal data extracted from the hospital chart and follow up data collected prospectively. Results: Of the 163 infants born weighing <1250g in the study time period 36(22%) required CC in the delivery room. Mortality for this group was higher(53% vs 24%, p<0.001). The 17 survivors in the CC group were compared to 63 survivors in the non CC group who met the inclusion criteria. There were no differences in birth weight (881±179g vs 962 ±186g) or days of mechanical ventilation(21±13 vs 15 ±22) between the two groups although the CC group was born at a more premature gestation (27.2±1.6 vs 28.1±2.5, p< 0.04) and stayed longer in hospital (99±25 vs 80±39, p<0.01). There were no significant differences in the rates or severity of intraventricular hemorrhage, seizures, hearing loss or clinical diagnosis of cerebral palsy between the two groups. The CC group had a significant increase in retinopathy of prematurity of grade 3 or 4 (37% vs 17%, p<0.03). The gross motor, fine motor, adaptive and language developmental quotients as assessed using the Gessel Scales showed no significant differences between the two groups. Conclusion: In contrast to previous literature our data suggest that infants that require cardiac compressions at birth, although having a higher mortality have a comparable neurodevelopmental outcome to those that do not.