Diagnosis Of Cerebral Palsy Research Articles

General movements assessment, part II: the use of general movement assessment as a predictive tool of cerebral palsy – a scoping review

The diagnosis of cerebral palsy is usually made between the 12 and 24 months of age which often delays the implementation of early therapeutic intervention. General movements assessment is one of the tools for the early diagnosis of cerebral palsy. The aim of this study was to present the current knowledge on the use of the general movements assessment in predicting cerebral palsy. The literature review was made in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The PubMed medical database was searched, 24 publications were identified and included in the detailed analysis. The highest sensitivity was demonstrated for the general movements assessment performed during the fidgety period and in preterm infants. General movements assessment and/or Hammersmith Infant Neurological Examination (HINE) are recommended as a routine screening of newborns with documented risk factors for cerebral for the earliest possible diagnosis. Raising the awareness of medical personnel should be of key importance for the implementation of the recommended procedure.

Mortality in Neuromuscular Early Onset Scoliosis Following Spinal Deformity Surgery.

The purpose of this study was to report mortality and associated risk factors in neuromuscular early onset scoliosis following spinal deformity surgery. This is a multicenter retrospective cohort study of patients with cerebral palsy (CP), spinal muscular atrophy, myelodysplasia, muscular dystrophy, or myopathy undergoing index spine surgery from 1994 to 2020. Mortality risk was calculated up to 10 years postoperatively. Proportional hazard modeling was utilized to investigate associations between risk factors and mortality rate. A total of 808 patients [mean age 7.7 y; 439 (54.3%) female] were identified. Postoperative 30-day, 90-day, and 120-day mortality was 0%, 0.001%, and 0.01%, respectively. 1-year, 2-year, 5-year, and 10-year mortality was 0.5%, 1.1%, 5.4%, and 17.4%, respectively. Factors associated with increased mortality rate: CP diagnosis [hazard ratio (HR): 3.14, 95% confidence interval (CI): 1.71; 5.79, P<0.001]; nonambulatory status (HR: 3.01, 95% CI: 1.06; 8.5, P=0.04)]; need for respiratory assistance (HR: 2.17, 95% CI: 1.00; 4.69, P=0.05). In neuromuscular patients with early onset scoliosis, mortality risk at 10 years following spine surgery was 17.4%. As mortality was 1.1% at 2 years, premature death was unlikely a direct result of spine surgery. Diagnosis (CP) and markers of disease severity (nonambulatory status, respiratory assistance) were associated with increased mortality rate. Prognostic level II.

A Review on the Types, Risk Factors, Diagnosis, and Treatment of Cerebral Palsy

A Review on the Types, Risk Factors, Diagnosis, and Treatment of Cerebral Palsy

The Co-Occurrence of Autism Spectrum Disorder and Cerebral Palsy and Associated Comorbid Conditions in Children and Adolescents

ABSTRACT Background Comorbidity is the co-occurrence of two or more disorders in the same person. Aim This study investigated the frequency of comorbid conditions, in children and adolescents, with autism spectrum disorder (ASD), cerebral palsy (CP), and a comorbid diagnosis of ASD and CP. Method Ninety-six children and adolescents with ASD, CP, and both ASD and CP aged between 4 and 18 years participated in this study. Parents completed the Gastrointestinal Symptom Inventory, Children’s Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire, and the Vineland Adaptive Behavior Scales. Results Results of ANOVA analyses revealed significant group differences in sleep problems, social communication difficulties, and adaptive behavior. Regression analysis found that the presence of an intellectual disability significantly predicted levels of adaptive behavior. Conclusion This research demonstrated the importance of studying comorbidities in children and adolescents with CP alone, ASD alone, and combined ASD and CP.

Neurodevelopmental profiles of infants born

Background:Infants born <30 weeks postmenstrual age (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies report rates of impairment for individual outcomes separately. Our objective was to describe neurodevelopmental profiles of children born <30 weeks PMA, using cognitive, language, motor, and behavioral characteristics.Methods:We studied 587 children from a multi-center study of infants born <30 weeks PMA. Age 2 outcomes included Bayley-III subscale scores, Child Behavior Checklist syndrome scores, diagnosis of cerebral palsy (CP), and positive screen for autism spectrum disorder (ASD) risk. We used latent profile analysis (LPA) to group children into mutually exclusive profiles.Results:We found four discrete neurodevelopmental profiles indicating distinct combinations of developmental and behavioral outcomes. Two of the profiles included 72.7% of the sample with most having Bayley scores within the normal range. The other two profiles included the remaining 27.3% of the sample with most having Bayley scores outside of the normal range. Only one profile (11% of sample) was comprised of children with elevated behavioral problems.Conclusion:Child-centered analysis techniques could facilitate the development of targeted intervention strategies and provide caregivers and practitioners with an integrative understanding of child behavior.

Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters.&#x0D; AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy.&#x0D; MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of cerebral palsy, spastic diplegia, GMFCS 3, MACS 23, Ashworth Scale 23. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system Qualisys (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated.&#x0D; RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.012.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.528.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.097.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only accurate changes in biomechanical parameters, but also a number of other factors, in particular social and household ones.&#x0D; CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.

Antenatal magnesium sulphate for preventing cerebral palsy: An economic evaluation of the impact of a quality improvement program.

Previous work demonstrated that implementing a quality improvement (QI) program improves the uptake of guideline-recommended antenatal magnesium sulphate, a critical intervention known to reduce cerebral palsy risk. Here we estimate potential cost savings attributable to the improved uptake. By expanding coverage from 63 to 83% of eligible women, we estimated that five children potentially would not have received a diagnosis of cerebral palsy, a potential cost saving of $AU4.8 million in lifetime healthcare costs. Our findings strengthen the case for embedding QI approaches in perinatal care to reduce the incidence of cerebral palsy.

PHYSIOTHERAPY REHABILITATION OF 3-YEAR-OLD GIRL HAVING SPASTIC DIPLEGIC CEREBRAL PALSY

Cerebral palsy is a concept that denotes a collection of long-term motion and posture disturbances that hinder daily tasks. The incidence has been estimated to be between 2 and 2.5 per 1000 live births. Non-progressive reforms with in brain's progress across foetal or child advancement are viewed as evidence of this disorders. Cerebral palsy can be segregated into certain sorts of motor impediments relying on their topography: Diplegia, hemiplegia, quadriplegia, monoplegia, and triplegia. Such patients seemed to have cognitive, sensory, or motor illness. It has an effect on motion, posture, and physical activity as well. Supplemental abnormalities such as spasticity, which have an effect on general health and makes studying fresh chores distressing, are also prevalent in children with CP. Spasticity is a pervasive feature of a CNS lesion. This leads to issues with functionality. Medical surgical and physiotherapeutic approaches such as stretching, positioning, manual therapies such as massage, MFR, MET and Cryotherapy are also used along with a few other physiotherapy approaches to alleviate spasticity. MFR and cryotherapy have been shown to help children with CP counteract spasticity. The objective of this project is to focus on the perks of physiotherapy restoration in cerebral palsy, along with the influences of MFR and cryotherapy on spasticity in the limbs in a 3-year-old girl with spastic diplegic cerebral palsy. The key concerns of the patient were hurdle in rolling and crawling, failure to stand and sit without aid, and spasticity. When the assessment was performed using GMFCS and spasticity by MAS and MTS, the diagnosis of spastic diplegic cerebral palsy was ascertained. It has been claimed that physiotherapy care is viable in fulfilling intended outcomes. The following are the outcomes: Cryotherapy and Myofascial Release technique were used to manage spasticity, as well as ROM exercises, gradual passive stretching, balance training, swiss ball exercises, weight bearing exercises, orthosis, and a decent home fitness regimen. The analysis revealed that physiotherapy measures like those of cryotherapy and myofascial release technique had a promising effect on improving spasticity and raising ability to stand, roll, partial neck control, crawl, balance posture, and stand with AFO help.

Computer-Aided Diagnosis of Children with Cerebral Palsy under Deep Learning Convolutional Neural Network Image Segmentation Model Combined with Three-Dimensional Cranial Magnetic Resonance Imaging.

In this paper, we analyzed the application value and effect of deep learn-based image segmentation model of convolutional neural network (CNN) algorithm combined with 3D brain magnetic resonance imaging (MRI) in diagnosis of cerebral palsy in children. 3D brain model was segmented based on CNN algorithm to obtain the segmented MRI images of brain tissue, and the validity was verified. Then, 70 children with cerebral palsy were rolled into the observation group (n = 35), which received MRI for diagnosis after segmentation of brain tissue, and control group (n = 35), which were diagnosed by computed tomography (CT). The diagnosis results of the two groups were compared. The validity experiment verified that the image segmentation method based on CNN algorithm can obtain effective style graphics. In clinical trials, the diagnostic accuracy of 88.6% in the observation group was evidently superior to that of 80% in the control group (P < 0.05). In the observation group, one patient was diagnosed as normal, four patients had white matter lesions, 17 patients had corpus callosum lesions, and five patients had basal ganglia softening foci. In the control group, two patients were diagnosed as normal, two patients had white matter lesions, 19 patients had corpus callosum lesions, and four patients had basal ganglia softening foci. No notable difference was found between the two groups (P > 0.05). According to the research results, in the diagnosis of cerebral palsy in children, the image segmentation of brain 3D model based on CNN to obtain the MRI image of segmented brain tissue can effectively improve the detection accuracy. Moreover, the specific symptoms can be diagnosed clearly. It can provide the corresponding diagnostic basis for clinical diagnosis and treatment and was worthy of clinical promotion.

Association between brain structural network efficiency at term-equivalent age and early development of cerebral palsy in very preterm infants

Very preterm infants (born at less than 32 weeks gestational age) are at high risk for serious motor impairments, including cerebral palsy (CP). The brain network changes that antecede the early development of CP in infants are not well characterized, and a better understanding may suggest new strategies for risk-stratification at term, which could lead to earlier access to therapies. Graph theoretical methods applied to diffusion MRI-derived brain connectomes may help quantify the organization and information transfer capacity of the preterm brain with greater nuance than overt structural or regional microstructural changes. Our aim was to shed light on the pathophysiology of early CP development, before the occurrence of early intervention therapies and other environmental confounders, to help identify the best early biomarkers of CP risk in VPT infants. In a cohort of 395 very preterm infants, we extracted cortical morphometrics and brain volumes from structural MRI and also applied graph theoretical methods to diffusion MRI connectomes, both acquired at term-equivalent age. Metrics from graph network analysis, especially global efficiency, strength values of the major sensorimotor tracts, and local efficiency of the motor nodes and novel non-motor regions were strongly inversely related to early CP diagnosis. These measures remained significantly associated with CP after correction for common risk factors of motor development, suggesting that metrics of brain network efficiency at term may be sensitive biomarkers for early CP detection. We demonstrate for the first time that in VPT infants, early CP diagnosis is anteceded by decreased brain network segregation in numerous nodes, including motor regions commonly-associated with CP and also novel regions that may partially explain the high rate of cognitive impairments concomitant with CP diagnosis. These advanced MRI biomarkers may help identify the highest risk infants by term-equivalent age, facilitating earlier interventions that are informed by early pathophysiological changes.

Gait-assisted exoskeletons for children with cerebral palsy or spinal muscular atrophy: A systematic review.

Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA) are common causes of motor disability in childhood. Gait exoskeletons are currently being used as part of rehabilitation for children with walking difficulties. To assess the safety and efficacy and describe the main characteristics of the clinical articles using robot-assisted gait training (RAGT) with exoskeleton for children with CP or SMA. A computer search was conducted in five bibliographic databases regarding clinical studies published in the last ten years. In order to be included in this review for further analysis, the studies had to meet the following criteria: (1) assess efficacy or safety of interventions; (2) population had to be children with CP or SMA aged between 3 and 14; (3) exoskeleton must be bilateral and assist lower limbs during walking. Twenty-one articles were selected, of which only five were clinical trials. 108 participants met the inclusion criteria for this study, all with a diagnosis of CP. The evidence level of the selected papers was commonly low. RAGT therapy seems to be safe for children with CP. However, further investigation is needed to confirm the results related to efficacy. There is no evidence of RAGT therapy for SMA children.

Telerehabilitation and Wellbeing Experience in Children with Special Needs during the COVID-19 Pandemic.

Social distancing due to the COVID-19 pandemic represented a golden opportunity to implement telerehabilitation for clinical groups of children. The present study aims to show the impact that telerehabilitation had on the experience of well-being of children with special needs being treated at the Foundation IRCCS Neurological Institute ‘C. Besta’ in Milan (Specific Learning Disorders and Cerebral Palsy diagnosis); it aims to do so by comparing it with experiences of those who did not undertake telerehabilitation despite the diagnosis during the pandemic, and with typically developing children. Results show that the three groups differed in the Support, Respect and Learning dimensions of well-being experience. Post hoc comparisons revealed that children with Specific Learning Disorders and Cerebral Palsy scored higher than normotypical children in Support and in Respect scales. Furthermore, children who experienced telerehabilitation showed the highest scores on the Learning scale in comparison with the other two groups. These results support the importance of reorganizing care and assistance by integrating telemedicine, which seems to have fostered a positive experience of well-being in people with special needs, particularly in the perception of a supportive environment that respects psychological needs.

Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p&gt;0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity.

Failure of Hip Reconstruction in Children With Cerebral Palsy: What Are the Risk Factors?

The rates and risk factors contributing to failure after hip reconstruction among patients with cerebral palsy (CP) are not well established. In analyzing a large cohort of children with CP who underwent hip reconstruction, the objectives of this study are to establish (1) the failure rates and (2) associated risk factors. This retrospective study included chart and radiographic review of patients between the ages of 1 to 18, with a diagnosis of CP, who underwent a hip reconstructive procedure at a single children's hospital over a 9-year period (2010 to 2018). Patients without at least 2 years of follow-up were excluded. Age at time of surgery, sex, Gross Motor Function Classification System (GMFCS), procedure(s) performed, preoperative migration percentage (MP), neck-shaft angle, and acetabular index (AI) were recorded. Failure was defined as need for revision surgery or a MP >50% on follow-up radiographs. Logistic regression and multiple-variable regression-type models were used to test for significance of risk factors. Of the 291 hips in 179 patients (102 males, 77 females) that met inclusion criteria, 38 hips (13%) failed. Significant differences in the failure group were seen in age at time of surgery (6.2±3.2 vs. 8.1±3.2; P<0.001), preoperative MP (62.3±28.7 vs. 39.9±24.1%; P<0.001) and preoperative neck-shaft angle (164.9±8.2 vs. 157.3±15.6 degrees; P<0.001). Age below 6 at time of surgery significantly increased failure rate (26% vs. 6.3%, P<0.001) as did preoperative MP >70% (28.9% vs. 9.9%, P<0.001). Receiving an acetabular osteotomy was protective against failure (9.1% vs. 16.9%, P=0.048), particularly in patients with a preoperative AI >25° (odds ratio=0.236; confidence interval: 0.090-0.549). In this case series, failure after hip reconstruction for children with CP was determined to be 13.1%. There was a higher risk associated with age under 6 at time of surgery or a preoperative MP >70%. Correction of acetabular dysplasia when AI is more than 25 degrees with acetabular osteotomy at time of hip reconstruction, exerted a protective effect against subsequent failure. Level III-retrospective case series.

The use of neuroimaging, Prechtl's general movement assessment and the Hammersmith infant neurological examination in determining the prognosis in 2-year-old infants with hypoxic ischemic encephalopathy who were treated with hypothermia

BackgroundThe use of neuroimaging, the General Movement Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE) to identify the risk of neurodevelopmental delay in early infancy is recommended. AimThe aim of this study was to examine the predictive power of neuroimaging, GMA and HINE for neurodevelopmental delay and cerebral palsy (CP) in infants with hypoxic ischemic encephalopathy (HIE) who were treated with hypothermia. Study designRetrospective cohort. Subjects and outcome measuresThis retrospective study included 47 (18 female and 29 male) infants who were treated with hypothermia due to HIE. Neonates with a diagnosis of HIE were followed and assessed using neuroimaging, GMA, HINE and the Bayley Scales of Infant and Toddler Development-II (Bayley II) between 3 m and 2 years of age. ResultsOut of the 47 infants with HIE, no fidgety movements were observed in 5 infants. The sensitivity and specificity in determining the psychomotor developmental index (PDI) score were 97% and 100%, respectively, for MRI; 92.9% and 100% for GMA; and 91.9% and 80% for the HINE. The sensitivity and specificity in determining the mental developmental index (MDI) score were 95% and 85.7%, respectively, for MRI; 90.5% and 80% for GMA; and 91.9% and 50% for HINE. The sensitivity and specificity in determining CP diagnosis at the age of 2 years were 83.3% and 95%, respectively, for MRI; 83.3% and 100% for GMA; and 83.3% and 87.8% for HINE. ConclusionThe interpretation of MRI, GMA, and HINE that are performed within the early period of life may be the gold standard for the early detection of neurodevelopmental risks in 2-year-old infants with HIE. Clinical implementation of these methods in the early period in the follow-up of these infants offers useful information for the early identification of neurodevelopmental risk and for planning early intervention.

Barriers and enablers to participating in regular screening programmes for women with cerebral palsy: A qualitative life course study.

To determine the barriers and enablers to regular, women-oriented screening programmes for women with cerebral palsy (CP); and to discuss the participants' suggestions for change. Qualitative life course approach. Twenty-five life course interviews were conducted with women in 2020 who identified as having a diagnosis of CP. Interviews were conducted in person or using electronic platforms. Framework analysis was used to interpret the data. Access and utilization of regular screening programmes for women with CP across the life course are determined by multiple socioecological factors. Three themes are discussed focusing particularly on cervical and breast screening: 1. barriers, 2. enablers and 3. women's suggestions for change. Some women chose to opt out of sexual health checks for fear they would be too uncomfortable or the procedure would be too difficult. Practitioner attitudes towards disability in general, as well as the extent to which they understood the effects of CP for women, was highlighted as a barrier. Accessibility and adaptability of the environment also influenced women's uptake of screening. Women with CP face many challenges to their sexual and reproductive healthcare. These can deter them from participating in regular women-oriented screening programmes, which puts them at higher risk of preventable diseases. Understanding the lifelong effects of CP for women, and the interaction with their reproductive health could help to reduce unmet needs and increase participation in relevant screening across the life course. Knowledge of the challenges to regular screening programmes experienced by women with CP across the life course is crucial to provide appropriate preventative healthcare for women with CP across different stages of life. Elements of this knowledge could have benefits for the care of all disabled women.

Brain Computerized Tomography Scans Findings in Children with Cerebral Palsy

dnuorgkcaB: Cerebral palsy (CP) is a major cause of the disability in children. It is considered a neurological disease occurs due to a non-progressive brain injury or anomaly that occurs while the brain is developing. Intracranial imaging provides a window to see the brain lesion and potentially, provide an insight into the pathogenesis of CP. Objectives: To reveal the radiological changes of brain using CT scan in different clinical types of CP and in those CP children with functional impairments. Material and methods: Sixty eight children with previous diagnosis of cerebral palsy were scanned with computed tomography (Philips, brilliance 64) for brain without contrast at Azadi Teaching Hospital/Kirkuk city, from February 2013 to July 2016. Clinical information was obtained from the documentation of pediatricians. The images were reviewed by two board certificate radiologists with at least 6 years of experience. Result: Sixty-eight patients were included in the study, 42(61.8%) females and 26(38.2%) males with female to male ratio 1.6:1and an overall mean age at presentation was 12 months. Most (79.3%) children with cerebral palsy had abnormal neuro-radiological findings, Diffuse brain atrophy predominantly involving the cortical –subcortical grey matter with and without white matter hypodensities which indicate grey matter injury (35.4%) was the most common finding and it was more in the pyramidal CP (100%), followed by white matter atrophy and hyposensitizes with or without ventriculomegaly indicating white matter injury in (23.5%) which was the most common CT finding in cerebellar CP (50%), congenital malformations found in (8.8%) including pachygyria, and Dandy-Walker malformation, entirely seen in quadriplegic type, focal vascular brain insult seen in (5.9%) occurred only in diplegic type, and the least was ventriculomegaly labeled as miscellaneous (2.9%) occurred only in quadriplegic CP. CT scan was normal in (20.7%), predominantly in cerebellar type. There were significantly more patients with abnormal CT findings among CP children suffering from convulsion (p>0.05) than those without convulsion, this was not true in those with microcephaly (p<0.05). Conclusion: CT scan brain is a good modality for detection of structural brain abnormality in cerebral palsy (CP) cases. There was significant correlation between the topographic distribution of motor deficit and brain CT findings. There were significantly more patients with abnormal CT findings among CP children suffering from convulsion but not microcephaly

Children from Rural Appalachia And Urban Communities are Diagnosed With Cerebral Palsy Significantly Later Than Children From Suburban Communities

<h3>Research Objectives</h3> To investigate the relationship between community, age of cerebral palsy (CP) diagnosis, and gross motor function in children with CP. <h3>Design</h3> Retrospective, cohort study. <h3>Setting</h3> A single, pediatric hospital (2010-2020). <h3>Participants</h3> N=88 children with CP (N=29 rural, N=30 urban, and N=29 suburban), 0-18 years old (6.7±5.0 years old,55.7% male), all severity levels (N=38 Gross Motor Function Classification System (GMFCS) I, N=12 II, N=9 III, N=17 IV, N=12 V). <h3>Interventions</h3> Data were sourced from electronic medical records (EMR). Multiple linear regression models were used to evaluate relationships between community, age at CP diagnosis, and gross motor function for children with CP (α=0.03, Bonferroni adjustment). <h3>Main Outcome Measures</h3> All data was collected via EMR. Gross motor function was measured by Gross Motor Function Measure (GMFM-66). <h3>Results</h3> Age and community were significant predictors of age of CP diagnosis (respectively:F=100.2,p= < .001; F=4.0, p=0.02) when controlling for gross motor function (F=4.5, p=0.04) (R2=57.3%). Age and GMFCS level were significant predictors of gross motor function (GMFM-66) (respectively: F=13.1, p=.001; F=114.3, p=< 0.001) when controlling for community (F=2.9, p=0.06) and sex (F=0.0, p=0.88)(R2=84.7%). <h3>Conclusions</h3> These results suggest (1) age of CP diagnosis has decreased in the past 10 years, and (2) children from rural Appalachia and urban communities are diagnosed with CP between 1-1.7 years later than children from suburban communities. Early diagnosis for CP is critical, as neuroplasticity is greatest within the first 2 years of life, maximizing potential for motor change. Our study found that age of CP diagnosis has decreased over the past 10 years. This is most likely related to the implementation of international guidelines for detection and diagnosis for CP established in 2017. The results from our study also suggest the child's community may impact age of diagnosis. Future work should investigate factors that contribute to this difference, such as access to care, health equity, and health literacy in rural Appalachia and urban communities. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose. This work was partially funded by the Foundation for Physical Therapy Research PODS II Award to Rachel Bican.

Outcome of Gastrocnemius Soleus Facial Lengthening in Ambulatory Patients With Cerebral Palsy

Background: Treatment of equinus contractures in children with cerebral palsy (CP) varies across centers. Existing literature utilizes mixed study populations with a variety of procedures. As such, there is limited knowledge regarding recurrence rates and efficacy of a single procedure performed on a homogenous cohort. Here we retrospectively evaluate outcomes from gastroc soleus fascial lengthenings (GSFL) performed at 2 centers with consistent approaches in both patient selection and operative technique. Methods: Subjects meeting inclusion criteria including CP diagnosis, ambulation status, and minimum follow-up criteria were identified. Revision rate was reported based on need for additional calf lengthening procedures. Functional outcomes were evaluated using physical exam measures and selected variables from computational gait analysis. Outcomes factors were identified by comparing revised subjects to unrevised. Longitudinal outcomes of index surgeries were assessed by comparing preoperative functional data to short-term, mid-term, and long-term data. Results: A total of 64 subjects with 87 limbs met inclusion criteria. In all, 25% of subjects and 21% of limbs went on to revision. Factors influencing revision were age at index surgery and gross motor function classification system (GMFCS) level. More than half of revised limbs had index surgery before age 7. Revision rates for subjects less than 7 were 44% compared with a 17% revision rate for ages 7 to 12, and a 4% revision rate on children older than 12. GMFCSIII subjects had significantly higher revision rates (43%) compared with GMFCSII (18%) and GMFCSI (11%) subjects. Ankle range of motion measures improved significantly with GSFL and most maintained improvements at all time periods. GSFL did not lead to significant calcaneal gait or crouch. Conclusions: This study evaluates long term efficacy of GSFL to address equinus in ambulatory children with CP. Overall revision rates are similar to previous reports for GSFL and other calf lengthening procedures. This information may be useful in setting expectations and counselling families. Younger subjects and those with more severe involvement are more likely to need revision surgery, with these factors compounding the likelihood in the younger GMFCSIII child. Level of Evidence: Level III—retrospective comparative study.

Impact of Rehabilitation Intensity on 3-Year Mortality among Children with Moderate to Severe Cerebral Palsy: A Population-Based Cohort Study.

Though numerous studies demonstrated the positive effect of rehabilitation on cerebral palsy (CP) children, there was no literature addressing the role of rehabilitation on mortality among children with CP. Therefore, we aimed to evaluate the impact of rehabilitation intensity on mortality among children with moderate to severe CP. This retrospective cohort study was conducted by National Health Insurance Research Database in Taiwan. Children (<12 years) with newly diagnosed moderate to severe CP between 1 January 2000 and 31 December 2013 were included. All patients were followed up for 3 years after CP diagnosis or death or until 31 December 2013. The intensity of rehabilitation therapy within 6 months after CP diagnosis was categorized into <6 times and ≥6 times. The Cox proportional hazard analysis was used to determine the association between rehabilitation intensity and all-cause mortality after adjusting age, sex, other demographic factors and comorbidities. Among 3936 severe CP children, 164 (4.2%) died during the 3-year follow-up period. The mortality rate was higher among patients receiving rehabilitation < 6 times within 6 months than those ≥6 times within 6 months after adjusting demographic profile and comorbidities (adjust HR (aHR): 1.96, 95% CI 1.33–2.89, p < 0.001). We found that patients who were younger (aHR: 0.84, 95% CI 0.76–0.92, p < 0.001), who were receiving inpatient care more than twice in 1 year before their CP diagnosis (aHR: 2.88; 95% CI: 1.96–4.23; p < 0.001), and who have pneumonia (aHR: 1.41, 95% CI 1.00–1.96, p = 0.047), epilepsy (aHR: 1.41, 95% CI: 1.02–1.95, p = 0.039) and dysphagia (aHR: 1.55, 95% CI: 1.06–2.26, p = 0.024) have higher risk of mortality. Rehabilitation ≥ 6 times within 6 months has a potentially positive impact on pediatric CP survival. Besides having a younger age, being hospitalized more than twice within a year before diagnosis and having pneumonia, epilepsy and dysphagia were modifiable risk factors in clinical practice for these children.