Diagnosis Of Cerebral Palsy Research Articles

EFFECTS OF EXERCISE THERAPY WITH THE BOBATH METHOD ON BALANCE IN A CHILD WITH SPASTIC DIPLEGIC CEREBRAL PALSY: A CASE REPORT

ABSTRACT
 The overall birth prevalence of cerebral palsy is about 2 per 1000 live births. Weakness in balance control is one of the most common problems encountered in children with CP. One of the most widely used physiotherapy approaches for children with CP is Bobath therapy. Exercise with the Bobath method can improve postural control and balance in children with CP. This study aims is to determine the effect of exercise therapy with the Bobath method for balance in a child with spastic diplegic cerebral palsy. This study using a single-subject research conducted on a child with a diagnosis of spastic diplegic cerebral palsy who was given exercise therapy using the Bobath method 4 times a week for 4 weeks. Measurement of balance using the Pediatric Balance Scale (PBS) which was carried out before exercise therapy was given (A1), follow-up (A2), and evaluation of the final outcome (A3). The results showed that the patient had an increase in the PBS score, which means that there was an increase in functional balance. The conclusion of this study is that exercise therapy with the Bobath method which has been carried out 4 times a week for 4 weeks improves functional balance in a child with a diagnosis of spastic diplegic cerebral palsy.
 
 Keywords: Cerebral Palsy, Balance, Bobath Method

Clinical Characteristics and Possible Risk Factors of Epilepsy in Children with Cerebral Palsy: A Tertiary-Center Experience

Objective: The aim of this study was to evaluate the clinical characteristics of children with cerebral palsy (CP) and to investigate possible risk factors and prognosis of epilepsy in children with cerebral palsy (CP) with a special emphasis on drug-resistant epilepsy (DRE). Materials and Methods: A total of 145 pediatric patients who were followed up with a diagnosis of CP between 2019 and 2022 were evaluated. Demographic features, prenatal/perinatal history, etiology and type of CP, degree of impairment in motor and cognitive functions, seizure type, neuroimaging, and electroencephalography (EEG) findings were obtained retrospectively from hospital records. The patients were divided into two groups: CP patients with epilepsy and patients without epilepsy. Study variables were compared between these two groups and also between DRE and controlled epilepsy groups. Results: There were 91 (63%) boys and 54 (37%) girls with a mean age of 11.1 ± 4.2 years (3-18 years). Epilepsy was present in 107 (73.7%) cases and 40.1% of them had refractory epilepsy. Epilepsy was most common in the tetraplegic form of CP (p=0.028). Term gestation, birth weight of ≥2500 g, and history of neonatal seizures were significantly higher in patients with epilepsy (p=0.03, 0.01, and 0.03, respectively). Children with DRE were more likely to have tetraplegic CP (50%) and severe intellectual disability (56%). Conclusion: Determination of potential risk factors is important in predicting the development of epilepsy in patients with CP, as it may provide closer follow-up of patients at high risk. Particular attention should be paid to the early identification and treatment of comorbid epilepsy in children with CP.

"A Different Ride": A Qualitative Interview Study of Parents' Experience with Early Diagnosis and Goals, Activity, Motor Enrichment (GAME) Intervention for Infants with Cerebral Palsy.

Cerebral palsy is the most common physical disability of childhood, and early diagnosis followed by best practice early intervention is important for optimizing child and family outcomes. We investigated parents' views of an early diagnosis of cerebral palsy (CP), followed by Goals, Activity, Motor Enrichment (GAME) intervention. Semi-structured interviews were conducted within a pilot randomised clinical trial. Transcriptions were analyzed using grounded theory. Participants were nine mothers whose infants had received GAME intervention because they were identified as being at high risk for cerebral palsy early in infancy. The parenting experience was described as a "different ride". The diagnosis was devastating with many time-consuming challenges, but acceptance ensued. Parents wanted an early diagnosis, prognosis, and early intervention, despite the anxiety and workload, because it meant they could help. Parents perceived that GAME was beneficial because they were taught how to help; it was goal-based and home-based. They believed the collaboration and communication skills of the therapist shaped success. Future research should focus on a broader range of participants to understand parent's experiences with key aspects of early intervention more fully.

Большие моторные функции и иммунные показатели у детей со спастическим церебральным параличом: есть ли связь

Cerebral palsy (CP) is a group of persistent motor and postural disorders that cause activity limitations, which are explained by non-progressive disorders in the developing brain [1]. Inflammation is detailed in the pathogenesis of most perinatal brain injuries, which contributes to the risk of cerebral palsy, including neonatal stroke, preterm birth, birth asphyxia, and infection [2, 3]. Systematic reviews of the clinical literature now support an association between higher levels of circulating pro-inflammatory mediators and the diagnosis of cerebral palsy, especially in prematurity [4]. However, the duration and extent of this inflammation, as well as the consequences for children with cerebral palsy, remain unclear. Inflammation in cerebral palsy may consist in a change in the cytokine status [4]; altered immune response [5]; adaptive immune changes, including the distribution and function of T- and B-cells [6], as well as other genetic and non-genetic changes in signaling pathways [7]. Inflammation following perinatal brain injury is commonly reported to change over time, between the acute and chronic phases of injury [8]. However, persistent inflammation (i.e., inflammation lasting months to years after the primary injury phase) has been postulated to have detrimental effects on the brain and may contribute to severe forms of the disease. This is supported by the persistent inflammation hypothesis, also known as programming effects, whereby prenatal, antenatal, or neonatal pro-inflammatory cytokines induce inflammation that contributes to long-term cytokine dysregulation [9]. The study in children with an early residual stage of cerebral palsy demonstrated the relationship between the functional level on the GMFCS scale (Gross Motor Function Classification System) and some indicators of immune status.

A Training-Free Infant Spontaneous Movement Assessment Method for Cerebral Palsy Prediction Based on Videos

Early diagnosis of infant cerebral palsy (CP) is very important for infant health. In this paper, we present a novel training-free method to quantify infant spontaneous movements for predicting CP. Unlike other classification methods, our method turns the assessment into a clustering task. First, the joints of the infant are extracted by the current pose estimation algorithm, and the skeleton sequence is segmented into multiple clips through a sliding window. Then we cluster the clips and quantify infant CP by the number of cluster classes. The proposed method was tested on two datasets, and achieved state-of-the-arts (SOTAs) on both datasets using the same parameters. What's more, our method is interpretable with visualized results. The proposed method can quantify abnormal brain development in infants effectively and be used in different datasets without training. Limited by small samples, we propose a training-free method for quantifying infant spontaneous movements. Unlike other binary classification methods, our work not only enables continuous quantification of infant brain development, but also provides interpretable conclusions by visualizing the results. The proposed spontaneous movement assessment method significantly advances SOTAs in automatically measuring infant health.

“Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties”

“How could I apply this information?” Health care practitioners have suggested that many children from rural areas lack the resources to seek early identification and intervention services for a diagnosis of cerebral palsy (CP). This article did not identify a difference between the Appalachian and non-Appalachian groups for gross motor (GM) functioning; however, because both groups received services within the metropolitan health care system, this represents a limitation of the study. There are disparities identified in Appalachia, as stated in the purpose and within the literature review of this study. The authors suggest many families living in the Appalachian regions continue to have a higher risk of delivering a premature infant, have lower socioeconomic status, and a lack of resources and experience to ask their health care providers for referrals outside of their region. The pediatric physical therapist must continue to assist with identifying early signs of GM delay and provide education and resources to our families to seek interventions as early as possible for those infants born at high risk for CP. “What should I be mindful about when applying this information?” The authors, including Ms Blevins, the parent of a 2-year-old with CP, agree with the limitations of this study and the effect on the results as identified by the authors. She comments on her own child's difficulty in early identification of CP and the effect this might have had on his GM development had they not had availability of financial and interventional resources. She states, “I feel hospitals in Appalachia lack the resources and education of early identification and interventions that play a big part as to why many kids receive services later than maybe in a large city. For me, the signs were so clear that something was wrong but for whatever reason, they kept stalling. I also believe that we get the diagnosis later because of a financial strain on families. We had the privilege of being referred to specialists in our area like gastroenterology, cardiologist, and neurologist but nobody knew how to help and that's how we got sent to Cincinnati Children's. Most of our families would have just been left with unknown answers because of a financial strain to travel or the knowledge that they could seek other options.” This personal statement is in support of the authors' identified limitations. The limited sample size, and the sample taken only from a large metropolitan health care system, suggests that families in this study received services earlier than the many children in Appalachia. While this article is a beginning to identify GM skills within these 2 groups of children with CP, disparities remain among the Appalachian population. Lindsey Blevins, PTA Parent of a 2-year-old with cerebral palsy Marion, Virginia R. Bertie Gatlin, PT, DSc Associate Professor South College Knoxville, Tennessee Pediatric Physical Therapist Abingdon, Virginia

Effect of Adapted Physical Activity in Children and Young Adults with Cerebral Palsy: A Systematic Review

Cerebral palsy (CP) is considered the most common cause of disability in childhood. People suffering from CP are characterized by deficits that limit their abilities and make it difficult to perform daily activities. The application of adapted physical activity (APA) physiotherapy programs has interested many researchers over the years. This systematic review aimed to examine and evaluate the existing evidence on the effects of various APA in different domains of life of children and young adults with CP. The review will fill the existing knowledge gaps in the literature, offer suggestions for future research, and build evidence-based practices in APA for people with CP. The PRISMA guidelines were followed. The research was conducted by searching several scientific databases, including PubMed, Google Scholar, ResearchGate, and science direct. The inclusion criteria consisted of randomized controlled trials published from 2015 to 2021, full text in the English language, and a sample aged (15-30 years) with a medical diagnosis of CP. Studies that used adapted physical activity (APA) interventions were also included as long as they matched the predetermined standards. The methodological quality was assessed according to the PEDro scale. A total of 14 studies met the inclusion criteria. The samples covered all levels of the gross motor function classification system (GMFCS I-V) with an age range of 16–29 years and both genders. The results showed diversity and improvements in various health parameters of children and young adults with CP. APA significantly affects the motor and psychosocial status of young people with CP and may function as a therapeutic supplement in the existing physiotherapy programs.

Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties

This study evaluated gross motor outcomes between children with cerebral palsy from non-Appalachian and Appalachian counties in the United States. For this retrospective, matched-case controlled study, data were sourced from electronic medical record and compared between groups. Groups were matched by age and Gross Motor Function Classification System (GMFCS) level. Children from Appalachian counties had significantly higher Gross Motor Function Measure, 66 (GMFM-66) scores and had a cerebral palsy diagnosis reported in the electronic medical record significantly later compared with children from non-Appalachian counties, controlling for age and GMFCS level. Although it has been documented that families and children from Appalachian counties have poorer overall health outcomes, motor development may not be affected. Our study found that children with cerebral palsy from Appalachian counties scored significantly higher on the GMFM-66 across GMFCS levels.

The Effects of Trunk Stabilization Exercise on Gross Motor Function, Functional Independence and Trunk muscle activity of Spastic Cerebral Palsy Children

The purpose of this study is to investigate how applying trunk stabilization exercises for 8 weeks to children with spastic cerebral palsy on their gross motor function, functional independence, and trunk muscle activity. A diagnosis of spastic cerebral palsy was experienced in 15 children. The trunk exercise was composed of three types of exercises: abdominal drawing exercise, Bridge exercise, and Sit up exercise for 20 minutes at a time, twice a week, for 8 weeks. Significant increases were maintained in sitting, crawl and kneeling position among GMFM at both 4 weeks and 8 weeks of application (p<.05). There was a significant increase in both the WeeFIM mobility and locomotion category after 4 weeks and 8 weeks of application (p<.05). Trunk muscle activity also showed a significant increase in the rectus abdominis and external oblique abdominal muscles at both 4 and 8 weeks of application (p<.05). It was found that the trunk stabilization exercise program is an effective intervention method for improving gross motor function, functional independence, and muscle activity, which are measures of motor function in children with cerebral palsy.

Immunization Status in Children with Cerebral Palsy and Their Household Members, and Parental Beliefs and Attitudes About Childhood, Adulthood, and COVID-19 Immunizations

Objective: To assess the immunization rate of the vaccines included in the Turkish National Immunization Program (NIP) among children with cerebral palsy (CP) and their households and to analyze parental beliefs and knowledge about vaccines and attitudes toward childhood, adult, and COVID-19 immunizations. Material and Methods: This descriptive cross-sectional study included children aged 3-10 years with a diagnosis of spastic CP. The initial face-toface interview with parents of children collected data on their children’s immunization rates, beliefs, and knowledge about vaccines, and parents were given information about adult immunization. Approximately one year after the initial interview, mothers were interviewed by telephone about the immunization rates of mothers, fathers, and grandparents and their COVID-19 vaccine acceptance or hesitancy. Numbers and percentages were presented as descriptive statistics. Results: Sixty-eight child-parent pairs participated in the first interview, and 67 mothers participated in the second interview. According to NIP, all children with CP and their siblings had been fully vaccinated on time. 70.6% of mothers had a positive belief toward childhood immunizations. None of the parents knew about optional childhood or adult immunizations. None of the parent and grandparent pairs had been vaccinated with vaccines included in the national adult immunization schedule. None of the 64 parent pairs who accepted to receive adult vaccines during the initial interview received the vaccines. 17.9% of parent pairs were detected to have COVID-19 vaccine hesitancy or refusal. Conclusion: National health policies for adult immunization should be developed to provide immunization to households with chronically ill children.

A prospective assessment of gait kinematics and related clinical examination measures in cerebral palsy crouch gait

Background While prospectively assessed crouch gait in cerebral palsy (CP) does not necessarily progress, prospective changes in clinical examination measures have not been reported. This study prospectively examined the association between selected clinical examination variables and change in crouch gait in a cohort with bilateral CP. Methods Inclusion criteria were a diagnosis of ambulant bilateral CP, knee flexion at mid-stance &gt;190 and a minimum of two-years between gait analyses. The change in kinematic variables was assessed using Statistical Parameter Mapping (SPM) and changes in clinical measures using appropriate paired tests. Linear regression examined the association between progression of crouch and clinical examination variables. Results There was no mean change in crouch in 27 participants over 3.29 years. However, there was significant variability within this group. Clinical hamstring tightness (60.000 to 70.480, p&lt;0.01) and external knee rotation during stance (SPM analysis, p&lt;0.001) increased but there was no association between changes in clinical examination variables and changes in crouch (p-values 0.06 - 0.89). Conclusions The variability crouch gait progression highlights the pitfall of group mean values in such a heterogeneous population. The lack of association between changes in clinical examination variables and changes in crouch highlights the multi-factorial aetiology of this gait pattern and the need for larger prospective studies.

DNA Methylation Analysis Reveals Distinct Patterns in Satellite Cell-Derived Myogenic Progenitor Cells of Subjects with Spastic Cerebral Palsy.

Spastic type cerebral palsy (CP) is a complex neuromuscular disorder that involves altered skeletal muscle microanatomy and growth, but little is known about the mechanisms contributing to muscle pathophysiology and dysfunction. Traditional genomic approaches have provided limited insight regarding disease onset and severity, but recent epigenomic studies indicate that DNA methylation patterns can be altered in CP. Here, we examined whether a diagnosis of spastic CP is associated with intrinsic DNA methylation differences in myoblasts and myotubes derived from muscle resident stem cell populations (satellite cells; SCs). Twelve subjects were enrolled (6 CP; 6 control) with informed consent/assent. Skeletal muscle biopsies were obtained during orthopedic surgeries, and SCs were isolated and cultured to establish patient-specific myoblast cell lines capable of proliferation and differentiation in culture. DNA methylation analyses indicated significant differences at 525 individual CpG sites in proliferating SC-derived myoblasts (MB) and 1774 CpG sites in differentiating SC-derived myotubes (MT). Of these, 79 CpG sites were common in both culture types. The distribution of differentially methylated 1 Mbp chromosomal segments indicated distinct regional hypo- and hyper-methylation patterns, and significant enrichment of differentially methylated sites on chromosomes 12, 13, 14, 15, 18, and 20. Average methylation load across 2000 bp regions flanking transcriptional start sites was significantly different in 3 genes in MBs, and 10 genes in MTs. SC derived MBs isolated from study participants with spastic CP exhibited fundamental differences in DNA methylation compared to controls at multiple levels of organization that may reveal new targets for studies of mechanisms contributing to muscle dysregulation in spastic CP.

Level of Awareness and Attitude Toward Cerebral Palsy Among Parents in Al-Baha City, Saudi Arabia.

Background Cerebral palsy (CP) is a chronic disorder of motion, posture, and tone which occurs due to brain insult during the period of brain growth. It is a disabling disorder in both motor and intellectual aspects.Fortunately, CP is a manageable disease that can be managed in part by increasing the knowledge and understandingof the parents. Methodology This cross-sectional, prospective, community-based study aimed to assess the level of parents' knowledge and their attitude toward CP using an electronic questionnaire. The parents' knowledge was classified as good or poor based on an adopted scoring system. The parents' attitude was categorized as positive or negative. Results Our study results showed that good knowledge (those with a score more than 60% of the total score) was noted in 275 (61.1%) participants, whereas 175 of the participants had poor knowledge (38.9%), especially regarding awareness of the diagnosis of CP. Conclusions Most participants had an overall good knowledge of CP although they had insufficient knowledge of some aspects of the disease such as causes, disease course, clinical presentations, diagnosis, and prognosis. Although the results showed a positive attitude concerning playing with a child with CP, unfortunately, there was a negative attitude toward hiring a CP patient and a strongly negative attitude toward marrying a patient with CP.

BDNF as a potential predictive biomarker for patients with pediatric cerebral palsy

Background: Cerebral palsy (CP) is the most common motor disability in children, which is instigated by damage to the developing brain that affects the ability to control the muscles. The main types of CP are spastic CP, dyskinesia CP and mixed CP. The aim of this work was to estimate the concentrations of complete blood count (CBC), erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), brain-derived neurotrophic factor (BDNF), and tumor necrosis factor-α (TNF-α) in children with CP compared to the control group. Methods: A total of 75 Egyptian children were enrolled in this study, 45 had CP and 30 were controls. CBC, ESR, CRP, BDNF, and TNF-α were assessed. Results: The ESR, CRP and TNF-α levels showed statistically significant increases in cases compared with controls. While the neutrophil/lymphocyte ratio and the BDNF levels were significantly lower in CP compared with the controls. When comparing the different groups of CP with each other; there were no significant differences. Regarding the correlation of BDNF and different studied parameters, our study showed a positive correlation between BDNF and TNF levels only within the group with spastic CP. Conclusions: BDNF may be considered as a biomarker or treatment target for CP to avoid further complications as still there is insufficient progress in the prediction, early diagnosis, treatment, and prevention of CP. Furthermore, searching for novel strategies to increase BDNF levels may open a new opportunity for the treatment of CP.

Parental Age and Childhood Risk for Cerebral Palsy in California

To investigate the associations between maternal or paternal age at the time of delivery and offspring's risk for cerebral palsy (CP) in California. We conducted a population-based, case-control study that included 8736 singleton CP cases and 90 250 singleton controls, matched by sex and birth year, selected from California birth certificate records from 1994 to 2010. We estimated OR and 95% CIs for CP diagnosis according to maternal and paternal age recorded on the birth certificates. Causal mediation analysis was performed to estimate direct and indirect effects of parental ages on CP with preterm delivery as a potential mediator. Children born to younger mothers (≤19years) or older mothers (35-39years; ≥40years) had a greater risk of CP compared with children of mothers aged 25-29years (ORs ranging from 1.13 to 1.59). Compared with paternal age 25-29years, older paternal age (40-44years; ≥45years) also was associated with an increased risk for CP independent of maternal age. When analyzing jointly using both parents of ages 20-34years as the reference, the greatest risk was estimated for older parents (≥35years). Preterm birth was estimated to mediate 19%-34% of the total effects between maternal or paternal age and offspring CP risk. Young maternal age and an older age in either or both parents were associated with a greater risk of CP in their children. Although preterm birth was a mediator, additional factors related to parental age need further exploration to explain risk of CP.

Abstract 10057: Cerebral Palsy Patients Admitted for Acute Myocardial Infarction; Insights From the 2019 National Inpatient Sample

Introduction: Past studies have suggested that respiratory diseases are the most common cause of death among children with cerebral palsy (CP). At the same time, cardiovascular complications and cancer could be the leading killer among adult in those patients. The outcomes of cerebral palsy patients and risk factors following an episode of Acute Myocardial Infarction (AMI) have not been widely examined. Methods: A retrospective study via the 2019 National Inpatient Sample was conducted. Cases with CP diagnosis were retrieved via their appropriate ICD-10 codes (G80.0x). We also filtered to include patients with a principal diagnosis of AMI. Various categorical variables were compared via Chi-Square tests. Results: In 2019, 295 patients with cerebral palsy were admitted with AMI. CP patients were younger (mean age 63.20 vs. 66.93 years) and more common among Whites (86.0%), covered by Medicare (79.7%), and of ages &gt;60 (66.1%). Compared to non-CP patients, CP patients also recorded more cases with depression (20.3% vs. 9.3%) and drug abuse (8.5% vs. 3.0%). However, they had less cases with smoking (28.8% vs. 49.3), obesity (13.6% vs. 21.0%), hyperlipidemia (59.3% vs. 68.6%), old myocardial infarct (8.5% vs. 16.6%), hypertension (78.0% vs. 82.8%), diabetes (35.6% vs. 41.2%), peripheral vascular disease (6.8% vs. 10.6%), acute kidney injury (10.2 % vs. 20.8%), ventricular tachycardia (6.8% vs. 7.2%), and paroxysmal atrial fibrillation (6.8% vs. 9.9%). Only 38.6% of CP patients underwent PCI. Conclusions: CP patients may present with AMI at a younger age and express a higher depression and drug abuse rate. Physicians and providers linked with their care should be encouraged to reach out to them for signs of depression and provide them with adequate facilities to seek treatment.

Fracture Rates in Children with Cerebral Palsy: A Danish, Nationwide Register-Based Study.

In children with cerebral palsy (CP), fracture rates have been reported to be higher than in the general population but age-specific fracture rates have not been directly compared and the effect of comorbid epilepsy needs elucidation. This impairs decision-making regarding bone health interventions. We aimed to establish the age-specific fracture rates in children with CP with and without epilepsy in Denmark. Data from Danish registers were combined to establish cohorts of children with and without CP born in Denmark from 1997 to 2007. Fracture rates were calculated for 1997-2016. We identified 1,451 children with CP and 787,159 without CP. Female/male fracture rates per 1,000 person-years were 23/27 with CP and 23/29 without CP. Male sex, epilepsy and anti-seizure medication, but not the diagnosis of CP or GMFCS-level, were associated with higher fracture rates. Relatively more lower extremity fractures occurred in non-ambulant children with CP. We found no increased fracture rates in children with CP when compared to peers; however, fracture locations suggested bone fragility in non-ambulant children. All children with epilepsy and on anti-seizure medication had increased fracture rates. We suggest bone health optimization in these groups.

Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost–consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes

IntroductionCerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12–24...

Does the Addition of Intrathecal Baclofen Along with or After Soft-Tissue Hip Adductor Surgery Decrease the Need for Hip Reconstruction Compared with Soft-Tissue Surgery Alone for Children with Nonambulatory Cerebral Palsy?

Intrathecal baclofen (ITB) is a well-known treatment option for cerebral palsy (CP) spasticity. The combination of soft-tissue release and ITB for spasticity is common. This study compared patients who had soft-tissue release before ITB (PRE-ITB), soft-tissue release at the same time as ITB (ST-ITB), and no ITB (NON-ITB) but had soft-tissue release at a similar age as PRE-ITB. Inclusion criteria were a spastic or mixed nonambulatory CP diagnosis, prior hip adductor surgery, no prior reconstructive surgery, and at least a five-year post-operative follow-up. Thirty hips were identified as PRE-ITB, 20 hips as ST-ITB, and 43 hips as NON-ITB. The primary outcome variables were the subsequent hip surgery during the study period and/or a migration percentage ≥ 50% at the final follow-up defined as "unsuccessful hip." The mean follow-up duration was 9.0years (SD 2.4) for PRE-ITB, 9.4 (SD 3.6) for ST-ITB, and 9.3 (SD 3) for NON-ITB. The odds of unsuccessful outcomes were not different between NON-ITB and PRE-ITB but were lower for the ST-ITB group. The need for subsequent osteotomies or revision adductor surgery was significantly higher in ST-ITB compared with PRE-ITB (p = 0.02) or NON-ITB (p = 0.015). The incidence of surgical site infection over the whole follow-up period was higher in ST-ITB (40%) compared with PRE-ITB (13.3%, p = 0.035) and NON-ITB (0, p < 0.001). The addition of tone management with ITB did not reduce the need for later hip surgery but did increase the risk for surgical site infection.

Molecular Diagnostic Yield of Exome Sequencing and Chromosomal Microarray in Cerebral Palsy

There are many known acquired risk factors for cerebral palsy (CP), but in some cases, CP is evident without risk factors (cryptogenic CP). Early CP cohort studies report a wide range of diagnostic yields for sequence variants assessed by exome sequencing (ES) and copy number variants (CNVs) assessed by chromosomal microarray (CMA). To synthesize the emerging CP genetics literature and address the question of what percentage of individuals with CP have a genetic disorder via ES and CMA. Searched articles were indexed by PubMed with relevant queries pertaining to CP and ES/CMA (query date, March 15, 2022). Inclusion criteria were as follows: primary research study, case series with 10 or more nonrelated individuals, CP diagnosis, and ES and/or CMA data used for genetic evaluation. Nonblinded review was performed. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for assessing data quality and validity. Data were extracted by a single observer. A separate meta-analysis was performed for each modality (ES, CMA). The primary outcome was proportion/molecular diagnostic yield (number of patients with a discovered genetic disorder divided by the total number of patients in the cohort), evaluated via meta-analysis of single proportions using random-effects logistic regression. A subgroup meta-analysis was conducted, using risk factor classification as a subgroup. A forest plot was used to display diagnostic yields of individual studies. In the meta-analysis of ES yield in CP, the overall diagnostic yield of ES among the cohorts (15 study cohorts comprising 2419 individuals from 11 articles) was 23% (95% CI, 15%-34%). The diagnostic yield across cryptogenic CP cohorts was 35% (95% CI, 27%-45%), compared with 7% (95% CI, 4%-12%) across cohorts with known risk factors (noncryptogenic CP). In the meta-analysis of CMA yield in CP, the diagnostic yield of CMA among the cohorts (5 study cohorts comprising 294 individuals from 5 articles) was 5% (95% CI, 2%-12%). Results of this systematic review and meta-analysis suggest that for individuals with cryptogenic CP, ES followed by CMA to identify molecular disorders may be warranted.