Different Types Of Cerebral Palsy Research Articles

Clinical Phenotypes and Etiological Risk Factors in Children with Cerebral Palsy: A Retrospective Study

Background: Cerebral palsy is a motor impairment syndrome that arises from a lesion in the developing brain. The condition varies based on the timing of the lesion, as well as differences in clinical presentation, location, and severity. Objectives: The aim of this study is to determine the clinical features of patients with cerebral palsy, identify the associated risk factors, and analyze cranial MRI findings in relation to the different types of cerebral palsy. Methods: This study retrospectively evaluated the medical records of children diagnosed with cerebral palsy. Data collected included demographic information, details of potential relevant abnormalities during pregnancy, birth, and the neonatal period, comorbidities, types of cerebral palsy, cranial MRI findings, and classifications of motor impairments. Results: The mean age of the 202 patients with cerebral palsy in the study was 8.02 years, with a male predominance (60.4%). The most common type of cerebral palsy observed was spastic cerebral palsy, accounting for 81.6% of the cases. The most frequent cranial MRI finding was white matter damage of immaturity, present in 36.1% of the patients, while 8.4% of the cases had normal cranial MRI results. Epilepsy was the most common comorbidity, affecting 50.5% of the patients. White matter damage of immaturity was most commonly associated with spastic diparesis, and the identified risk factors for these patients included prematurity, low birth weight, oligohydramnios, multiple pregnancy, and neonatal sepsis/meningitis. Spastic tetraparesis was most frequently linked to miscellaneous MRI findings, with risk factors such as term birth, normal birth weight, polyhydramnios, asphyxia/resuscitation, and a history of neonatal convulsions. Focal infarction/hemorrhage was most often associated with spastic hemiparesis, while basal ganglia-thalamus damage was frequently seen in patients with choreoathetotic and dystonic cerebral palsy. In patients with dystonic cerebral palsy, vaginal delivery and a history of hyperbilirubinemia were identified as common risk factors. Cerebellar damage and malformations were most frequently associated with ataxic cerebral palsy. Conclusions: In this study, it was determined that MRI findings can serve as a valuable guide for identifying different types of cerebral palsy. Additionally, the risk factors, disease severity, and accompanying comorbidities were found to vary according to the specific type of cerebral palsy.

Sensory processing abilities in relation to motor capabilities in children with different types of cerebral palsy

Background and purpose. children with cerebral palsy have sensory processing issues as well as motor problems, which lead to severe developmental disability. In this study, we aimed to assess correlation between sensory processing abilities and motor capabilities in children with cerebral palsy and assess the effect of cerebral palsy types on sensory processing abilities and motor capabilities. Materials and methods. One hundred cerebral palsy children of both sex were included in the study; their age ranged from 4-10 years old were selected from pediatric rehabilitation out clinic of faculty of Physical Therapy Cairo University, fulfilling inclusion criteria. All children were assessed by Short sensory profile: to measure sensory processing ability, Gross Motor Function Classification System: to measure the gross motor skills and Manual Ability Classification System: to measure the fine motor skills. Result. there was a significant correlation between GMFCS, MACS and the total score of SSP as well as Low energy weak, tactile sensitivity score, taste smell sensitivity, Movement sensitivity, and Under-responsive seeks sensation (P ≤ 0.05*). There was no significant correlations between both auditory filtering and Visual-auditory sensitivity with GMFCS and MACS (P = 0.676 and 0.266, respectively). There was statistical variation among different CP types regarding SSP and motor assessment (P ≤ 0.05*). Conclusion. the study showed: sensory processing abilities effect on motor capabilities in children with cerebral palsy.

Evaluation of Hearing Status in Various Type of Cerebral Palsy Children in a Tertiary Hospital

Background: Cerebral palsy (CP) in children are frequently associated with sensorineural pathology.
 Objectives: To assess the severity of hearing impairment in children with CP and correlate the auditory impairment with different types of CP.
 Materials & Methods: This cross-sectional study was conducted in the Department of Pediatric neurology and Autolaryngiology- Head and Neck Surgery BSMMU, during March to September 2011. Diagnosed CP patients were included consecutively. After taking informed written consent, proper history and clinical examinations was done and severity of hearing loss was assessed.
 Results: Among the 50 children with CP, Tympanometry result revealed that negative middle ear pressure was present in 32% in spastic quadriplegia(SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was present in 62.5% in spastic hemiplegia. In TOAE result 52% were pass and 48% were referred and ABR were suggested. On the basis of result of TOAE, those were referred, initially they were encountered as hearing impairment in this study. Among them, in SQ were 18%, SH were 12% and mixed. Follow up auditory brain stem response revealed mild, moderate and severe sensorineural hearing loss were 8% in spastic quadriplegic type and the spastic diplegia and athetoid group were 2% only mild, Moderate sensorineural hearing were 2% in spastic hemiplegia group.
 Conclusion: Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment. Perinatal asphyxia and prematurity were the main risk factor of hearing impairment.
 BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 19-22

Assessment of Children with Cerebral Palsy Using Common Brief Core Set of International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

Objective: To assess children with cerebral palsy using the Common Brief Core Set of International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY).
 Study Design: Cross-sectional study
 Place and Duration of Study: Children Hospital & Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021.
 Methodology: Fifty-nine children with cerebral palsy (CP) aged 0-18 years were included. Common Brief Core Set of International Classification of Functioning, Disability, and Health in Children and Youth (ICF-CY) was administered to children with cerebral palsy to assess their functional status. Strengths and weaknesses in body structure, body function,activity and participation and environmental factors were evaluated using the Common Brief Core Set of ICF-CY. 
 Results: The majority of study participants were 38(64.4%), were spastic quadriplegic. Periventricular leukomalacia was noted in 36(67.9%) cases on MRI brain. Moderate to severe impairment was noted in body functions like intellectual function 46(78%). In addition, 26(44.1%) children with cerebral palsy had mild to moderate impairment in walking, while 4(6.8 %) could walk without any impairment. Social attitudes, construct, and design of buildings were the major barriers affecting the functionality of children with cerebral palsy.
 Conclusion: It was found that the Common Brief Core Set of ICF-CY in children with different types of cerebral palsy is a useful tool for assessing their functional level.Keywords: Cerebral Palsy, Common Brief Core Set, Disability, Health in Children and Youth (ICF-CY), International Classification of Functioning.

Correlations of CT Scan Findings in Different Types of Cerebral Palsy: A Study in a Tertiary Care Centre in Bangladesh

Introduction: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. CT scan is helpful for identification of structural abnormalities, etiology, categorize the types of brain lesions and planning of intervention in the child with CP.
 Objective: This study was done to find relationship between types of CP and CT scan findings of brain.
 Materials and methods: This cross sectional descriptive study was done among 110 clinically diagnosed CP case from department of Paediatric Neurology & IPNA, BSMMU, during March 2016 to August 2017. Demographic, clinical characteristics & physical examination were done & collected data were recorded. CT scan of brain was done in all cases & all data were analyzed.
 Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Among them quadriplegic CP were the most common (39.1%), followed by 28.2% cases of hemiplegic CP, 16.4% were of mixed type, 7.3% were diplegic. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of studied children. Children with hemiplegic CP had brain atrophy in 87% of cases, calcification was found mostly in quadriplegic CP. Brain malformation was found mostly in mixed type of CP.
 Conclusion: Most common CT scan finding was brain atrophy and commonly found in hemiplegic CP. Encephalomalacia and calcifications were commonly found in quadriplegic CP. Brain malformation were commonly found in mixed type of CP.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 67-73

Frequency and Severity of Auditory Impairment in Children with Cerebral Palsy in a Selected Tertiary Health Care Centre

Cerebral palsy is the most common chronic motor disorder in children and frequently associated with sensorineural pathology. Deafness is very important public health concern. Because it determines long-term life span disability in individuals, decrease their quality of life. To observe the rate of occurrence of hearing impairment in children with cerebral palsy (CP) and to assess the severity of hearing impairment children with CP and correlate the auditory impairment with different types of CP were aim of the study. Total 50 children with Cerebral Palsy were taken. A structured questionnaire was filled up including history of patient and important variables related to hearing status like family history of deafness, consanguinity, antenatal history, preterm LBW, perinatal asphyxia, kernicterus, neonatal septicemia, neonatal seizure and meningitis were included in study. Physical examination and neurological examination like hearing, vision, motor, cognitive, speech delay were assessed. In this study, among the 50 children with CP, Tympanometry showed that negative middle ear pressure was 32% in spastic quadriplegia (SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was 62.5% in spastic hemiplegia. Secretory otitis media was 36.4% in spastic quadriplegia. Auditory brain stem response revealed severe sensorineural hearing loss was 8% in spastic quadriplegic type. Moderate sensorineural hearing loss was 2% in spastic hemiplegia group. Hearing loss was frequent in children with Cerebral Palsy. Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment.

Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review.

Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

Visual Perceptual Deficits in Different Types of Cerebral Palsy

Abstract Introduction: Children with cerebral palsy (CP) have been found to present with visual perceptual impairments (VPI). Research indicates differences in VPI in various subtypes of CP. However, visual perceptual deficits in children with CP has not been investigated in terms of occupational therapy assessment and treatment in a South African context. The purpose of this study was to determine the specific VPI in learners ages 4-18 years with various subtypes of CP attending a school for learners with special needs in Johannesburg, South Africa. Method: The Test of Visual Perceptual Skills 3 rd ed. (TVPS-3) was used to assess 80 learners and their subtest scores and composite scores were compared according to their subtype of CP as well as other demographic variables including age, gender and GMFCS level. Results: All the subtypes of CP were found to present with VPI, with the right spastic unilateral (hemiplegic) group having the fewest number of impairments and the ataxic group greatest number of impairments. A significant difference in visual discrimination and figure ground scores were found based on the subtype of CP while the Composite Basic Processes scores on the TVPS-3 differed significantly for both the subtypes of CP and gender. No significant differences were found for VPI based on age and GMFCS levels. Conclusion: Visual perceptual impairments were found in a high percentage of participants with CP with significant differences between the subtypes of CP and according to gender but not for age and GMFCS levels. Key words: Cerebral Palsy, Visual Perception, TVPS-3, Visual Perceptual Impairment, Occupational Therapy

The Impact Of Diagnosis Type on Inflammatory and Brain Markers in Adults With Cerebral Palsy

Cerebral palsy (CP) is caused by a traumatic injury to a developing brain. Damage to different areas in the brain lead to different types of CP, which could potentially impact the concentrations of brain derived neurotrophic factor (BDNF) and selective inflammatory cytokines. The objective of this study is to identify whether concentrations of BDNF and inflammatory cytokines (INFα, IL-1b, 2,4,6,8 and 10, hs-CRP, IGF-1) differ between CP types.

Investigation of feeding problems in children with cerebral palsy

Introduction: Eating and swallowing are important for child health and play an essential role in her/his physical, social, emotional and cultural development. In children with cerebral palsy because of neuromuscular disorders, there is high prevalence of feeding and swallowing disorders. Early diagnosis, prevention and management of feeding problems are important process. In this study, feeding problems in different types of cerebral palsy were investigated. Materials and methods: In this cross-sectional descriptive study, 60 children with cerebral palsy that referred to clinical centers were selected using random sampling. Feeding and swallowing skills of these children were investigated with using of Pediatric assessment scale for severe feeding problems. Results: Findings indicated that children with spastic and flaccid cerebral palsy have feeding problems with similar severity. Also children with athetoid cerebral palsy showed lowest severity of feeding problems. Conclusion: Swallowing performance and proper feeding skills plays an important role in children's development. Given the high prevalence of feeding problems in children with cerebral palsy, early diagnosis and intervention should be done to prevent of secondary problems. Keywords: cerebral palsy, feeding skills, swallowing

Sense of Coherence in People with Cerebral Palsy in Greece

Purpose: The basic aim of this research was to evaluate the Sense of Coherence (SOC) in people with Cerebral Palsy in Greece. Also, the correlation of SOC with their Quality of Life was investigated. Method: For the purposes of the research, a mixed methodological approach was chosen. The Sense of Coherence (SOC) was administered to 37 people with Cerebral Palsy. Semi-structured interviews at Special Educators were also conducted and observation of the participants was carried out in order to collect sufficient data both for their Sense of Coherence and Quality of Life. Results: The results depict high scores of sense of coherence in people with cerebral palsy, which is in significant correlation to their quality of life. It appeared that there was no statistically significant difference between them (Ζ = -0.736, p-value = 0.462) and the significance level was determined at a = 5%. Also, there was no statistically significant differentiation in SOC-score between people with different types of cerebral palsy (F = 0.258, p-value = 0.933), with the significance level at 5%. Conclusion: As a conclusion, people with Cerebral Palsy are satisfied with their everyday life. They can control their feelings and they can cope with unknown situations. They experience pleasant feelings and do not easily experience the emotion of disappointment.

Ambulatory Potential in Children with Cerebral Palsy

ABSTRACT Ambulation is a major concern in cerebral palsy (CP) rehabilitation. The present study was carried out in 175 CP cases, belonging to the age group of 2 years and above. The aim of the article was to identify the independent ambulators in different types of CP, to study the age of achieving independent ambulation, and to determine some parameters that affect ambulatory outcome. Among 175 cases, 69 (39.4%) cases were found to be able to walk independently. Of this, the maximum number of cases were children with spastic hemiplegia, 37 of 39 (94.9%), followed by children with spastic paraplegia, 7 of 18 (41.1%) and diplegia, 15 of 45 (33.1%). Majority of these children were found to have either normal intelligence or mild degree of mental retardation (MR). Degree of spasticity was mild in these cases. Majority of the children who were able to walk had achieved independent sitting by 2 years of age, i.e., in 54 of 69 (78.3%) cases. The present study highlights that CP children with spastic hemiplegia had the highest potential for independent walking. Spasticity of mild degree in association with a normal intelligence or mild degree of MR and achievement of independent sitting by 2 years of age appear to be favorable for ambulation. How to cite this article Laisram N, Saha S. Ambulatory Potential in Children with Cerebral Palsy. Indian J Phy Med Rehab 2017;28(2):49-52.

The grading diagnosis of the magnetic resonance imaging and magnetic resonance spectroscopy and gross motor rating scale for children with cerebral palsy

Objective To investigate the grading diagnostic value of magnetic resonance spectroscopy and magnetic resonance imaging and gross motor rating scale for children with cerebral palsy. Methods Forty cases of healthy children under 1.0~2.0 years old and 42 cases of cerebral palsy children under 1.1~2.0 years old were enrolled in the study, and we compared the inspection reports on MRI and MRS statistical analysis.According to the results of MRI for dividing cerebral palsy, and MRS indexing of NAA/Cr, CHO/Cr, LAC/Cr levels were compared; different types of cerebral palsy by GMFM scores were examined. Results Nuclear magnetic resonance(MRI)and MRS could effectively distinguish typical pathological changes in the brain of children with cerebral palsy, the cerebral NAA, Cr, Cho could appear significant formant when the children detected by MRS, could be quantitatively detected with MRS.The levels of NAA/Cr、CHO/Cr、LAC/Cr of different MRS and MRI degree was different, and the difference of moderate CP and severe CP was significant(P<0.05). Compared with MRS, the accordant rates of the MRI was not ideal, But gross motor rating scale score suggested that there were differences between the cerebral palsy of the MRI and MRS degree(P<0.05). Conclusion The magnetic resonance imaging and magnetic resonance spectroscopy and gross motor rating scale can effectively improve the dividing diagnosis of cerebral palsy, and this method for different types of cerebral palsy in children has some guiding value. Key words: Nuclear magnetic resonance spectroscopy; Child cerebral palsy; Gross motor function measure

Sex differences in cerebral palsy on neuromotor outcome: a critical review.

Sex differences have been reported in children with cerebral palsy (CP), with males having a higher risk of developing CP, but it is not entirely clear whether sex may also affect the severity of motor impairment. The aim of the present study was to critically review the existing literature on sex influence on neuromotor outcome in children with CP. The published papers confirm that CP occurs more frequently in males than in females. Within different types of CP or individual level of impairment, however, there was limited evidence that sex also had an effect on their performance.

Story retelling and language ability in school-aged children with cerebral palsy and speech impairment.

Research on retelling ability and cognition is limited in children with cerebral palsy (CP) and speech impairment. To explore the impact of expressive and receptive language, narrative discourse dimensions (Narrative Assessment Profile measures), auditory and visual memory, theory of mind (ToM) and non-verbal cognition on the retelling ability of children with CP and speech impairment. Fifteen speaking children with speech impairment (seven girls, eight boys) (mean age = 11 years, SD = 1;4 years), and different types of CP and different levels of gross motor and cognitive function participated in the present study. Story retelling skills were tested and analysed with the Bus Story Test (BST) and the Narrative Assessment Profile (NAP). Receptive language ability was tested with the Test for Reception of Grammar-2 (TROG-2) and the Peabody Picture Vocabulary Test - IV (PPVT-IV). Non-verbal cognitive level was tested with the Raven's coloured progressive matrices (RCPM), memory functions assessed with the Corsi block-tapping task (CB) and the Digit Span from the Wechsler Intelligence Scale for Children-III. ToM was assessed with the false belief items of the two story tests "Kiki and the Cat" and "Birthday Puppy". The children had severe problems with retelling ability corresponding to an age-equivalent of 5;2-6;9 years. Receptive and expressive language, visuo-spatial and auditory memory, non-verbal cognitive level and ToM varied widely within and among the children. Both expressive and receptive language correlated significantly with narrative ability in terms of NAP total scores, so did auditory memory. The results suggest that retelling ability in the children with CP in the present study is dependent on language comprehension and production, and memory functions. Consequently, it is important to examine retelling ability together with language and cognitive abilities in these children in order to provide appropriate support.

CEREBRAL PALSY;

Background: Cerebral Palsy is a disorder of movement and postural balance due to insult to the brain. The injury to the developing brain may be prenatal, natal or postnatal. The diagnosis is clinical mainly. The spastic Cerebral Palsy is classified into monoplegic, hemiplegic, diplegic, and quadriplegic types. There is a difference in the frequency of these types of Cerebral Palsy in different studies. The patterns of various forms of Cerebral Palsy emerge gradually with a delay in developmental milestones. A spectrum of associated developmental disabilities has been found to be common in these children. Management is through a multi-disciplinary approach. Objectives: To find out the frequency of different types of Cerebral Palsy and degree of associated developmental delay. Methodology: A cross sectional study was carried out for a period of six months (October 1, 2006 to March 31, 2007) at The Children’s Hospital &amp; Institute of Child Health Lahore. 100 Cases diagnosed as Cerebral Palsy on clinical basis were assessed for the type of cerebral palsy and the degree of associated developmental delay. Results: Out of the total 100 patients 54% had quadriplegia, 32% had diplegia, 10% had himiplegia and 4% had monoplegia. The total fifty-four cases of quadriplegic cerebral palsy 54 had developmental delay and amongst them 4 (7%) had mild delay, 16 (30%) had moderate delay while 34 (63%) had severe delay. Amongst the total forty-six other three types of cerebral palsy 12 (26%) had mild delay, 6 (13%) had moderate delay and 28 (61%) had severe delay. The P-value was &gt;0.05. Conclusions: Quadriplegic is the commonest type of CP, associated with the factors (peri-natal more than socio-demographic) and had significant effect on the developmental parameters.

Intrathecal injection of CD133-positive enriched bone marrow progenitor cells in children with cerebral palsy: feasibility and safety

Background aimsRecent studies have proposed that cellular transplantation may have some regenerative and functional efficacy in the treatment of cerebral palsy (CP); however, much remains to be understood regarding its safety, feasibility and efficacy. This study was initiated to evaluate the safety of autologous bone marrow–derived CD133+ cell intrathecal injection. MethodsChildren (n = 12), aged 4 to 12 years, who were diagnosed with different types of CP underwent BM aspiration. CD133+ cells were enriched from the BM samples and intrathecally injected. The Gross Motor Function Measure (GMFM-66), Gross Motor Function Classification System (GMFCS), UK FIM+FAM, Functional Independence Measure (FIM) and Functional Assessment Measure (FAM) were assessed at baseline and 6 months after the procedure. Patients' ability to balance was measured by the Berg Balance Scale (BBS), and severity of spasticity was evaluated by the Modified Ashworth Scale. Magnetic resonance imaging was done at baseline and 6 months after therapy. This study was registered in ClinicalTrials.gov (NCT01404663). ResultsThere were no adverse events detected by clinical and laboratory tests or imaging studies, with the exception of a seizure in 1 patient. A significant improvement was observed 6 months after cell transplantation versus baseline according to GMFM, GMFCS, FIM+FAM, Ashworth Scale, and BBS outcomes. ConclusionsSubarachnoid injection of CD133-positive enriched bone marrow progenitor cells in children with CP is a safe approach. The results suggest a possible short-term improvement in neurological function.

Vliv Halliwickova konceptu na rozvoj plaveckých dovedností u dětí s mozkovou obrnou a autismem

Stoking post describes how to use Halliwick concept in swimming training. Swimming is for clients diagnosed with cerebral palsy (CP) and autism, one of the best physical activities. For clients with special needs but requires only changing the activity but the approach instructors. One of the ways that fully respect these requirements is Halliwick concept of swimming lessons. Motor competence is one of the important indicators of personality development, has a social dimension. The term motor skills with noise continuum: analysis and description of the state - the adoption of measures to modification and improvement (Válková, 2010) to evaluate the results of the use of the test swimming skills (hereinafter WOTA - Water orientation test (Tirosh, Katz-Leurer &amp; Getz, 2008). The present results represent a pilot study. Study was conducted in 15 probands with different types of cerebral palsy and autism. Study had pretest and posttest design with a two-month intensive training session with swimming Halliwick concept. Since we have worked with a homogeneous group of clients probands were divided into three groups according to the type of diagnosis (quadruparetic form of cerebral palsy, diparetic form of cerebral palsy and autism) and after a two-month course we evaluated the changes of swimming skills through WOTA test.

Non‐infectious risk factors for different types of cerebral palsy in term‐born babies: a population‐based, case–control study

To identify non-infectious antenatal and perinatal risk factors for cerebral palsy (CP) and its subtypes in children born at term. A population-based, case-control study. The western healthcare region of Sweden. A population-based series of children with CP born at term during 1983-94 (n=309) was matched with a control group (n=618). A total of 62 variables, maternal characteristics, and prepartal, intrapartal and postpartal variables were retrieved from obstetric records. Both univariate and multivariate analyses were performed for spastic and dyskinetic CP, and for the total CP group. Cerebral palsy (CP) and subtypes. Univariate analysis resulted in 26 significant risk factors for CP. Birthweight (OR 0.54, 95% CI 0.39-0.74), not living with the baby's father (OR 2.58, 95% CI 1.11-5.97), admittance to a neonatal intensive care unit (NICU) (OR 4.43, 95% CI 3.03-6.47), maternal weight at 34 weeks of gestation (OR 1.02, 95% CI 1.00-1.03) and neonatal encephalopathy (OR 69.2, 95% CI 9.36-511.89) were found to be risk factors for CP in the total CP group in our multivariate analysis. Factors during the periods before, during and after delivery were all shown to increase the risk of spastic diplegia and tetraplegia, whereas mostly factors during the period before delivery increased the risk of spastic hemiplegia, and only factors during delivery increased the risk of dyskinetic CP. Admittance to an NICU was a risk factor for all CP subtypes. The risk factor pattern differed by CP subtype. The presented risk factors may be useful indicators for identifying children at risk of developing CP, and helpful for targeting individuals for early intervention programmes.

Neuro‐ophthalmological disorders in cerebral palsy: ophthalmological, oculomotor, and visual aspects

Cerebral visual impairment (CVI) is a disorder caused by damage to the retrogeniculate visual pathways. Cerebral palsy (CP) and CVI share a common origin: 60 to 70% of children with CP also have CVI. We set out to describe visual dysfunction in children with CP. A further aim was to establish whether different types of CP are associated with different patterns of visual involvement. A total of 129 patients (54 females, 75 males; mean age 4 y 6 mo, SD 3 y 5 mo; range 3 mo-15 y) with CP (51 with diplegia, 61 with tetraplegia, and 17 with hemiplegia; 62 [48%] of participants were able to walk) and CVI enrolled at the Centre of Child Neuro-ophthalmology (at the Department of Child Neurology and Psychiatry, IRCCS 'C. Mondino Institute of Neurology', University of Pavia) underwent an assessment protocol including neurological examination, developmental and/or cognitive assessment, neuro-ophthalmological evaluation including ophthalmological assessment, evaluation of visual acuity, contrast sensitivity, optokinetic nystagmus, visual field and stereopsis, and neuroradiological investigations. Visual dysfunction in diplegia was characterized mainly by refractive errors (75% of patients), strabismus (90%), abnormal saccadic movements (86%), and reduced visual acuity (82%). The participants with hemiplegia showed strabismus (71%) and refractive errors (88%); oculomotor involvement was less frequent (59%). This group had the largest percentage of patients with altered visual field (64%). Children with tetraplegia showed a severe neuro-ophthalmological profile, characterized by ocular abnormalities (98%), oculomotor dysfunction (100%), and reduced visual acuity (98%). Neuro-ophthalmological disorders are one of the main symptoms in CP. Each clinical type of CP is associated with a distinct neuro-ophthalmological profile. Early and careful neuro-ophthalmological assessment of children with CP is essential for an accurate diagnosis and for personalized rehabilitation.