Diplegic Cerebral Palsy Research Articles

Gross motor abnormalities in relation to balance and weight indicators in children with spastic diplegia

BackgroundOver the past 10 years, the prevalence of obesity in the cerebral palsy population has increased in the USA, ranging from 7.7 to 16.5%. Obesity is linked to health problems as well as challenges with walking and balance. The current study investigated the correlation between BMI, balance, and gross motor abnormalities in children with diplegia.MethodsThis cross-sectional-correlation study was done at the Outpatient Clinic at the Faculty of Physical Therapy, Cairo University. The study included 104 diplegic children aged from 5 to 10 years, 53 in the normal weight group and 51 in the overweight group. Dynamic balance was evaluated by the overall stability index (OSI) in the Biodex Balance System and gross motor capacities (GMC) were evaluated by standing and walking dimensions in GMFM.ResultsOn comparing outcome variables, there were significant differences among groups in BMI, GMC, and OSI (P < 0.001). Moreover, there was a significant negative strong correlation between GMC and OSI (r = − 0.792 and P < 0.001).ConclusionOverweight and obese diplegic cerebral palsy children have decreased balance and GMC significantly when compared to normal-weight children. There was also a significant correlation between GMC and OSI (r = − 0.792).Trial registrationThe study registered in ClinicalTrial.gov in October 2024 (NCT06642922).

Effects of Pediatric Endurance and Limb Strengthening Program versus Lower Limb Strength Training in Diplegic Cerebral Palsy: A Randomized Clinical Trial

Objective: To evaluate the comparative effects of pediatric endurance and limb strengthening (PEDALS) program versus lower limb strength training in diplegic cerebral palsy (CP). Methodology: This Randomized clinical trial on a sample of 24 children with CP enrolled consecutively was completed after ethical approval. Group A (n=12) received the PEDALS program and group B (n=12) received lower limb strength training. PEDALS program was applied for 30 minutes, 3 days/week for 12 weeks and Group B received the intervention 6-8reps, 1-3sets for3 days/ week for 12 weeks. Outcome was measured with GMFM-88, Six-minute walk test and range of motion using goniometer pre and post treatment. Results: Mean age was 9.95±2.21 years. Post treatment mean value for total GMFM score for Group A was 64.916±8.129 and Group B was 65.33±9.92 with p-value &gt; 0.05 respectively. Post treatment mean value for six minutes' walk test for Group A was 199.58±13.55 and for Group B was 195.50±15.71 with p-value &gt;0.05 and post treatment ROM for Group A and Group B with p-value&gt;0.05, there was no significant difference between these techniques. Conclusion: PEDALS program as well as lower limb strength training is equally effective in improving endurance, gross motor function and ROM in children with diplegic CP .

Relationship Between Body Mass Index, Selective Voluntary Motor Control and Functional Independence in Children With Cerebral Palsy

Objectives: This study detects the relationship between body mass index (BMI), selective voluntary motor control (SVMC) and functional independence in children with spastic diplegic cerebral palsy (CP). Methods: A total of 84 children with spastic diplegic CP (levels II and III of gross motor function classification system [GMFCS]), aged 6-9 years with a mean age of 7.09±0.68 participated in this correlational study. BMI, selective control assessment of the lower extremity and pediatric functional independence measure (WEE FIM) were used to assess BMI, SVMC and functional independence, respectively. Results: The data demonstrated the presence of a positive strong significant correlation between selective control assessment of the lower extremity and WEE FIM. On the other hand, there was a negative, significant correlation between WEE FIM and BMI. In addition, a negative moderate considerable correlation between BMI and selective control assessment of the lower extremity was detected Discussion: Functional independence is significantly correlated with BMI and SVMC in children with spastic diplegic CP. BMI and SVMC are major factors that influence functional independence in these children. So, they are highly recommended to be part of the evaluation of the functional independence of children with spastic diplegia in clinical settings and research.

Foot Progression Angle in Relation to Spatiotemporal Parameters of Gait in Children with Cerebral Palsy

OBJECTIVE: This study assessed the difference in the foot progression angle and measure spatiotemporal parameters of gait of children with diplegic cerebral palsy and to examine the relation among foot progression angle of right and left lower limb and spatiotemporal parameters of gait. DESIGN: Cross-sectional and Correlation study. SUBJECTS: Sixty children with spastic diplegia, aged 5 to 8 years. The participants were categorized into 3 age groups of equivalent number: group A (5 to 6 years), group B (6 to 7 years), as well as group C (7 to 8 years). METHODS: Foot progression angle and spatiotemporal parameters of the gait for both feet were evaluated utilizing a dynamic footprint. RESULTS: a moderate negative significant correlation was noted among left FPA and right step length, and right stride length. There was moderate positive significant correlation among left FPA and cadence . A weak non-significant correlation was observed among right and left FPA and gait parameters among three groups. CONCLUSION: foot progression angle assessment and spatiotemporal measurements and the correlation among them can give objective and quantitative data that could be utilized in rehabilitation and clinical evaluations to identify functional deficiencies.

Epilepsy in Cerebral Palsy: Unraveling Prevalence, Risk Factors, and Subtype Associations in a Large-Scale Population Study.

Background and Objective: Cerebral palsy (CP) constitutes a group of enduring movement disorders arising from non-progressive brain damage, often accompanied by epilepsy. This study aims to explore the prevalence of epilepsy in CP patients, dissecting demographic characteristics, healthcare parameters, and nuanced risk factors. Materials and Methods: The study employed the National Inpatient Sample (NIS) database (2016-2019, four years). CP patients were identified through ICD-10 codes, excluding non-CP patients and those with missing values. Baseline characteristics of CP patients, such as age, subtype distribution, and types of epilepsy, were tabulated, and disparities were assessed using the chi-squared test. Univariate and multivariate logistic regression analyses were conducted to examine predictors of epilepsy according to CP subtypes and infant-related conditions. Data were presented as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results: In this comprehensive analysis of 88,138 CP patients, 44,901 with epilepsy and 43,237 without epilepsy, disparities between those with and without epilepsy were uncovered, revealing distinct demographic patterns and healthcare characteristics. Spastic diplegic CP showed the strongest association with epilepsy (adjusted OR = 1.88, 95% CI [1.73-2.04], p < 0.0001), underscoring the significance of subtype-specific considerations. Perinatal infection emerged as a noteworthy risk factor for epilepsy development (adjusted OR = 1.61, 95% CI [1.17-2.23], p = 0.004). Conclusions: The study provides nuanced insights into the prevalence and associations of epilepsy in CP patients. Specific CP subtypes and perinatal factors play pivotal roles in epilepsy risk. These findings offer a foundation for tailored clinical management and support services, addressing the complex needs of individuals with CP and epilepsy.

Novel GNB1 Variant and the Development of Spastic Diplegic Cerebral Palsy.

Novel GNB1 Variant and the Development of Spastic Diplegic Cerebral Palsy.

Effect of adapted dance program on gait in adults with cerebral palsy: a pilot study.

The gait function in adults with cerebral palsy (CP) deteriorates rapidly with age. Dance has been used as an effective intervention to improve balance, postural control, and gait. This study aimed to investigate the feasibility and effects of an adapted dance program (ADP) on the gait in adults with CP. The ADP, which consists of floor and barre workouts, was designed to be adapted for individuals with CP. Ten female adults with spastic diplegic CP (mean age 52.3 ± 6.34, Gross Motor Function Classification System level II) participated in this study. Outcome measures, examined using 3D gait analysis, included spatiotemporal gait parameters and the Gait Deviation Index (GDI) based on nine kinematic variables in all planes of motion. To assess feasibility, we conducted post-questionnaires and a group interview. The ADP, each lasting 90 min, was held twice per week for 12 weeks. A statistically significant improvement was observed in GDI (Δ5.74 points, p = 0.014), with a large effect size (d = 0.76). Foot off (Δ-0.72%), first double support (Δ-0.2%), second double support (Δ1.5%), and single support (Δ0.64%) showed no significant differences. Step length (Δ1.48 cm), cadence (Δ3.95 steps/min), and walking speed (Δ6.41 cm/s) tended to increase, though the differences were not statistically significant. Participants expressed high levels of physical and emotional satisfaction, suggesting a need for early intervention. The ADP may improve gait patterns in adults with spastic diplegic CP. The feasibility results indicated that the ADP is suitable for adults with spastic diplegic CP. This study provides evidence for improvement in gait patterns through dance, which has not been reported in previous dance studies on individuals with CP, offering additional information on the benefits of dance.

Exploratory Investigation of Head Stability in Children with Cerebral Palsy and Typically Developing Children during a Targeted Stepping Task

Children with cerebral palsy (CP) exhibit head instability during simple overground walking, which may comprise sensory input and reduce stepping accuracy. Investigations of head stability during more challenging tasks, where fall risk may be increased, are limited. This study explored differences in head stability between ambulatory children with hemiplegic CP (N = 9) and diplegia (N = 9) (GMFCS I and II) and typically developing (TD) children (N = 8) during a targeted stepping task. All children completed five trials stepping into two successive rectangular floor-based targets whilst walking along an 8 m walkway. Three-dimensional motion capture enabled calculation of head stability and foot placement within and before each target. A two-way mixed-design ANOVA compared differences between all groups and target approach. Children with diplegic CP showed greater sagittal, frontal, and resultant head-to-laboratory and head-to-trunk head instability compared to children with hemiplegic CP and TD children. Anteroposterior foot placement error was significantly greater in children with hemiplegic CP (8.5 ± 5.0 cm) compared to TD children (3.8 ± 1.5 cm). Group differences in head instability were not consistent with group differences in foot placement error. To better understand how head instability might affect fall risk in children with CP, more challenging environments should be tested in future.

The effect of chiropractic spinal manipulation on the H-reflex and muscle strength in children with cerebral palsy: A feasibility study

Background Children with cerebral palsy (CP) have deficits in various aspects of motor control, including motor neuron excitability, which can affect muscle strength, gait, and ability to perform activities of daily living. Previous research on chiropractic spinal manipulation in healthy adults, athletes, and a brain-injured population has indicated improvements in motor neuron excitability, muscle strength, and various aspects of motor control. Thus, chiropractic spinal manipulation may improve motor control in children with CP. Methods Children with spastic diplegic CP, aged 8-13 years, were recruited for a randomized, controlled feasibility study. Feasibility was assessed in terms of recruitment strategy and rate, data collection procedures, equipment, intervention, and compliance. Results Three children completed the data collection comprising pre- and post-measurements of the H reflex, V-wave, and muscle strength. The recruitment strategy and rate were not feasible. The data collection procedures were appropriate and complied with, except for the V-wave measurements. The H-reflex threshold decreased and s50 and slope increased in the participants who received chiropractic spinal manipulation; the opposite was seen in the control group. The changes in MVC force were inconsistent between subjects. Conclusion This study answered some important feasibility questions regarding conducting a large-scale randomized controlled study with the same design. Some aspects proved feasible, such as H-reflex recordings, and some aspects, such as recruitment methods and V-wave recordings, need to be altered for future research in this area.

The Effect of Rood's Ontogenic Motor Patterns on Trunk Control and Balance in Spastic Diplegic Cerebral Palsy Children

Background: Cerebral palsy (CP) is a non-progressive neuromotor disorder affecting movement, muscle tone, and posture due to brain injury during early development. Effective interventions are essential for improving functional outcomes in children with spastic diplegic CP.Objective: This study aimed to evaluate the effects of Rood's Ontogenic Motor Patterns (ROMP) on trunk control and balance in children with spastic diplegic cerebral palsy.Methods: A single-blinded randomized clinical trial was conducted with 22 children aged 3-10 years, diagnosed with spastic diplegic CP. Participants were randomly assigned to two groups: Group A received Functional Electrical Stimulation with ROMP, and Group B received conventional physical therapy. The intervention lasted five weeks, with three sessions per week. Outcomes were assessed using the Modified Ashworth Scale, Gross Motor Function Measurement Scale (GMFM-88), and Pediatric Berg Balance Scale. Data were analyzed using SPSS 27.Results: Group A showed significant improvement in balance (PBBS: pre 13.81 ± 1.64, post 24.18 ± 4.67; p=0.017) and GMFM-88 scores (pre 9.95 ± 109.50, post 15.73 ± 173.0; p&lt;0.001). Spasticity reduced significantly in the ROMP group (MAS: pre 11.50 ± 126.50, post 7.30 ± 73.00; p=0.010).Conclusion: ROMP significantly improved balance and reduced spasticity in children with spastic diplegic CP compared to conventional therapy, suggesting its potential integration into rehabilitation programs.

A - 75 Clarifying the Complex: International Adoptees as Exemplars of Culturally-Informed Neuropsychological Assessment

Abstract Objective School-age international adoptees are underrepresented in the literature despite their unique cultural, linguistic, and academic experiences. The lack of representative norms paired with reduced cultural exposure in the United States requires special consideration from the neuropsychologist. This case report of an internationally adopted child with cerebral palsy illuminates the varying responsiveness of measures to changing levels of acculturation, language acquisition, and educational intervention. Method Patient was adopted at age 10 from China. He experienced lifelong institutionalization and limited formal education; he was illiterate at time of adoption. Brain MRI was consistent with his diagnosis of diplegic cerebral palsy (GMFCS Level I). Beginning approximately one year after adoption, he underwent three neuropsychological evaluations over five years. Testing accommodations to support language, behavior, and executive functioning were provided across evaluations. Results Patient’s initial neuropsychological evaluation demonstrated below age expectation performance across nearly all domains of cognitive functioning. Subsequent evaluations evidenced notable improvements across language, memory, mood, behavior, and adaptive functioning, with many areas revealing age appropriate abilities. Improvements across domains commonly affected by cerebral palsy were more limited, and academics were a longstanding, refractory area of difficulty. Conclusions Traditional administration and interpretation of neuropsychological measures can have difficulty characterizing the cognitive skills of medically involved, international adoptees. Thoughtful measure selection, administration, and interpretation are needed to differentiate underlying ability from performance. Interpreting assessment data can be challenging due to dynamic levels of language acquisition, academic proficiency, and acculturation. Rate of skill acquisition/development across multiple evaluations may be a better indicator of underlying ability than normative comparisons.

Postural Stability in Children with Cerebral Palsy.

Background: A lack of postural control is one of the key problems in children with cerebral palsy (CP). The goals of the present study were to assess static postural stability in children with mild CP using a force platform compared to that of typically developing peers and to identify differences in static stability between children with hemiplegic and diplegic CP. Methods: This study included 45 children with hemiplegic CP and 45 children with well-functioning diplegic CP (Gross Motor Function Classification System; GMFCS scores between I and II) who were patients of local paediatric rehabilitation centres. The testing procedure included two interrelated parts: (1) the analysis of the body weight distribution and (2) the posturometric test (the centre of pressure; CoP measurements) using the force platform. Results: The results of the present study show that children with CP, compared to their TD peers, demonstrated significantly higher values for all of the analysed indexes of postural stability. The obtained results indicate differences in disorders of static postural stability between children with hemiplegic and diplegic CP. Compared to their TD peers, children with hemiplegic CP showed greater body weight asymmetry between the affected and unaffected sides of the body and greater CoP sway in the medial-lateral direction. In contrast, children with diplegic CP exhibited greater CoP displacements in the anterior-posterior direction. Conclusions: The findings of the present study show that (1) children with CP have increased static postural instability compared to their TD peers and (2) children with diplegic CP exhibit weaker mediolateral stability in standing, whereas children with hemiplegic CP show reduced anterior-posterior stability.

Effectiveness of Multidisciplinary Physiotherapeutic exercise on the patients with Spastic Diplegic Cerebral Palsy

Effectiveness of Multidisciplinary Physiotherapeutic exercise on the patients with Spastic Diplegic Cerebral Palsy

Effect of Foot Posture on Limits of Stability in Children With Spastic Diplegic Cerebral Palsy.

Cerebral palsy (CP) is a neurological condition that affects musculoskeletal system causing altered balance control, which is governed by constant adjustments by muscular activity and joint positioning. Since the foot is the platform upon which we stand and balance, it is important to study and characterize foot posture abnormalities in CP to better understand their possible effect on multidirectional limits of stability (MDLS) in standing. Our aim was to find relation between foot posture and MDLS in diplegic children. Thirty diplegics (13 pes-planus and 17 pes-cavus) between the age of 6 to 14, gross motor function classification system (GMFCS) levels I and II, whose parents consented were included in this study. Diplegics unable to stand unsupported for < 2 minutes, undergone lower-limb surgeries in 6 months, having visual impairments were excluded. Foot posture was assessed with arch index, MDLS were measured by GEAMASTER stabilometer. There was significant positive correlation between foot posture and limits of stability. Diplegic children having pes-planus have better MDLS as compared with pes-cavus.

Combined effects of functional task training with electrical stimulation on motor abilities and balance in children with diplegia

BackgroundChildren with spastic diplegic cerebral palsy (CP) often demonstrate gluteus medius weakness that causes balance deficits and frequent falling during walking.PurposeThe aim of the study was to evaluate the combined effects of functional task training with electrical stimulation of bilateral hip abductor muscles on motor abilities (standing and walking) and balance in children with spastic diplegic CP.MethodsThirty children with diplegic CP of both sexes whose ages ranged from 7 to 10 years were assigned randomly into two equal groups. For both groups, motor abilities were assessed by gross motor function measure (GMFM), and balance (static and dynamic) was assessed by the humac balance system before and after the study. The control group received a functional training program focusing on standing walking and balance exercises. While children in the study group received the same functional training program with bilateral electrical stimulation of gluteus medius muscles for 50 min. The treatment program for both groups was conducted for 3 sessions/week for 8 weeks.ResultsThere were statistically significant differences between the control and study group post-treatment in GMFM as well as the center of pressure test and weight shift test in favor of the study group (p < 0.05).ConclusionUsing functional task training with electrical stimulation for treatment of children with spastic diplegic CP have significant effects on improving their motor abilities and balance that suggests using it in rehabilitation for these children.

Retrograde Insertion Approach for Anterior Distal Femoral Hemiepiphysiodesis Procedure: A Case Report.

A 13-year-old adolescent boy with spastic diplegic cerebral palsy (CP) presented with crouch gait and bilateral knee flexion contractures (KFCs). After failure of conservative treatments, the patient was referred to orthopaedics for surgical intervention. Anterior distal femoral hemiepiphysiodesis (ADFH), using a retrograde approach, and Strayer gastrocnemius recession were performed bilaterally. No complications were reported during surgery/follow-up. Full-active knee extension and improved gait were achieved. KFC is prevalent in ambulatory patients with CP, reducing gait function. Retrograde ADFH is an effective surgical intervention to reduce KFC and improve gait, and offers simpler insertion/removal than the traditional antegrade technique.

The effects of ankle mulligan mobilisation in children with cerebral palsy: A randomized single blind control study.

To assess the impact of range of motion changes before and after Mulligan mobilisation with ankle movement interventions on the daily lives of children with diplegic cerebral palsy. The single blind randomised controlled study was conducted from July 30, 2022, to January 10, 2023, at 3 rehabilitation centres in Hebron, Palestine, after approval from the ethics review committee of Eastern Mediterranean University, Northern Cyprus, and comprised children with cerebral palsy, who were randomised into intervention group IG and control group CG. All the subjects received regular physiotherapy sessions, overseen by their parents, while those in group IG received mobilisation with ankle movement treatment 3 times per week for 4 weeks. Post-intervention assessment of ankle range of motion, balance, functional performance and quality of life was done using a goniometer, the timed up and go test, 88-item gross motor function measure, 6-minute walk test and the cerebral palsy quality of life questionnaire. Data was analysed using SPSS 24. Of the 64 patients, 40(63%) were girls, and 24(37%) were boys. The overall age range was aged 4-12 years. There were 32(50%) patients in each of the two groups. Mobilisation with movement had a significant effect on active and passive range of motion for the left and right ankles (p<0.05) as well as on balance, gross motor function and quality of life (p>0.05). However, mobilisation with movement had no significant effect on the the distance covered during the 6-minute walk test (p>0.05). Mobilisation with movement had a significant impact on active and passive ankle range of motion, balance and quality of life in diplegic children with cerebral palsy, but it had no impact on gait function. The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05500924.

Effectiveness of Neurodevelopmental Therapy with Conventional Physiotherapy on Gross Motor Function and Spasticity in Spastic Diplegic Cerebral Palsy Children

Effectiveness of Neurodevelopmental Therapy with Conventional Physiotherapy on Gross Motor Function and Spasticity in Spastic Diplegic Cerebral Palsy Children

Differences in pulmonary function between diplegic and hemiplegic spastic cerebral palsy children

Differences in pulmonary function between diplegic and hemiplegic spastic cerebral palsy children

Cerebral Palsy Phenotypes in Genetic Epilepsies

BackgroundAlthough there are established connections between genetic epilepsies and neurodevelopmental disorders like intellectual disability, the presence of cerebral palsy (CP) in genetic epilepsies is undercharacterized. We performed a retrospective chart review evaluating the motor phenotype of patients with genetic epilepsies. MethodsPatients were ascertained through a research exome sequencing study to identify genetic causes of epilepsy. We analyzed data from the first 100 individuals with molecular diagnoses. We determined motor phenotype by reviewing medical records for muscle tone and motor function data. We characterized patients according to CP subtypes: spastic diplegic, spastic quadriplegic, spastic hemiplegic, dyskinetic, hypotonic-ataxic. ResultsOf 100 individuals with genetic epilepsies, 14% had evidence of possible CP, including 5% characterized as hypotonic-ataxic CP, 5% spastic quadriplegic CP, 3% spastic diplegic CP, and 1% hemiplegic CP. Presence of CP did not correlate with seizure onset age (P = 0.63) or seizure control (P = 0.07). CP occurred in 11% (n = 3 of 27) with focal epilepsy, 9% (n = 5 of 54) with generalized epilepsy, and 32% (n = 6 of 19) with combined focal/generalized epilepsy (P = 0.06). ConclusionsIn this retrospective analysis of patients with genetic epilepsies, we identified a substantial portion with CP phenotypes, representing an under-recognized comorbidity. These findings underscore the many neurodevelopmental features associated with neurogenetic conditions, regardless of the feature for which they were ascertained for sequencing. Detailed motor phenotyping is needed to determine the prevalence of CP and its subtypes among genetic epilepsies. These motor phenotypes require clinical management and represent important targeted outcomes in trials for patients with genetic epilepsies.