Level Of Gross Motor Function Research Articles

A Cross-Sectional Study Examining the Relationship Between Malnutrition and Gross Motor Function in Cerebral Palsy.

Introduction Cerebral palsy (CP) characterizes a range of permanent, nonprogressive symptoms of postural and motor dysfunction caused by an insult to the developing central nervous system in a fetus or an infant. CP manifests early in life, often within the first two to three years of age. CP is associated with poor growth, that is the deviation from the normal growth parameters. The prevalence of CP ranges from 2.0 to 3.5 per 1000 live births in high-income countries which is comparable to the estimates from low-income countries. Antenatal and perinatal insults are among the most commonly reported causes of CP; however, a large number of cases do not have an identifiable etiology of CP. The current study aims to examine the relationship between malnutrition and gross motor function in children with CP. Materials and Methods This study was conducted at the Department of Pediatrics and Neonatology, Nehru Hospital, Baba Raghav Das (BRD) Medical College, Gorakhpur (UP) over a period of one year (August 2020 to July 2021) after obtaining ethical clearance from the College Research Council. Children of age 1-15 years with CPattending the pediatric outpatient and inpatient departmentswere enrolled as the study participants after obtaining informed consent from a legal guardian. Assessment of motor function was done using the gross motor function classification system (GMFCS). Associations of malnutrition across levels of gross motor function were tested using Chi-square or Fisher's exact test whichever was applicable. Statistical significance was set at p< 0.05 as significant. Data was analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Result We analyzed 110 children with a diagnosis of CP (median age 6.5 years, interquartile range (IQR) 4.4-9.0 years). The majority (65/110; 59%) of the patients were male, and 68 (61.8%) delivered at term gestation. The most common presenting symptom among children with CP was seizures (79/110; 72.3%), the second most common being delayed milestones among 73 (66.8%), followed by difficulty in breathing among 63 (57.5%). The association between the anthropometric index of participants and GMFCS was found to be highly significant. Conclusion Most CP patients were facing gross motor disturbances. Spastic type of CP was most frequent, and more than half of the patients experienced feeding difficulty. A statistically significant association was found between gross motor functioning and the prevalence of malnutrition and stunting.

Longitudinal trajectory of medial gastrocnemius muscle growth in the first years of life.

To define the longitudinal trajectory of gastrocnemius muscle growth in 6- to 36-month-old children with and without spastic cerebral palsy (SCP) and to compare trajectories by levels of gross motor function (Gross Motor Function Classification System, GMFCS) and presumed brain-lesion timing. Twenty typically developing children and 24 children with SCP (GMFCS levels I-II/III-IV = 15/9), were included (28/16 females/males; mean age at first scan 15.4 months [standard deviation 4.93, range 6.24-23.8]). Three-dimensional freehand ultrasound was used to repeatedly assess muscle volume, length, and cross-sectional area (CSA), resulting in 138 assessments (mean interval 7.9 months). Brain lesion timing was evaluated with magnetic resonance imaging classification. Linear mixed-effects models defined growth rates, adjusted for GMFCS levels and presumed brain-lesion timing. At age 12 months, children with SCP showed smaller morphological muscle size than typically developing children (5.8 mL vs 9.8 mL, p < 0.001), while subsequently no differences in muscle growth were found between children with and without SCP (muscle volume: 0.65 mL/month vs 0.74 mL/month). However, muscle volume and CSA growth rates were lower in children classified in GMFCS levels III and IV than typically developing children and those classified in GMFCS levels I and II, with differences ranging from -56% to -70% (p < 0.001). Muscle growth is already hampered during infancy in SCP. Muscle size growth further reduces with decreasing functional levels, independently from the brain lesion. Early monitoring of muscle growth combined with early intervention is needed.

Factors Associated With Short-Term Recovery Following Single-Event Multilevel Surgery for Children With Cerebral Palsy

To examine the role of multiple factors, including therapy dose, on recovery of mobility function during post-single-event multilevel surgery (SEMLS) rehabilitation in youth with cerebral palsy. Several factors expected to influence postoperative change in Gross Motor Function Measure (GMFM) were examined: age, Gross Motor Function Classification System (GMFCS) level, cognition, number of osteotomies, surgical complications, medical comorbidities, number of therapy sessions, and preoperative measures of gait, balance, and gross motor function. Sixty-nine youth with cerebral palsy, GMFSC levels I-IV, who had undergone SEMLS and rehabilitation had on average 2.6 osteotomies and 89 postoperative therapy sessions. Fewer osteotomies, higher therapy dose, higher preoperative GMFM, and lower GMFM at postoperative admission were significant in determining GMFM change. The most relevant factors on post-SEMLS recovery were therapy dose, surgical burden, and level of gross motor function immediately before and after surgery.

Relationship Between Gross Motor Function and Nutritional Status in Children with Cerebral Palsy attending a Tertiary Children’s Hospital of Nepal

Introduction: Malnutrition is a common problem in children with cerebral palsy and their management outcome is not satisfactory unless we address their nutritional aspect. The present study aims to find the relationship between gross motor function and nutritional status in these children by comparing the proportion of stunting, wasting and under-weight between the various levels of gross motor function. Methods: Our study was across- sectional study conducted on 82 cases of cerebral palsy between one to five years of age visiting Kanti Children’s Hospital, Kathmandu, Nepal from May 2017 to September 2018. Their level of gross motor function was ascertained by applying the Gross Motor Function Classification System (GMFCS) and anthropometry was done using standard methods. On the basis of their motor function, the children were divided into two categories: those with poorer motor function who had poor self-mobility even with assistance (GMFCS level 4 and 5) and those with better motor function who had self-mobility with various degrees of assistance (GMFCS level 1, 2 and 3). Wasting, stunting and under-weight were compared between the two categories and odds ratio with 95% confidence interval was estimated for malnutrition. Results: The children belonging to poorer motor function were more likely to be underweight (Odds ratio 3.41; CI 1.36-8.52; p-value 0.008) and stunted (Odds ratio 3.9; CI 1.47-10.53; p-value 0.048) than those with better motor function. Conclusions: Children with poorer motor function are more likely to develop malnutrition (Specially stunting) than those with better motor function indicating that chronic form of malnutrition is more common in these children.

Goal-Directed Therapy to Improve Gross Motor Function and the Quality of Life of Children with Cerebral Palsy: A Randomized Controlled Trial

Background: The multiplicity of interventions for the treatment of cerebral palsy (CP) can cause confusion about which are most suited to certain individuals. Hypothesis is that goal-directed therapy (GDT) can guide integrating therapies to improve clinical outcomes compared with conventional therapy (CT).&#x0D; Method: A prospective, assessor-blinded, randomized controlled trial was done with 23 children with CP (mean age, 4 years 4 months old; SD 1y4mo), who were divided into groups according to their level of gross motor function: GDT and CT. Both groups received 12 physiotherapy (PT) sessions and advice on daily home programs. The GDT group additionally had a team meeting to set a specific goal, and PT programs were shaped toward that goal. Assessments were done at baseline and after treatments, using the Thai-version Gross Motor Function Measure (GMFM-66), CP-Quality of Life (CP-QOL), caregiver burden, and home program compliance.&#x0D; Results: After the treatments, the GDT group showed significant improvements in GMFM-66, CP-QOL, and caregiver burden, while the CT group revealed improvements in caregiver burden and some domains of the GMFM, including sitting and crawling &amp; kneeling. Comparisons between groups found GDT was more effective than CT in improving GMFM-66 and CP-QOL. Home program compliance was higher in the GDT (69%) than the CT group (42%).&#x0D; Conclusion: GDT demonstrated clear gains for children with CP regarding gross motor function and QOL improvements. Team communication toward a customized goal was crucial, empowering the children and their caregivers to comply with home programs to achieve the set goal.

Analysis of Social Skills and Functional Characteristics of Adolescents with Cerebral Palsy

Abstract This study aims to describe the repertoire of adolescents with cerebral palsy in relation to social skills and to characterize their levels of gross motor function, communication, and functional activities. As an analytical observational study, 15 adolescents with cerebral palsy participated: five with articulated speech and ten without articulated speech. The instruments used were Identification Form; Social Skills Inventory for Students Without Articulated Speech; Social Skills Inventory for Adolescents; Expanded and Revised Gross Motor Function Classification System; Communication Function Classification System; and Pediatric Evaluation Disability Inventory Computer Adaptive Test - Adapted Brazilian Version. With quantitative and qualitative descriptive analysis, the results did not indicate a significant difference in the total score between groups, but the participants showed developmental deficits. Adolescents without articulated speech are more motor and communicatively compromised. Studies like this can contribute to the production of knowledge in the fields of Psychology, Special Education, and Social Skills.

Effects of minimally invasive surgery and functional physiotherapy on motor function of children with cerebral palsy: A non-randomised controlled trial

PurposeThis non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). MethodsFifty-two children with spastic CP aged 5–7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. ResultsThere was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). ConclusionSPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.

Postural asymmetries, pain, and ability to change position of children with cerebral palsy in sitting and supine: a cross-sectional study

Purpose To examine any associations between postural asymmetries, postural ability, and pain for children with cerebral palsy in sitting and supine positions. Methods A cross-sectional study of 2,735 children with cerebral palsy, 0-18 years old, reported into the Swedish CPUP registry. Postural asymmetries, postural ability, the gross motor function classification system levels I–V, sex, age and report of pain were used to determine any relationship between these variables. Results Over half the children had postural asymmetries in sitting (n = 1,646; 60.2%) or supine (n = 1,467; 53.6%). These increased with age and as motor function decreased. Children were twice as likely to have pain if they had an asymmetric posture (OR 2.1–2.7), regardless of age, sex and motor function. Children unable to maintain or change position independently were at higher risk for postural asymmetries in both supine (OR 2.6–7.8) and sitting positions (OR 1.5–4.2). Conclusions An association was found between having an asymmetric posture and ability to change position in sitting and/or lying; and with pain. The results indicate the need to assess posture and provide interventions to address asymmetric posture and pain. Implications for rehabilitation Postural asymmetries are present in children with cerebral palsy at all levels of gross motor function. Postural asymmetries increase with age and are associated with pain. Assessment of posture should be included in surveillance programs to enable early detection and treatment.

Physical workload during caregiving activities and related factors among the caregivers of children with cerebral palsy.

Caregiving demands contribute to both psychological and physical health of caregivers. Physical workload (PW) can be an important cause of musculoskeletal disorders in caregivers of children with cerebral palsy (CP). To investigate PW during caregiving activities and related factors among caregivers of children with CP. Children with CP (n = 291) and their caregivers (n = 291) were recruited for this cross-sectional study. Caregivers were categorized as their child has presence of intellectual disability (ID) and independent walking ability. Gross motor function was assessed using the Gross Motor Function Classification System (GMFCS) in children. PW; presence and distribution of musculoskeletal pain sites; levels of disability of neck, low back, arm, and leg; levels of depressive symptoms; and health-related quality of life (HRQOL) were assessed in caregivers. Significant differences were observed in PW, low back pain-related disability, depressive symptoms, and HRQOL between caregivers of children with and without an ID (p < 0.05). All study variables were significantly different between caregivers of children who can and cannot independently walk (p < 0.05). PW was correlated with caregiver's age, body mass index, lower extremity dysfunction, depressive symptoms, and child's GMFCS level (p < 0.05). Caregivers of a child having an ID and walking disability had higher PW. These caregivers had more problems related to musculoskeletal disorders, higher depressive symptoms, and lower HRQOL. Higher PW was associated with lower level of gross motor function of child and older age, higher body mass index, higher level of lower extremity disfunction and low back pain disability, and lower HRQOL of caregivers.

Independence of young people with cerebral palsy during transition to adulthood: a population-based 3 year follow-up study

AbstractBackgroundThis study describes developmental and service transitions during a 3-year period among young people with cerebral palsy (CP) as measured by the Rotterdam Transition Profile (RTP) and evaluates the test-retest reliability of the RTP. The RTP is a questionnaire developed to classify phases of transition across nine participation domains.MethodsA three-step design was applied: Step I consisted of a translation and test-retest reliability study of the RTP, Step II was a comparison of independence between youth with and without CP and Step III was a follow-up survey of youth with CP describing changes of independence after a 3-year transition period. A sample of 103 typically developing youth were recruited for Steps I and II, and a population-based sample of 76 (response rate = 59%) youth with CP (males = 40) from South-Eastern Norway aged 16–17 years were recruited for Steps II and III. The subtypes of CP were classified as spastic unilateral (n = 30), spastic bilateral (n = 37), dyskinetic (n = 8) and ataxic (n = 1) CP. The levels of gross motor function followed the categories of the Gross Motor Function Classification System (GMFCS) as level I (n = 30), level II (n = 17), level III (n = 6), level IV (n = 8) and level V (n = 15).ResultsTwenty-six participants had epilepsy and 13 had gastrostomy. Forty-four of the youth with CP (response rate = 58%) responded to the 3-year follow-up survey in Step III. The test-retest study of the RTP showed excellent reliability (Kw 0.76–0.93). At baseline (Step II), the reference group was significantly more independent than the youth with CP in all the participation domains. At the 3-year follow-up (Step III), the levels of independence had increased significantly for all the participation domains in the youth with CP except for transportation and leisure. Despite increased independence during the transition period regarding health services, only 25% independently formulated their own care needs or applied for services and assistance at 19–20 years of age. Youth who responded to the RTP by a caregiver proxy more often had a diagnosis of epilepsy and/or gastrostomy and higher GMFCS levels. These individuals were significantly less independent than those who self-reported, both at baseline and at follow-up.ConclusionsIn conclusion, the excellent test-retest results support the use of the RTP as a tool for classifying phases of transition among youth with CP. The youth with CP were significantly less independent than their typically developing peers at baseline, yet increased their independence during a 3-year period. Those who self-reported to the RTP were generally more independent than those who proxy-reported, which supports the need to distinguish between the service needs of subgroups during the transition phase.

Visit to the Disability Integrating Health Post and Its Effect on the Quality of Life of Children with Cerebral Palsy: A Multivariate Evidence from Sukoharjo, Central Java

Background: An assessment of the quality of life of children with cerebral palsy is important to be carried out, as part of the indicators of achiev­ing health service delivery goals. To faci­litate access to health services for children with dis­­abilities, the government of Sukoharjo Dis­trict esta­b­lished an integrated health post (pos­yandu) for children with disabilities called in­clu­sion cen­ters. This study aimed to deter­mine the quality of life of children with cerebral palsy who receive ser­­­vi­ces at the inclusion center. Subjects and Method: his was a cross sec­tional study conducted in 12 inclusion centers in Suko­harjo, Central Java. A sample of 100 child­­ren with cerebral palsy (CP) aged 4-18 years old was selected by fixed disease samp­ling. The depen­dent variable was the quality of life of CP child­ren. The independent variables were the level of gross motor function capa­bility, parental cop­ing, quality service, and freq­uency of pos­yandu visits. Gross motor func­t­ion capability was mea­sured by Gross Motor Funt­ion Classifi­cation Sys­tem (GMFCS). Qua­lity of life was measured by the Cerebral Palsy Qua­lity of Life (CP-QOL) ver­sion of the parent proxy. Data collection used ques­tion­­naire and analyzed by a multiple linear reg­ression run on Stata 13. Results: Better quality of life of children with cereb­ral palsy was influenced by lower GMFCS levels (b= -128.72; 95% CI= -220.34 to -37.10; p= 0.006), good parental coping (b= 18.87; 95% CI= 10.85 to 26.89; p<0.001), good service quality (b= 20.79; 95% CI= 9.99 to 31.59; p<0.001), and more frequent visits to posyandu (b= 214.86; 95% CI= 56.66 to 373.15; p= 0.008). Conclusion: Quality of life of children with cerebral palsy is influenced by lower GMFCS levels, good parental coping, good service qua­lity, and more frequent visits to posyandu. Keywords: quality of life, disability, cerebral palsy, integrating health post (posyandu) Correspondence: Retno Dwi Rohaniyati, Masters Program in Pub­­lic Health, Universitas Sebelas Maret, Jl. Ir. Su­­tami 36A, Surakarta, Central Java, Indo­ne­sia. Email: retnodr16@gmail.com. Mobile: 08­15­4626 8418. Journal of Maternal and Child Health (2020), 5(2): 193-199 https://doi.org/10.26911/thejmch.2020.05.02.09

FEEDING PROBLEMS AT DIFFERENT LEVEL OF GROSS MOTOR FUNCTION IN CHILDREN WITH CEREBRAL PALSY.

Objective: To determine the Association and frequency of feeding problems at different level of Gross Motor Function among Cerebral Palsy children. Methodology: The study design was cross-sectional study; Data was collected from Rising Son and Children Hospital Lahore and completed within 4 months (from March 2019 to July 2019) after approval of synopsis. 41 children, age 2-8 years of age were selected. Data collected using Standardized variables by Nonprobability sampling & analyzed by SPSS-25. Results: Significant association was found between the level of GMFCS and feeding difficulties (Refuse to eat (P=0.007) and takes >20 minutes to finish meal (P=0.047). No Significant association was found between level of GMFCS and feeding difficulties including (food sits in child’s mouth (P=0.788), Child chokes or gags at mealtimes (P=0.723), child’s eats only ground, strained or soft food (P=0.620) and require NG feed (P=0.582)). Feeding problems including difficulty in chewing 26.8%, Choking during meal 29.26%, Takes >20 minutes for meal 68.3%, NG feeds 4.9%. food sits in child’s mouth and does not swallow it 26.83% Occasionally and 24.4% Regularly. 78.0% child’s eats only ground, strained or soft food. 22.05% refuse to eat but requests food immediately after the meal. Conclusion: Significant association was found between level of GMFCS and feeding difficulties (Refuse to eat and takes >20 minutes to finish a meal). No Significant association was found between level of GMFCS and feeding difficulties including (food sits in child’s mouth, Child chokes or gags at mealtimes, child’s eats only ground, strained or soft food and require NG feed). Keywords: Cerebral Palsy, Dysphagia Gross Motor Function Classification System

Effectiveness of exercise interventions for children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials.

ObjectiveThe results of previous research into exercise interventions for children with cerebral palsy are inconsistent. The aim of this study is to assess the effectiveness of such exercise interventions.DesignSystematic review and meta-analysis.MethodsSystematic searches of the PubMed, Embase and Cochrane Library databases for randomized controlled trials involving exercise interventions for children with cerebral palsy, from inception to January 2020, were performed. Pooled weighted mean differences (WMDs) with 95% confidence intervals (95% CI) for gross motor function, gait speed, and muscle strength were calculated using random-effects models.ResultsA final total of 27 trials, including 834 children with cerebral palsy, were selected for quantitative analysis. Exercise interventions had no significant effect on the level of gross motor function (WMD 1.19; 95% CI −1.07 to 3.46; p = 0.302). However, exercise interventions were associated with higher levels of gait speed (WMD 0.05; 95% CI 0.00–0.10; p = 0.032) and muscle strength (WMD 0.92; 95% CI 0.19–1.64; p = 0.013).ConclusionThese results suggest that exercise interventions may have beneficial effects on gait speed and muscle strength, but no significant effect on gross motor function in children with cerebral palsy.LAY ABSTRACTCerebral palsy is the most common cause of physical impairment in children. This study evaluated the effectiveness of exercise interventions for children with cerebral palsy. Exercise interventions were significantly associated with increased gait speed and muscle strength, while gross motor function was not affected. Exercise interventions should therefore be used for children with cerebral palsy.

Pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy

Purpose Investigate pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy compared to references. Materials and methods Young adults with cerebral palsy (n = 97, aged 21–34 years) and age-matched references from the general population (n = 190) rated pain using a numeric rating scale and fatigue, depressive symptoms, sleep disturbance and global health using Patient-Reported Outcomes Measurement Information System® short forms. Scores were compared between cerebral palsy subgroups and the reference population. Correlation coefficients and linear regression analyses assessed interrelationships of health issues and associations with global health. Results Individuals with Gross Motor Function Classification System level I had less pain, fatigue and depressive symptoms, while individuals with levels II and III–V had more pain (53% and 56%, p < 0.001) and those with levels III–V more fatigue (39%, p = 0.035) than references (pain: 26%, fatigue: 14%). Pain and fatigue were more interrelated (correlation coefficients: 0.71 vs. 0.41) and stronger associated with global mental health in individuals with cerebral palsy. Conclusions Young adults with Gross Motor Function Classification System levels II–V report more pain and those with levels III–V report more fatigue than references. Pain and fatigue are highly interrelated and specifically relate to mental health in individuals with cerebral palsy. Implications for rehabilitation Except for those in the highest level of motor function, young adults with cerebral palsy report higher levels of pain and fatigue compared to the general population of the same age. Pain and fatigue are strongly interrelated and associated with mental health in young adults with cerebral palsy. The present study recommends to monitor pain and fatigue in young adults with cerebral palsy with low levels of gross motor function. We advise rehabilitation professionals to consider combined treatment for both pain and fatigue.

Impact of Physiotherapy Treatment in Children with Cerebral Palsy Aged Between 6 Months to 5 Years

Background: Cerebral Palsy has various structural and functional impairments which can lead to inability to walk, move independently which impairs their overall growth and development physiotherapy treatment in these subjects is a routine practice. Its applicability and outcomes is still an upcoming research area. This treatment has a longer duration of application for better outcomes. It is a big challenge for parents to do so due to many reasons. The impact of physiotherapy should be found out for all the age groups irrespective of their pathology and presentations. This study is an effort to do so. Objective: 1. To study the types of cerebral palsy. 2. To assess the children with cerebral palsy. 3. To study the impact of physiotherapy on levels of gross motor function in children with cerebral palsy. Method: Ethical Clearance was obtained from the Institutional ethical committee. 64 cerebral palsy children were selected aged between 6 months to 5 years divided in 3 groups according to their age both girls and boys were selected. They were assessed using Gross Motor Function Classification System scale which was recorded for a duration of 3 months. According to which conclusion was derived with appropriate statistical method. Result: Group A shows maximum in level IV,Group B shows maximum in level I and II and Group C shows maximum in level III. Conclusion: We found that level of Gross Motor Function was improved in the age group of 2 to 4 years and above when compared with age below 2 years after receiving physiotherapy treatment.

Transition-Age Young Adults with Cerebral Palsy: Level of Participation and the Influencing Factors.

Background and Objectives: The aim of this study was to identify the level of participation in the context of the developmental transition from adolescence to adult life for young adults with cerebral palsy (CP) and the factors that had an influence on participation. Materials and Methods: Eighty-one young adults (16–21 years old) with CP and with normal or slightly decreased cognitive function participated in this study. Assessments were made using the Rotterdam Transition Profile (RTP) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). In the binary regression model, levels of participation (RTP scores) were set as dependents and the level of disability (WHODAS 2.0 scores), age, and level of gross motor function were set as independent variables. Results: In the age group <18 years, in three out of seven RTP domains, less than 10% of participants were in phase 2 (experimenting and orientating toward the future), i.e., finance—7%, housing—7%, sexuality—4%. In the age group ≥18 years, 21% (education and employment), 56% (intimate relationships), and 59% (sexuality) of the participants were in phase 0 (no experience). Higher scores in WHODAS 2.0 domains showed positive associations with RTP domains, i.e., cognition with social activities, mobility with transportation, self-care with sexuality and transportation, and life activities with transportation. Age was positively associated with education and employment, finance, housing, and sexuality. Low motor function according to the Gross Motor Function Classification System (GMFCS) had negative associations with autonomy in social activities, sexuality, and transportation. Conclusions: Young adults with cerebral palsy showed low levels of autonomy in all domains of participation. When addressing a person’s improvement in terms of their participation, the promotion of abilities in cognition, mobility, self-care, and life activities should be attempted. Age and gross motor function influenced autonomy in participation, but not in all domains.

Bone mineral density in comparison to anthropometric parameters and level of gross motor function in children with cerebral palsy

Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification system- expanded and revised (GMFCS-E&amp;R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults &amp; Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 ? 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&amp;R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score -1.60 ? 1.40 standard devation (SD); hip Z-score -2.00 ? 3.00 SD], as well as lower anthropometric parameters [height Z-score -2.74 ? 4.28; body weight Z-score - 3.22 ? 6.96; body mass index (BMI) Z-score -2.64 ? 6.03]. In the observed sample, bone mineral density in the spine (p &lt; 0.01) and the hip (p &lt; 0.05) was reduced in all subjects, and all children had a lower body weight (p &lt; 0.01) and the BMI (p &lt; 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&amp;R had a significantly lower bone density (spinal Z-score -1.90 SD; hip Z-score -3.40 SD), with the reduction even more pronounced at level V (spinal Z-score -3.80 SD; hip Z-score -2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&amp;R levels IV and V) had significantly lower bone mineral density.

Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica.

Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated.

The severity of chewing disorders is related to gross motor function and trunk control in children with cerebral palsy

Purpose: The frequency of chewing disorders increases with decreasing level of gross motor function in children with cerebral palsy (CP). Besides its frequency, the severity of chewing disorders is also important. The aim of this study was to determine the relationship between chewing performance level and gross motor function, and trunk postural control in children with CP.Materials and methods: The study included 119 children with CP (age 2–10 years). Chewing performance level was determined by the Karaduman Chewing Performance Scale (KCPS). The Gross Motor Function Classification System (GMFCS) was used to determine the level of gross motor function. Segmental Assessment of Trunk Control (SATCo) was used to measure trunk control.Results: Children with spastic CP with a median age of 4 years were evaluated, of which 50.4% were male. The percentages of patients classified to GMFCS levels I to V were 43.7%, 6.7%, 9.2%, 5.0%, and 35.3%, respectively. The median KCPS score was 3 (min = 0, max = 4). A good correlation was found between KCPS and GMFCS (p < .001, r = 0.70). Negative, excellent correlations between KCPS and SATCo static, SATCo active, and SATCo reactive postural controls were found (p < .001, r = –0.75, r = –0.77, r = –0.79; respectively).Conclusions: The severity of chewing disorders is related to the level of gross motor function and trunk postural control in children with CP.Clinical trial number: NCT03241160

Incidence of scoliosis in cerebral palsy

Background and purpose — Surveillance of scoliosis in individuals with cerebral palsy (CP) is important for ensuring timely diagnosis and identification of curve progression. We analyzed the incidence of scoliosis in relation to age, sex, and gross motor function in a population-based cohort of individuals with CP.Patients and methods — This was a prospective register study of all 1,025 individuals born 1990–2012 in southern Sweden (1.4 million inhabitants) in the Swedish surveillance program for CP, which included >95% of the total population of people with CP in the area. Annual clinical examinations and radiographic measurement of the Cobb angle of those with a moderate or severe scoliosis were registered. We determined the incidence of scoliosis related to age, sex, and the Gross Motor Function Classification System (GMFCS) level.Results — The inclusion criteria were fulfilled by 962 individuals. The number of people (140/962) with scoliosis increased up to 20–25 years of age. The incidence of scoliosis was related to age and GMFCS level. In individuals at the lowest level of gross motor function (GMFCS V) scoliosis was seen in 10/131 before 5 years of age and at the age of 20 years 75% of these individuals had a Cobb angle ≥40°. No one in the highest level of motor function (GMFCS I) developed a Cobb angle ≥40°Interpretation — Surveillance programs for scoliosis in CP should be based on age and GMFCS level and should be initiated at a young age and continued into adulthood.