Motor Disorders Of Cerebral Palsy Research Articles

Cerebral Palsy: Opinions on Development, Occurrence, Presentation and Management

Cerebral palsy (CP) is the most common childhood disability affecting motor function as a result of injury to the underdeveloped brain, occurring in 2-3 children in every 1000 live births. However, CP as a disease is been studied well, and understood by the pathologist, general physicians, researchers, obstetricians, and paediatricians. The motor disorders of cerebral palsy are often associated with disturbances of sensation, perception, cognition, communication, and behaviour, epilepsy, and secondary musculoskeletal problems. There are multiple risk factors have been identified for CP in the last decade, likely; premature birth (before 37 weeks) and low birth weight (less than 2.7 KG) these. two are most classically associated with CP. Others include the mother’s systemic illness, substance abuse, maternal undernutrition, Gestational diabetes, excessive bleeding per vagina, and preeclampsia, along with multiple gestations, C-section, vacuum-assisted delivery, forceps delivery, post-term delivery, induction of labour, obstructed labour, asphyxia, etc. When considered to be a movement disorder, it can be classified as spastic, dyskinetic, or ataxic. When considering the area of presentation, it can be quadriplegic, hemiplegic, diplegic, and monoplegic. Hypertonicity of the muscles is the most common symptom along with other motor issues such as impaired balance, coordination, and hand function. periventricular leukomalacia is the most common neurological finding seen. Keeping cognizance of the impairment these symptoms can cause to the independent functioning of the child in society, early diagnosis is extremely important.

Multiple motor disorders in cerebral palsy.

To characterize motor disorders in children and young people with cerebral palsy (CP). This was a cross-sectional study of 582 children and young people with CP (mean age 9 years 7 months; range 11 months-19 years 9 months; standard deviation 4 years 11 months; 340 males) attending a rehabilitation clinic at a specialized children's hospital (May 2018-March 2020). Data on motor disorders, topography, functional classifications, and non-motor features, such as epilepsy, intellectual disability, and sensory impairments, were collected using the Australian Cerebral Palsy Register CP Description Form. Fifty-five per cent (n = 321) of children and young people with CP presented with multiple motor disorders, often affecting the same limb(s). The most common motor disorders were spasticity and dystonia (50%), spasticity only (36%), and dystonia only (6%), but 18 different combinations were identified, including choreoathetosis, ataxia, and generalized hypotonia with increased reflexes. Children with spasticity only had less severe functional deficits (p < 0.001) and lower rates of associatedintellectual disability (p < 0.01) and epilepsy (p < 0.001) than those with both spasticity and dystonia. Multiple motor disorders in children and young people with CP are common and associated with more severe functional impairment. Accurate assessment of motor disorders is essential to guide prognosis and ensure personalized evidence-based interventions. More than half of children and young people with cerebral palsy presented with multiple motor disorders. Dystonia was identified in 60% of study participants. Dystonia was associated with more severe functional impairments and rates of non-motor features.

Responses to Sensory Events in Daily Life in Children with Cerebral Palsy from a Parent Reported Perspective and in a Swedish Context.

The motor disorders of cerebral palsy (CP) are often accompanied by sensory disturbances, but knowledge of their relationship to motor functioning is sparse. This study explored responses to sensory events in relation to spastic subtype and motor functioning in children with CP. Parents of 60 children with CP (unilateral: 18, bilateral: 42) with GMFCS levels I:29, II:13, III:15 and IV:3 of mean age 12.3 years (3.7 SD) participated. The parents (n = 55) rated their children´s responses with the norm-referenced questionnaire Child Sensory Profile-2© (CSP-2©), Swedish version, incorporating nine sections and four sensory processing patterns/quadrants, and replied (n = 57) to two additional questions. On the CSP-2©, thirty (55%) of the children were reported to have responses "much more than others" (>2 SD) in one or more of the sections and/or quadrants and 22 (40%) in the section of Body Position, overrepresented by the children with bilateral CP. The additional questions revealed that a greater proportion of children at GMFCS levels III-IV compared to level I frequently were requested to sit/stand up straight (14/17 versus 6/26, p < 0.001) and were sound sensitive at a younger age (14/17 versus 10/26, p = 0.005). The findings of this study highlight the sensory aspects of motor functioning in children with spastic CP.

Epilepsy in Cerebral Palsy: A Brief Narrative Review

Cerebral palsy is defined as “A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems [1].” Between 30-40% of people with cerebral palsy also have epilepsy [2-4]. Some of the risk factors for developing epilepsy include low birth weight, low APGAR scores, seizures in the neonatal period and first year of life, positive imaging findings, severity of cerebral palsy, intellectual disability and spasticity. Children with epilepsy and cerebral palsy often experience their first seizure before 2 years of age, and may have a higher risk for refractory epilepsy and status epilepticus. Anti-seizure medications are the mainstay of treatment, and are typically chosen based upon the epilepsy syndrome, seizure type, side effect profile and EEG findings. If two or more anti-seizure medications fail to control seizures, early evaluation for surgical options, which could potentially be curative, should be pursued. This review article examines the pathophysiology of cerebral palsy and epilepsy, summarizes recent literature about risk factors for developing epilepsy, clinical and EEG features, treatment outcomes in children with epilepsy and CP, and discusses management strategies.

Cerebral palsy biomarker

Cerebral palsy is a neurological disorder that is attributed to non-progressive injury or malformation that occurred in the developing fetal or infant brain. The motor disorders in cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, and by epilepsy. Cerebral palsy is a complex disorder that is likely to be of multifactorial origin. Epidemiological studies have shown that the origins of most CP are prior to labor. A number of clinical risk factors for cerebral palsy have been described in the literature including preterm birth, low birth weight, inflammation, maternal infection during pregnancy and placenta pathology. Hypoxia at birth may be primary or secondary to preexisting pathology, but the currently known clinical risk factors do not explain the majority of cases. Many of these risk factors may have a genetic component. Several single nucleotide polymorphisms, DNA copy number variations and epigenetic patterns increase genetic susceptibility for cerebral palsy. Whole genome sequencing and gene expression studies may extend the percentage of cases with a genetic pathway. Clinical risk factors could act as triggers for CP where there is genetic susceptibility. These new findings should refocus research about the causes of these complex and varied neurodevelopmental disorders on the search for biomarkers of the risk of cerebral palsy. Genomics, proteomics and metabolomics have huge potential for deepening our understanding of many complex diseases by identifying diagnostic and prognostic panels of biomarkers, especially in various neurological disorders, including cerebral palsy.

Skanda (Bala Graha) and Cerebral Palsy – A Review

Among the Ashtanga Ayurveda, Kaumarbhritya focuses on child care in particular. Graharogais the most neglected portion due to excess mythological explanation, difficulty in clinical understanding, diagnosis, severity, complication, and treatment is entirely different from the routine disorder of children. Graharogas are those entities that attack and seize the body then affect the neonates and children very quickly with high mortality. Different acharyas describe Graha with their types, symptoms and treatment. Acharya Sushruta and Acharya Vagabhatta describe Skanda graha- commander-in-chief of the army of Devatas. The symptoms of the affected child resemble very much with Quadriplegic Cerebral Palsy. Cerebral palsy (CP) is the leading cause of childhood disability affecting function and development. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition communication, and behavior. Therefore, this paper aims to understand Balagraha with the modern aspect as well as its clinical application in day-to-day practice.

The applicability of magnetic resonance imaging classification system (MRICS) for cerebral palsy and its association with perinatal factors and related disabilities in a Croatian population-based sample

AimTo investigate the association of cerebral palsy motor disorders, perinatal factors, and related disabilities with brain magnetic resonance imaging classification score (MRICS)-based groups in a population-based sample.MethodsThe study enrolled children with cerebral palsy born from 2003 to 2015 treated at Split University Hospital who underwent brain MRI scanning. Perinatal data (plurality, birth weight, gestational age, and Apgar score) were collected from hospital records. Motor disorders of cerebral palsy (gross and fine motor function) and the related disabilities (intellectual status, speech and eating ability, epilepsy, vision and hearing status) were evaluated with neurological status assessment. Neuroimaging findings were presented as MRICS-based groups.ResultsOf 115 enrolled children, an abnormal finding on brain MRI was confirmed in 95%, including white matter injury (66%), maldevelopments (13.9%), gray matter injury (9.6%), and miscellaneous findings (6.1%). Gross and fine motor function were not significantly associated with MRICS-based group. All related disabilities and perinatal factors, except Apgar score, were significantly associated with MRICS-based group.ConclusionBrain MRICS-based groups were associated with perinatal risk factors and related disabilities of cerebral palsy, but not with common motor disorders. MRI classification score is a reliable diagnostic tool, which strongly correlates with perinatal factors and related disabilities of cerebral palsy.

Ocular defect in children with cerebral palsy and its correlation with the types of cerebral palsy

Background: Cerebral palsy (CP) describes a group of permanent disorder of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbance that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy, and secondary musculoskeletal problem. However, no known study has been found on this aspect. Objective of this study was to evaluate the ocular defect in children with cerebral palsy and to correlate with the types of CP.Methods: Study was done in the Paediatric Neurology unit of BSMMU from January 2012 to July 2012. One hundred thirty children with cerebral palsy were studied. The patients were randomly selected who full filled the inclusion criteria and ophthalmological examination was done.Results: Sixty four (64%) of CP patients had pathological finding and 36% percent had normal finding. Most of the abnormalities were squint (strabismus) (40%) and refractive error (36.9%). Most of the ocular defects were found in spastic cerebral palsy, mainly in spastic quadriplegia (34.6%) and spastic diplegia (29.2%).Conclusions: Ocular defect like squint and refractive error common associations of cerebral palsy. Spastic quadriplegic and diplegic children had more ocular defects.

Definition and diagnosis of cerebral palsy in genetic studies: a systematic review.

To conduct a systematic review of phenotypic definition and case ascertainment in published genetic studies of cerebral palsy (CP) to inform guidelines for the reporting of such studies. Inclusion criteria comprised genetic studies of candidate genes, with CP as the outcome, published between 1990 and 2019 in the PubMed, Embase, and BIOSIS Citation Index databases. Fifty-seven studies met the inclusion criteria. We appraised how CP was defined, the quality of information on case ascertainment, and compliance with international consensus guidelines. Seven studies (12%) were poorly described, 33 studies (58%) gave incomplete information, and 17 studies (30%) were well described. Missing key information precluded determining how many studies complied with the definition by Rosenbaum et al. Only 18 out of 57 studies (32%) were compliant with the Surveillance of Cerebral Palsy in Europe (SCPE) international guidelines on defining CP. Limited compliance with international consensus guidelines on phenotypic definition and mediocre reporting of CP case ascertainment hinders the comparison of results among genetic studies of CP (including meta-analyses), thereby limiting the quality, interpretability, and generalizability of study findings. Compliance with the SCPE guidelines is important for ongoing gene discovery efforts in CP, given the potential for misclassification of unrelated neurological conditions as CP.

Cerebral palsy prevalence, subtypes, and associated impairments: a population‐based comparison study of adults and children

To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP. CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), andwiththe most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males). Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01). Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed. Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.

Respiratory morbidity in children with cerebral palsy: an overview

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.

Objectification of motor disorders in children with cerebral palsy: what we know so far

This study provides an overview of the recent literature regarding the assessment methods of the functional state of the locomotor system in children with cerebral palsy. The objective methods of quantitative assessment of motor disorders in cerebral palsy are presented, including the measurement of stability, biomechanical assessment of walking, and video analysis of movements. The influence of the cognitive load on the ability to maintain the vertical posture in children with cerebral palsy as well as the changes in the stability of the vertical posture with closed eyes were observed. Changes in the walking parameters with an increase in the speed were also recorded in children with cerebral palsy.&#x0D; Methods that assess hand motion in children with cerebral palsy include tests involving the moving of objects, tests for speed assessment in joint movements, and video analysis of motions.&#x0D; The methods and tests for such an evaluation require to be valid and reliable, allowing an objective assessment of the severity of motor disorders in cerebral palsy.

Development of The Viking Speech Scale to classify the speech of children with cerebral palsy

Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k>.58 for all comparisons). Test-retest reliability was substantial to almost perfect for all groups (k>.68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review.

The Epidemiology of Cerebral Palsy: New Perspectives From a Canadian Registry

Cerebral palsy (CP)wasfirst recognized as a distinct clinical entity in the mid-19th century. Since then, our conceptualization of this neurodevelopmental disability has evolved with reification of its case definition. Presently, the most widely accepted consensus definition utilized for both clinical and research purposes is the one put forward by Rosenbaum et al in 2007, “cerebral palsy describes a group of permanent disorders of movement and posture, causing activity limitations, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbance of sensation, perception, cognition, communication and behavior, by epilepsy and by musculo-skeletal problems.” This consensus definition ably captures the inherent heterogeneity of CP. This heterogeneity is manifest in all its aspects: clinical presentation, neuromotor impairment evident, etiology, pathogenesis, comorbidities experienced, and natural history. Indeed CP appears never to be the same disorder twice. There is also an explicit recognition in the consensus definition that although the core feature is an objective early onset of neuromotor impairment that leads to activity

Dental management of early childhood caries in spastic quadriparesis: A case report and clinical guidelines

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by epilepsy, secondary musculoskeletal problems, and disturbances of sensation, perception, cognition, communication, and behavior. Spastic quadriparesis is the most severe form of spastic cerebral palsy. The present report describes the management of a 5-year-old patient with early childhood caries and spastic quadriparesis. The oral manifestations and clinical guidelines are discussed considering the special health care needs in these patients so as to provide comprehensive dental care.

Theory of mind and irony comprehension in children with cerebral palsy

The main goal of the present study was to characterise the pragmatic abilities of French children with cerebral palsy through their understanding of irony and other people's mental states. We predicted that children with cerebral palsy would have difficulty understanding false-belief and ironic remarks, due to the executive dysfunction that accompanies the motor disorders of cerebral palsy. We conducted an experiment in which children with cerebral palsy and typically developing matched controls performed theory-of-mind and executive function tasks. They then listened to ironic stories and answered questions about the speakers' beliefs and attitudes. The groups differed significantly on second-order theory of mind, irony comprehension and working memory, indicating pragmatic difficulties in children with cerebral palsy.

Knowledge Discovery and Multimodal Inputs for Driving an Intelligent Wheelchair

Cerebral Palsy is defined as a group of permanent disorders in the development of movement and posture. The motor disorders in cerebral palsy are associated with deficits of perception, cognition, communication, and behaviour, which can affect autonomy and independence. The interface between the user and an intelligent wheelchair can be done with several input devices such as joysticks, microphones, and brain computer interfaces (BCI). BCI enables interaction between users and hardware systems through the recognition of brainwave activity. The current BCI systems have very low accuracy on the recognition of facial expressions and thoughts, making it difficult to use these devices to enable safe and robust commands of complex devices like an Intelligent Wheelchair. This paper presents an approach to expand the use of a brain computer interface for driving an intelligent wheelchair by patients suffering from cerebral palsy. The ability with the joystick, head movements, and voice inputs were tested, and the best possibility for driving the wheelchair is given to a specific user. Experiments were performed using 30 individuals suffering from IV and V degrees of cerebral palsy on the Gross Motor Function (GMF) measure. The results show that the pre-processing and variable selection methods are effective to improve the results of a commercial BCI product by 57%. With the developed system, it is also possible for users to perform a circuit in a simulated environment using just facial expressions and thoughts.

Evidence‐based physical therapy for the management of children with cerebral palsy

Developmental Medicine & Child NeurologyVolume 47, Issue 12 p. 795-795 Free Access Evidence-based physical therapy for the management of children with cerebral palsy Margaret Mayston, Margaret MaystonSearch for more papers by this author Margaret Mayston, Margaret MaystonSearch for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2005.tb01081.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Damiano DJ. (2004) Physiotherapy management in cerebral palsy: Moving beyond philosophies. In: D. Scrutton, DJ. Damiano, MJ. Mayston, editors. Management of the Motor Disorders of Cerebral Palsy. Clinics in Developmental Medicine No. 161 2nd edn. Mac Keith Press : London.p 161– 169. 2 Palisano R., Rosenbaum P., Walter S., Russell D., Wood E., Galuppi B. (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39: 214– 223. 3 Coster W., Deeney TA., Haltiwanger JT., Haley SM. (1998) School Function Assessment: User's Manual. San Antonio , TX : Therapy Skill Builders. 4 World Health Organization. (2001) International Classification of Functioning, Disability and Health. (ICF) Geneva : World Health Organization. 5 Rosenbaum P., Stewart D. (2004) The World Health Organization International Classification of Functioning, Disability and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol 11: 5– 10. 6 Dodd KJ., Taylor NF., Damiano DJ. (2002) A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil 83: 1157– 64. 7 Damiano DJ., Abel MF. (1998) Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil 79: 119– 125. 8 Schindl MR., Forstner C., Kern H., Hesse S. (2000) Treadmill training with partial body weight support in non-ambulatory patients with cerebral palsy. Arch Phys Med Rehabil 81: 301– 306. Citing Literature Volume47, Issue12December 2005Pages 795-795 ReferencesRelatedInformation

Definition and classification of cerebral palsy

‘Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.’

Pathophysiology of the corticospinal system and basal ganglia in cerebral palsy

Motor disability is the cardinal symptom of cerebral palsy. Based on the nature of motor dysfunction, cerebral palsy can be subdivided into three major types: 1) spastic cerebral palsy associated with damage to cortical motor areas and/or underlying white matter, 2) choreoathetotic cerebral palsy associated with damage to the basal ganglia, and 3) ataxic cerebral palsy associated with damage to cerebellar structures. People with cerebral palsy often exhibit a wide range of motor symptomatology representing a mix of these three basic conditions. Common motor disorders in cerebral palsy that may appear in different combinations include co-contraction of antagonist muscles, spasticity and related signs such as clonus and reflex irradiation, mirror movements, impaired ability for rapid and selective voluntary activation of muscles, increased muscle tone often appearing as sustained involuntary contractions at rest, chorea, athetosis, dystonia, impaired balance control, and ataxia. This paper focuses on recent neurophysiological developments in understanding the nature of motor impairments in cerebral palsy, particularly with reference to co-contraction of antagonist muscles, mirror movements, and basal ganglia circuit dysfunction that may underlie choreoathetotic disorders. MRDD Research Reviews 3:153-167, 1997. © 1997 Wiley-Liss, Inc.