Motor Function Classification System Level Research Articles

Correlation of Gross Motor Functional Classification System (GMFCS) Level and Encountering Barriers to Access Healthcare

<h3>Research Objectives</h3> To evaluate the relationship of cerebral palsy (CP) motor severity, as measured by the Gross Motor Functional Classification System (GMFCS), on healthcare access. <h3>Design</h3> A prospective, cross-sectional cohort study. <h3>Setting</h3> Accredited clinical motion analysis laboratory at a regional children's hospital. <h3>Participants</h3> 72 ambulatory, adult patients with CP who had previously received care at the children's hospital participated. Ages ranged from 18-48 years (mean = 24.5). <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Patient interviews evaluated access to healthcare services and insurance status. A physical therapist determined each participant's GMFCS level, and higher GMFCS levels correspond with higher levels of mobility impairment. Fisher's exact tests were used to identify associations between GMFCS level and access to care. <h3>Results</h3> GMFCS level varied with 28 GMFCS 1 patients, 29 GMFCS 2 patients, 13 GMFCS 3 patients, and 2 GMFCS 4 patients. With increasing GMFCS level, patients were more likely to report they encountered barriers accessing healthcare (p = 0.025). Patients with a higher GMFCS level were also more likely to report that their health insurance did not offer benefits or cover services that met their needs (p=0.018). Similarly, the patients with a higher GMFCS level were more likely to report that their health insurance did not allow them to see the healthcare providers they need, with a correlation that approached statistical significance (p=0.084). In this patient population, patients categorized as GMFCS 3 or 4 were also more likely to have Medicaid or Medicare than those categorized as GMFCS 1 or 2 (p=0.018). <h3>Conclusions</h3> This data suggests that patients with higher GMFCS levels have less access to adequate healthcare services. Further research is warranted to identify specific barriers to healthcare access, better understand the needs of this unique population, and ensure healthcare systems are adequately providing care for patients with more severe CP. <h3>Author(s) Disclosures</h3> There are no conflicts of interest.

Evaluating the Effectiveness and Safety of AbobotulinumtoxinA in Pediatric Lower Limb Spasticity (PLLS)

<h3>Research Objectives</h3> To assess the longitudinal attainment of patient-centered, function-related goal attainment scale (GAS) T-score after repeated abobotulinumtoxinA (aboBoNT-A) injections. <h3>Design</h3> Phase IV, prospective, observational study. <h3>Setting</h3> 28 US-based centers. <h3>Participants</h3> Patients aged 2–17 years with PLLS. <h3>Interventions</h3> AboBoNT-A injections over ≤30 months (≤10 cycles). <h3>Main Outcome Measures</h3> Assessment of cumulated GAS T-scores across all cycles to measure progress of therapy goals; scores of ≥50 reflect goal achievement. <h3>Results</h3> Of 210 patients, 77.6% (n=163) were previously treated with botulinum neurotoxin. Available Gross Motor Function Classification System (GMFCS) levels showed that 31.3% (n=61/195) of patients were non-ambulatory (GMFCS IV/V). Mean±SD cumulated GAS T-score was 51.1±9.3. Overall, 75.2% of patients achieved their primary goals. Across all cycles, the number of muscles injected ranged from 5.5±2.9‒7.0±3.7; the number of injection points ranged from 8.1±2.7‒9.9±5.7, with gastrocnemius injections being most common (85.7%). Injection guidance techniques were used in >70% of patients in Cycles 1‒6; electrostimulation was most frequent (>50%). In the safety population (N=242), 102 patients (42.1%) reported 392 treatment-emergent AEs, which were mostly mild to moderate. Overall, a total of 35 AEs in 15 patients (6.2%) were deemed treatment-related. <h3>Conclusions</h3> Overall, goals were achieved as or better than expected in the majority of patients. AboBoNT-A was well tolerated, with a low incidence of treatment-related AEs. These results confirm aboBoNT-A as an effective treatment option, with a positive risk-benefit profile. <h3>Author(s) Disclosures</h3> MG: Received consultancy fees/research support from Ipsen; ED: Received consultancy fees and/or research support from Allergan, Ipsen, Solstice, Merz; AT: Received consultancy fees/research support from Ipsen; AC: Received research support from Ipsen; SHE: Received consultancy fees from Biogen and Ipsen; FCG and JG: Employees of Ipsen.

Reliability and validity of the East Asian children's version of mini-MACS in children with cerebral palsy.

Mini-Manual Ability Classification System (Mini-MACS) was developed for children with cerebral palsy aged 1-4 years, but its validity and reliability in different cultures are unavailable yet. This study was to determine the reliability and validity of Mini-MACS in East Asian children with cerebral palsy and investigate the correlation between Mini-MACS and Gross Motor Function Classification System. One hundred and four East Asian children with cerebral palsy aged 12-48 months were classified by one of their parents, an occupational therapist, and a physical therapist with Mini-MACS. The results were analyzed for inter-rater reliability by using intraclass correlation coefficient (ICC). The Nine-hole Peg Test was used for the criterion-related validity analysis, and parents retested their children after 2 weeks to evaluate test-retest reliability. Gross Motor Function Classification System levels were also collected to investigate the correlation with Mini-MACS. Good inter-rater reliability among the occupational therapist, physical therapist, and parents was found [ICC = 0.984 (95% confidence interval, CI, 0.976-0.989), 0.973 (95% CI 0.960-0.982), and 0.966 (95% CI 0.950-0.977), respectively; p < 0.01]. The test-retest reliability in parents was almost perfect [ICC = 0.985 (95% CI 0.977-0.990), p < 0.01]. Mini-MACS had consistency with the Nine-hole Peg Test (r = 0.582, 0.581, and 0.566, respectively; p < 0.01). A correlation was found between Gross Motor Function Classification System and Mini-MACS (r = 0.626, 0.596, and 0.598, respectively; p < 0.01). The Mini-MACS demonstrates evidence that it is a valid and reliable tool to classify manual ability in East Asian children with cerebral palsy and is also positively related to the Gross Motor Function Classification System.

The incidence of avascular necrosis in children with cerebral palsy after hip containment surgery.

To establish the rate of avascular necrosis after hip reconstruction surgery in children with cerebral palsy and to identify risk factors that influence the development of avascular necrosis in this population. An institutional review board-approved retrospective review was conducted on children with cerebral palsy who underwent hip containment surgery at a single institution. Radiographs were evaluated at three time points. The Reimer's migration percentage, neck shaft angle, epiphyseal shaft angle, acetabular index, center edge angle, and acetabular angle were measured. The presence of avascular necrosis was evaluated and graded by the Bucholz/Ogden and the Kalamchi/MacEwen classification systems. Multivariate logistic regression was performed to identify risk factors associated with the development of avascular necrosis. A total of 154 children with cerebral palsy underwent hip containment surgery on 223 hips. Twenty-nine children (18.8%) underwent both pelvic and femoral procedures; 36 children (23.4%) had only femoral procedures; 47 children (30.5%) had femoral and soft tissue; and 42 children (27.3%) had pelvic, femoral, and soft tissue procedures. Using the Bucholz and Ogden or the Kalamchi classifications, the rate of avascular necrosis was 24.7% (38/154). Of the variables evaluated, preoperative Reimers was found to be significant predictors of avascular necrosis. The rate of avascular necrosis was 26.7% for Gross Motor Functional Classification System level III, 24.1% for Gross Motor Functional Classification System level IV, and 27.3% for Gross Motor Functional Classification System level V. The overall rate of avascular necrosis in children undergoing hip containment surgery was 26.7%. Together, age at surgery, open reduction, previous surgery, preoperative Reimers, and estimated blood loss contributed to the development of postoperative avascular necrosis; however, only preoperative Reimers significantly contributed to the development of avascular necrosis in children with cerebral palsy undergoing hip containment procedures.

Effectiveness of Vojta Therapy on Gross Motor Function in Children with Cerebral Palsy at GMFCS Levels 4 and 5: A Randomized Controlled Trial

Objective: To study the effectiveness of the Vojta therapy on gross motor function in children with cerebral palsy at the Gross Motor Function Classification System (GMFCS) levels 4 and 5. Materials and Methods: The present study was a randomized controlled trial, assessor-blinded, in 24 children with cerebral palsy, GMFCS 4 and 5 at Thai Red Cross Rehabilitation Center. Participants were randomly allocated to the Vojta therapy as the intervention group or conventional therapy as the control group and were trained by physical therapists. All participants in both groups received a home program for eight weeks. Outcomes were motor function assessment by the Gross Motor Function Measure (GMFM)-88, range of motion of lower extremities and parent’s satisfaction. Results: Twenty-four participants were randomly assigned with twelve participants each in the intervention and the control group. The mean age of participants in the intervention group was 7.08±3.17 years. The Vojta therapy significantly improved the GMFM-88 Dimension A- lying and rolling (p=0.001) and the improvement was greater than that of the control group (p=0.001). Both groups had significant increase in range of motion, including bilateral hip flexion, bilateral hip extension, bilateral knee flexion, and bilateral ankle dorsiflexion. Parent’s satisfaction in both groups were very satisfied and had no adverse effects. Conclusion: The Vojta therapy significantly improved gross motor function and range motion of the lower extremities in children with cerebral palsy at GMFCS levels 4 and 5. The Vojta therapy was superior to conventional therapy in the GMFM-88 Dimension A- lying and rolling. Keywords: Cerebral palsy; Vojta therapy; Gross motor function; GMFM-88; GMFCS

The effect of medial only versus medial and lateral hamstring lengthening on transverse gait parameters in cerebral palsy.

Benefits of hamstring lengthening surgery on the sagittal plane in children with cerebral palsy have been previously demonstrated, but there is limited information on its effects on the transverse plane. This study compared the effects of medial hamstring lengthening (MHL) with those of medial and lateral hamstring lengthening (MLHL) procedures in the transverse plane. Children with gross motor function classification system (GMFCS) levels I-III who had MHL or MLHL were included. Baseline, short- (1-2 years), and long-term (3+ years) postoperative three-dimensional gait analysis outcomes were compared using analysis of variance. Children were excluded if they had concurrent osteotomies or tendon transfers. One hundred fifty children (235 limbs) were included, with 110 limbs in the MHL group (age 8.5 ± 4.1 years, GMFCS I-27%, II-52%, and III-21%) and 125 limbs in the MLHL group (age 10.0 ± 4.0 years, GMFCS I-23%, II-41%, and III-37%). Time between surgery and short- and long-term follow-up gait analysis was 1.5 ± 0.6 years and 6.6 ± 2.9 years, respectively. Transmalleolar axis became more external after MHL at both short and long terms ( P < 0.05), whereas there were only significant differences at long term in MLHL ( P < 0.05). Although hamstring lengthening has a positive impact on stance phase knee extension in children with cerebral palsy, intact lateral hamstrings after MHL likely contribute to increased tibial external rotation after surgery. Significant increases in external rotation at the knee in the long term are likely related to a trend present with growth in children with cerebral palsy rather than a direct result of surgical intervention.

Efficacy of a Hip Brace for Hip Displacement in Children With Cerebral Palsy

There is no consensus on interventions to slow the progress of hip displacement in patients with cerebral palsy. To investigate the efficacy of a novel hip brace in preventing progressive hip displacement in patients with cerebral palsy. This 2-group randomized clinical trial was conducted at 4 tertiary hospitals in South Korea from July 2019 to November 2021. Participants included children aged 1 to 10 years with nonambulatory cerebral palsy (Gross Motor Function Classification System level IV or V). Block randomization was used to assign an equal number of patients to the study and control groups via computerized random allocation sequences. Data were analyzed from November to December 2021. The intervention group wore the hip brace for at least 12 hours a day for the study duration (ie, 12 months). Follow-up evaluations were performed after 6 and 12 months of wearing the brace. Both groups proceeded with conventional rehabilitation therapy during the trial. The primary outcome was the Reimers migration index (MI) on radiography, as assessed by 3 blinded investigators. Primary outcome variables were analyzed using linear mixed models. Secondary outcomes include change in the Caregiver Priorities & Child Health Index of Life with Disabilities, on which lower scores indicate better quality of life. A total of 66 patients were included, with 33 patients (mean [SD] age, 68.7 [31.6] months; 25 [75.8%] boys) randomized to the intervention group and 33 patients (mean [SD] age, 60.7 [24.9] months; 20 [60.6%] boys) randomized to the control group. The baseline mean (SD) MI was 37.4% (19.3%) in the intervention group and 30.6% (16.3%) in the control group. The mean difference of the MI between the intervention group and control group was -8.7 (95% CI, -10.2 to -7.1) percentage points at 6 months and -12.7 (95% CI, -14.7 to -10.7) percentage points at 12 months. The changes in the Caregiver Priorities & Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, -14.2; 95% CI, -25.2 to -3.3). In this randomized clinical trial, the novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group. It effectively improved quality of life in patients with nonambulatory cerebral palsy. Therefore, hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy. ClinicalTrials.gov Identifier: NCT04033289.

Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy

BackgroundSelective motor control (SMC) is a fundamental component of typical human motion. As a result of brain damage, impaired SMC often leads to difficulties with coordination, balance, gait efficiency and symmetry. Research questionWhat is the association between impaired SMC and lower limb motor ability, functional balance and gait performance in children with bilateral spastic cerebral palsy (CP)? MethodsThirty-six children (aged 5–16 years) with spastic bilateral CP in Gross Motor Function Classification System (GMFCS) level I to II were included in this study. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Gross motor function was assessed using Gross Motor Function Measure-88 items D and E dimension (GMFM-88 D&E). Functional balance was assessed using Pediatric Balance Scale (PBS) and Timed Up and Go Test (TUG). Gait quality was assessed using Edinburg Visual Gait Score (EVGS) and 10-Meter Walk Test (10MWT). Spearman's rank correlation analyses were used to determine the association between SMC and other factors. ResultsCorrelation analyses showed that SCALE was strongly positively correlated with GMFM-88 (D&E) (rs=0.756, p < 0.001), PBS (rs=0.769, p < 0.001), and height-normalized fast walking speed (rs=0.632, p < 0.001), and strongly negatively correlated with TUG (rs=−0.766, p < 0.001) and EVGS (rs=−0.893, p < 0.001). SignificanceLower extremity SMC deficits are associated with poor gross motor function and balance control, more severe overall gait deviations and decreased fast walking speed in children with bilateral spastic CP. Physical therapy should include interventions that promote selective motor control in order to improve overall functional ability.

Impact of Occupational Therapy on Self-Care After Selective Dorsal Rhizotomy Among Children With Cerebral Palsy.

Selective dorsal rhizotomy (SDR) is an established treatment for spastic cerebral palsy (CP). The effects and predictors of occupational therapy's benefit for self-care after SDR in children with CP have not been thoroughly investigated. To identify changes in self-care after occupational therapy post-SDR and determine whether changes were affected by age, Gross Motor Function Classification System (GMFCS) level, and number of occupational therapy dressing sessions. In this retrospective cohort study, we collected outcomes pre-SDR, at discharge, and at 1-yr follow-up. Paired t tests and regression analysis were performed. Commission on Accreditation of Rehabilitation Facilities-accredited pediatric inpatient rehabilitation facility. Seventy-three children (GMFCS Levels I-III, ages 4-17 yr) diagnosed with spastic CP who underwent SDR from 2014 to 2018. After having SDR, each child received an average of twice daily occupational therapy for an average of 37.3 days. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and Functional Independence Measure for Children® (WeeFIM) were used to assess self-care performance. The mean WeeFIM dressing (upper and lower body) and mean PEDI-CAT daily activities scores from baseline to discharge and mean WeeFIM lower body dressing at 1-yr follow-up improved significantly. The improvement in lower body dressing correlated with GMFCS level and the number of occupational therapy dressing sessions. The improvement in upper and lower extremity dressing and PEDI-CAT daily activities scores suggests that inpatient occupational therapy post-SDR may provide benefits. What This Article Adds: Children diagnosed with CP may undergo surgical interventions to improve their ability to walk. This article demonstrates the benefit of occupational therapy services after SDR to improve upper and lower body dressing skills.

Is Standing Function Improved After Orthopaedic Surgery in Children With Cerebral Palsy at GMFCS Levels III/IV?

Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels III/IV are at risk for losses in standing function during adolescence and transition to adulthood. Multilevel surgery (MLS) is an effective treatment to improve gait, but its effects on standing function are not well documented. The objectives of our study were to describe standing function in children with CP classified as GMFCS levels III/IV and evaluate change after MLS. This retrospective study included children with CP (GMFCS III/IV) ages 6 to 20 years who underwent instrumented gait analysis. A subset who underwent MLS were evaluated for change. Primary outcome measures were Gross Motor Function Measure dimension D, gait velocity, functional mobility scale, and the Pediatric Outcomes Data Collection Instrument (PODCI). Additional impairment level measures included foot pressure, knee extension during stance phase of gait, and knee extension passive range of motion. Four hundred thirty-seven instrumented gait analysis sessions from 321 children with CP (ages 13.7±4.8y; GMFCS III-81%/IV-19%) were included. The GMFCS III group had higher Gross Motor Function Measure dimension D, gait velocity, PODCI scores, and better knee extension compared with the GMFCS IV group ( P <0.05); 94 MLS were evaluated for postoperative change 15.3±4.2 months after MLS. Children at GMFCS level III had improved PODCI scores ( P <0.05), better knee extension passive range of motion ( P <0.01), and improved coronal plane foot pressure ( P <0.05) post MLS. Maximum knee extension during stance and heel impulse improved significantly in both groups ( P <0.01). Standing function of children with CP at GMFCS IV was significantly more limited than at GMFCS III. After MLS, both groups (III/IV) showed improvement in impairment level outcomes (knee extension and foot position), whereas only those functioning at GMFCS III had improvement in activity/participation outcomes according to the PODCI. For children with CP at GMFCS levels IV, MLS may improve standing function, but appropriate goals related to assisted standing and measurement protocols sensitive to limited functional mobility should be adopted. Level III-retrospective comparative study.

The Greek Version of Mini-Manual Ability Classification System (Mini-MACS): Translation and Reliability Study.

The Mini-Manual Ability Classification System (Mini-MACS) is an adaptation of the MACS for children with cerebral palsy (CP) aged 1-4 years, which classifies children's performance to handle objects that are relevant to their age and development. The availability of a reliable Mini-MACS in Greek would allow for using it safely and properly in the clinical and research context of Greece. Therefore, the purpose of this study was to translate the original English version into Greek and examine its test-retest and interrater reliability. The English Mini-MACS was translated into Greek using the "forward-backward" method. Sixty-three children with CP, Gross Motor Function Classification System (GMFCS) levels I-V, aged 12 -50 months were included in the reliability study. Test-retest and interrater reliability were assessed using the interclass correlation coefficient (ICC). The association between Mini-MACS and GMFCS level ratings was also assessed using Spearman's rho correlation coefficient (ρ). The translated version was easy to understand and use. The Greek Mini-MACS was found to have excellent test-retest reliability (ICC > 0.96) for both parents and therapists, good interrater reliability (ICC=0.89) between therapists and parents, and moderate-to-strong correlation with the GMFCS (ρ= 0.56-0.64, p < 0.0001). The Greek Mini-MACS constitutes a user-friendly and reliable scale for use in the Greek population.

Reliability and Convergent Validity of Digital Photography in Assessing Postural Orientation of Children with Cerebral Palsy: A Methodological Study

Background: This study aimed to assess the test-retest intra-rater reliability and convergent validity of digital photography (DP) in detecting the postural orientation of children with cerebral palsy (CP). Methods: The study recruited children with various types of CP with the Gross Motor Function Classification System level I or II and spasticity &lt; 2 on the Ashworth Scale, without any visual or cognitive impairments. Children who had undergone any surgical intervention or received a botulinum toxin injection within the previous six months were excluded. A digital camera was fixed at 1.5 meters from the participants at the height of 90 cm. Non-reflective markers were attached to eight anatomical landmarks to localize the upper and lower center of mass on both sides. The same examiner took three digital photos to detect intra-rater reliability using the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analysis were used to assess the convergent validity of the DP method compared with the Pediatric Balance Scale (PBS) scores. Results: Thirty children (7.44 ± 2.38 years) were assessed to test the reliability of DP, and 55 others (8.06 ± 2.19 years) participated in the convergent validity study. Intra-rater reliability was found to be perfect (ICC &gt; 0.995) and there was a strong significant negative correlation between DP measures and PBS scores (Pearson's correlation &gt; 0.75) with high adjusted R2 (R2 &gt; 0.567), indicating goodness of fit between the measures. Conclusions: Digital photography (DP) is a reliable and valid method for assessing postural orientation in children with various types of CP.

Real-time daily fatigue, sleep, physical activity, and health-related fitness in adults with cerebral palsy.

To explore whether subgroups of adults with cerebral palsy (CP) with different fatigue diurnal profiles can be discerned, and to explore whether sleep, physical activity, or health-related fitness are associated with these profiles. Thirty-two adults (median age 29 years 8 months; range 20-54 years; 11 males, 21 females) with spastic CP (Gross Motor Function Classification System levels I-III) with physical activity-related fatigue complaints participated. Real-time fatigue and physical activity were assessed for 7 consecutive days by short message service text four times during the day and by wearing an accelerometer respectively. Sleep was assessed by the Pittsburgh Sleep Quality Index, and fitness by assessing body composition and aerobic capacity. Latent class growth modelling was used to classify subgroups according to their diurnal profiles of real-time fatigue. Univariable multinomial logistic regression analysis explored whether participant characteristics, sleep, physical activity, or health-related fitness were associated with diurnal profiles. Three distinct fatigue diurnal profiles were identified: stable low (n= 10), increasing (n= 14), and stable high (n= 8). Only aerobic capacity was associated with fatigue profiles (odds ratio 1.15, 95% confidence interval 1.00-1.34; p= 0.05). Fatigue in adults with CP may be low or high stable or may increase during the day. These findings indicate the relevance of assessing fatigue variability. We found three patterns of daily fatigue in adults with cerebral palsy (CP). Only aerobic capacity was associated with fatigue profiles in adults with CP. Moment-to-moment variations in fatigue can help with personalized fatigue management.

Impact of femoral anteversion and tibial torsion on balance in children with spastic diplegic cerebral palsy

Purpose: To investigate the relation between femoral anteversion angle, tibial torsion and balance abilities in children with spastic diaplegic cerebral palsy. Methods: A cross-sectional correlational research design study utilizing a sample of 50 spastic diplegic children (22 girls and 28 boys), with gross motor functional classification system levels I, II were recruited and their ages ranged from 7 to 13 years. Femoral anteversion and tibial torsion angles were measured by computed tomography scan, while balance abilities were assessed by Biodex balance system. Results: Data analysis revealed that there was a statistically significant moderate positive correlation between right femoral anteversion angle and the overall stability index and the antero posterior stability index, while a weak positive non-significant correlation with the medio-lateral stability index was found. There was a weak negative non-significant correlation between left femoral anteversion angle and stability indices. There was a weak non-significant correlation between tibial torsion angle and stability indices. Conclusion: It can be concluded that the relation between femoral anteversion angle, tibial torsion angle and balance in spastic diplegic children can provide quantitative and objective information that could be used in the clinical assessment and rehabilitation strategies.

Reliability and validity of the gait classification system in children with cerebral palsy (GCS-CP)

BackgroundGait classification systems (GCS) may enable clinicians to differentiate gait patterns into clinically significant categories that assist in clinical decision-making and assessment of outcomes. Davids and Bagley in 2014 [1] described a GCS for children with cerebral palsy (GCS-CP). The purpose of our study was to use the GCS-CP for the first time on a sample of patients with CP and to evaluate the reliability and utility of the classification system. MethodsThe gait of 131 children with CP was retrospectively reviewed and classified according to Davids and Bagley’s classification using two-dimensional (2D) video and three-dimensional (3D) lower limb kinematics and kinetics. Gross Motor Function Classification System (GMFCS) levels were determined, and the Gait Profile Scores (GPS) calculated to characterize the sample concerning gait classification. The comparison between the groups was performed using the Kruskal-Wallis test with respect to the non-normal distribution of the data. The intrarater and interrater reliability was determined using the Kappa index (k) statistics with 95% CI. ResultsAll GCS-CP groups were represented within the evaluated sample. Of the 131 cases evaluated, 127 (96.95%) were able to be classified with respect to sagittal plane stance phase gait deviations. All patients in the sample were able to be classified with respect to sagittal plane swing phase and transverse plane gait deviations. The interrater reliability was 0.596 and 0.485 for the first and second levels of the classification, respectively, according to the Fleiss’s Kappa statistics. Intrarater reliability was 0.776 and 0.714 for the raters one and two, respectively, according to the Cohen’s Kappa statistics. SignificanceThe GCS-CP exhibited clinical utility, successfully classifying almost all subjects with CP in two planes, based upon kinematic and kinetic data. The classification is valid and has moderate interrater and moderate to substantial intrarater reliability.

Novel weight estimation equation for children with cerebral palsy in low-resource settings: Validation in a population-based cohort.

To validate a novel equation to estimate weight from mid-upper arm circumference (MUAC) among children with cerebral palsy (CP) in rural Bangladesh. Children with CP aged 2 to 18 years registered in the Bangladesh CP Register were randomly selected. Data on sociodemographics, Gross Motor Function Classification System level, and anthropometric measurements were extracted. Bland-Altman plots with a 95% agreement limit and Lin's concordance correlation coefficient with 95% confidence intervals (CI) were reported to measure agreement between observed and estimated weight. Percentage error was used to determinate the method's accuracy. There were 497 participants with a mean age at assessment of 9 years (SD 4 years 11 months) (47.7% female). Lin's concordance correlation coefficient between the observed and estimated weights was 0.90 (95% CI 0.89-0.92). Bland-Altman plots showed a reasonable accuracy of the equation in the study cohort. The mean percentage error of the equation was 5.04%. The average difference between observed and estimated weights was -1.02 kg (SD 5.1). The differences between observed and estimated weights were significantly greater among children with weight-for-age, height-for-age, or BMI-for-age z-scores less than or equal to -4. It is possible to predict the weight of children with CP from MUAC with sufficient accuracy. The equation can be used for populations in low-resources and low- and middle-income countries. The equations predict the weight of children with cerebral palsy from their mid-upper arm circumference reasonably accurately. The difference between observed and estimated weights ranged between 0 kg and ± 5 kg in 81.5% of children. Sex and Gross Motor Function Classification System level did not affect the accuracy of the equations. The equations were less accurate for estimating the weight of severely undernourished children.

What can we learn from the relationship between gait deviations and clinical impairments when comparing two databases?

BackgroundSeveral previous studies have tried to determine the relationship between gait and clinical impairments in children with Cerebral Palsy (CP). The heterogeneity of the population and the methodology used could explain the discrepancy within the results. Recently, Papageorgiou et al. (2019) used a Statistical Parametric Mapping (SPM) analysis to investigate this relationship, allowing to test across the kinematic waveforms parameters. Research questionAre we able to replicate the results of Papageorgiou et al. (2019) on a population of children with CP from another center? MethodsRetrospectively, youth with spastic unilateral (uCP) or bilateral (bCP) CP (3–18 years of age) who underwent a clinical gait analysis at the Geneva University Hospitals (HUG) were screened. Following Papageorgiou et al. 2019, the same inclusion and exclusion criteria as well as the same methodology were applied. Mann-Whitney-U test was used to compare the impairments score between the two centers. A Student T-Test using SPM was applied to compare the kinematic waveforms from the two centers. A canonical correlation analysis using SPM was realized to assess the relationship between clinical impairments and the combined sagittal motion of the pelvis, hip, knee and ankle. Results and significanceA total of 211 patients were included with 131 uCP (10 [8–14] years old) and 80 bCP (11 [7–14] years old). The distribution of the Gross Motor Function Classification System levels and the proportion of previous treatment differs between centers. In both CP groups, significant differences were observed in the composite score and lower limb kinematics, reflecting less impaired patients with CP at HUG compared to Papagergiou et al. (2019). While similar associations between spasticity and kinematic were observed in both centers, the association with muscle weakness, selectivity, and range of motion differed.

Correlation between trunk control and upper extremity function in subjects with cerebral palsy

Cerebral Palsy (CP) is prevalent disability starting in early childhood characterized as a series of difficulties caused by Central Nervous System lesions. Motor and secondary musculoskeletal problems are seen in CP. The trunk plays an important role in the organization of postural control, balance and also provides free movement of upper limb but in subjects with CP may challenge by manual skills such as fine motor activities and may also have difficulty in maintaining trunk control. : Aim of the study was to assess and investigate the correlation between trunk control and upper limb function in subjects with cerebral palsy. Cross sectional study was conducted in which 34 Subjects from SBB College of physiotherapy, SVP hospital and private clinics were taken. Subjects diagnosed with any clinical type of either gender aged 6 to 15 years CP with Gross Motor Functional Classification System level Ⅱ, Ⅲ, Ⅳ, were included and recent trauma or surgery of upper extremity and spine (less ˂ 6 months) were excluded in the study by convenient sampling. After taken consent, Trunk Control Measurement scale (TCMS) were filled up by primary therapist and ABILHAND kids Gujarati version questionnaires were filled up by parents personal interview. : Data analysis for 34 subjects was done by using SPSS version 16 and Microsoft excels 2019. For data screened nonparametric Spearman correlation co˗ efficient test was used with level of significance kept at 5%. Results showed that there is strong positive correlation between trunk control and upper limb function (r ₌ 0.773 p ₌ 0.05) in subjects with cerebral palsy. Study concluded that Trunk Control is highly correlated with upper limb function in subjects with CP. Therefore, it is important in NeuroRehabilitation applications to improve upper limb function along with control of trunk.

Metabolic assessment of cerebral palsy with normal clinical MRI using 18F-FDG PET imaging: A preliminary report.

To explore the cerebral metabolic patterns of cerebral palsy (CP) patients without structural abnormalities by brain magnetic resonance imaging (MRI) scans, we evaluated 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) imaging features in patients. Thirty-one children with CP [Gross Motor Function Classification System (GMFCS) levels II-V] showing no structural abnormalities by MRI were enrolled in this study. Regional glucose metabolic activity values were calculated using Scenium software and compared between the right and left cerebral hemispheres. These comparisons revealed asymmetric metabolic reductions in the central region, cerebellum, frontal lobe, and parietal lobe (p < 0.01). We next determined whether averaged brain metabolic activity values in different brain regions correlated with GMFCS levels. The metabolic activity values of basal ganglia, left temporal lobe, and cerebellum correlated negatively with GMFCS scores (all p < 0.05). This method was applied to the left cerebellum, which showed higher metabolic activity values than those in the right cerebellum in most patients (83.8%), and these values also correlated negatively with GMFCS scores (Spearman's r = −0.36, p = 0.01). Differential cortical glucose metabolism by 18F-FDG PET, may help to distinguish between different CP diagnoses that are not detected by MRI.

Epidemiology of fractures in children with cerebral palsy: a Swedish population-based registry study

BackgroundChildren with cerebral palsy (CP) form a heterogeneous group and may have risk or protective factors for fractures compared with typically developing children. The fracture sites may also differ from those of children who do not have CP. We analyzed the fracture epidemiology in a total population of children with CP.MethodsThis was a retrospective registry study based on data from the Swedish Cerebral Palsy Follow-Up Program (CPUP) and the Swedish National Patient Register. All children in the CPUP born in 2000–2015 were included. The Gross Motor Function Classification System (GMFCS) level, reported fractures, fracture site, and epilepsy diagnosis were recorded up to 2018. Hazards and hazard ratios were calculated for first-time fractures.ResultsOf the 3,902 participants, 368 (9.4%) had at least one reported fracture. The cumulative risk of sustaining a fracture before age 16 years was 38.3% (95% confidence interval 33.9–42.4). The hazard for fracture was 7 times higher in children with epilepsy. The overall fracture incidence was not statistically significantly related to sex or GMFCS level. Fractures in the upper extremities were most prevalent in children with a lower GMFCS level, and femoral fractures were most prevalent in children at GMFCS level V. Most fractures occurred in early childhood and after 8 years of age.ConclusionsChildren with CP were at similar risk of sustaining fractures as typically developing children, but the risk was higher in children with comorbid epilepsy. Fractures occurred in children at GMFCS levels I–III at sites similar to those for typically developing children; fractures in the upper extremities were the most frequent. Children at GMFCS levels IV or V and those with epilepsy were more likely to have a fracture in the lower extremities, and the femur was the most frequent site.