Severe Forms Of Cerebral Palsy Research Articles

Creatinine as a predictor of muscle mass deficiency in patients with severe cerebral palsy

Energy processes in muscles can be reflected by the creatine phosphokinase system of ATP resynthesis from ADP and creatine phosphate. The product of non-enzymatic degradation of creatine (creatine phosphate) is creatinine, which accumulates in the blood serum, and its concentration correlates with the volume of the patient’s muscle tissue, subject to the normal functioning of the kidneys. Purpose. To assess the perioperative serum creatinine level as a biological marker of muscle mass in patients with severe forms of cerebral palsy, IV–V level according to GMFCS, during orthopedic interventions on the hip joint. Material and methods. A prospective clinical observational study included 82 patients with severe forms of cerebral palsy, spastic dislocations (subluxations) of the hips, for which reconstructive or palliative interventions were performed on the hip joints. The trophological status of children was assessed before surgery, the level of serum creatinine was determined in the intraoperative period, on the first postoperative day, and on the fifth day after surgery. Results. The circumference of the middle third of the shoulder in 28 % of patients, as well as the thickness of the skin-fat fold over the triceps in 61 % of children were below the 10th centile, which was regarded as malnutrition. The calculated proportion of body fat equal to 10 [8; 20] % in combination with the circumference of the muscles of the middle third of the shoulder suggest a combination of protein-energy deficiency and muscle mass deficiency in 1/5 of the patients. Creatinine indicators at all stages of observation corresponded to the minimum age norm or were below these values, tended to decrease and had a random agreement (W = 0,129). Conclusion. The level of creatinine in the blood serum correlates with the «shoulder muscle circumference» parameter in children with severe forms of cerebral palsy, severe movement disorders of IV–V level according to GMFCS. Plasma creatinine can be used as a biological marker of skeletal muscle mass in patients with severe cerebral palsy.

Community-based respiratory health measures in children and young people with cerebral palsy: A scoping review.

To identify, map, and describe outcome measurement domains and instruments used within a community setting to assess respiratory health in children and young people aged 1 to 18 years, diagnosed with cerebral palsy (CP). A scoping review methodology informed structured searches in nine databases, grey literature, and registries, conducted in August 2021 (updated in February 2023). Articles were screened for eligibility by two independent researchers. Any outcome measurement instruments used to assess respiratory health or associated impact were extracted, categorized, and mapped to health and health-related domains of the International Classification of Functioning, Disability, and Health. Seventy-six outcome measurement instruments were identified across 78 articles worldwide between 1970 and 2023. These were categorized into 'Body functions and structures' (n = 20), 'Activity and performance' (n = 22), and 'Participation and quality of life' (n = 19), with a further 15 mapped to 'Health care resources use'. No consensus of 'what' to measure and 'how' to measure respiratory health in children and young people with CP was found. Moreover, many measures were not replicable in individuals with more severe forms of CP, excluding those at increased risk of respiratory-related morbidity and mortality. Further research is required to agree important outcome domains and associated measures in research and clinical practice.

Features of treatment of hip fractures in children with severe forms of cerebral palsy

Features of treatment of hip fractures in children with severe forms of cerebral palsy

Nutritional status of children with severe forms of cerebral palsy undergoing surgical orthopedic treatment for spastic hip dislocation

Nutritional status of children with severe forms of cerebral palsy undergoing surgical orthopedic treatment for spastic hip dislocation

НАРУШЕНИЯ НЕВРОЛОГИЧЕСКОГО РАЗВИТИЯ ДЕТЕЙ, РОЖДЕННЫХ НЕДОНОШЕННЫМИ

There has been a shift in the spectrum of diseases in preterm infants recorded recently: a significant improvement in survival rates has been achieved as well as a decrease in severe forms of cerebral palsy. However, many children born prematurely show manifestations of CNS developmental disorders, which include motor, cognitive and behavioral disorders. Premature birth leads to a slowdown and distortion of neuroontogenesis. The article deals with the morphophysiological prerequisites for neurological development disorders in children born prematurely. The bibliographical data and own studies of neurological disorders and deviations in neuropsychic development in 122 children aged 5 to 8 y/o born prematurely with Extremely low body weight (500 to 999 g, GA 25 to 30 weeks), VLBW (1000 to 1499 g, GA 28 to 33 weeks) and LBW (1500 to 2499 g, GA 31 to 36 weeks) were analyzed. The mechanisms and frequency of occurrence in prematurely born children of violations of general intellectual development, speech, schooling skills, attention deficit and hyperactivity disorder, autism, dyspraxia, tics, tension headache, anxiety and behavioral disorders are discussed. Under conditions of cerebral damage in the developing brain the neuroplasticity - a process of biological adaptation associated with the structure and functional reorganization of the CNS - acquires decisive importance. The developing brain has high neuroplasticity and significant reserve capabilities, which provide the ability of the elements of the nervous tissue for adaptive restructuring and compensatory (restorative) capabilities of the brain.

Modern approaches to visual rehabilitation of patients with neuromotor disorde

Background. Approximately 50 % of children with cerebral palsy have vision problems, manifested in strabismus, impaired eye mobility, refractive errors, nystagmus development and partial atrophy of the optic nerve.The aim: to present a clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy (CP).Materials and methods. A clinical case of combined correction of myopia and divergent strabismus in a patient with cerebral palsy is presented. General anesthesia was used to perform a two-stage treatment under one anesthesia: the first stage – laser myopia correction by femtosecond extraction of the lenticule through a small access (SMILE) to both eyes, the second stage was the strabismus correction by performing tenoscleroplasty of the external rectus muscle and resection of the internal rectus muscle of both eyes. The sequence of stages is due to the relative traumatism of strabismus surgery, in some cases, accompanied by a reaction from the bulbar conjunctiva and the cornea in the form of edema, which, during subsequent femtosecond vision correction, can affect the refractive result and worsen visual acuity in the postoperative period.Results. The performed treatment let significantly increase uncorrected visual acuity, achieve a correct and stable eye position, which became the basis for changing the vision nature from monocular to binocular.Conclusion. Thus, modern laser and surgical technologies in combination with an adequate anesthesia allow rehabilitating patients as much as possible in a short time, even with severe forms of cerebral palsy, and significantly improving the quality of life.

Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects.

Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.

The paradoxical relationship between severity of cerebral palsy and renal function in middle-aged adults: better renal function or inappropriate clinical assessment?

Purpose To determine the association between severity of cerebral palsy with serum creatinine (sCr) and sCr-based equations to estimate glomerular filtration rate (eGFR), a marker of renal function. Methods A clinic-based sample of 30–64 year-olds with cerebral palsy was examined and stratified by motor impairment: gross motor function classification system (GMFCS) I/II (n = 79), GMFCS III (n = 78), and GMFCS IV/V (n = 137). sCr, which is influenced by muscle mass, was obtained and sCr-based eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Results sCr was lower with increasing GMFCS. The opposite pattern was observed for eGFR: GMFCS IV/V had significantly higher eGFR derived from MDRD compared to other GMFCS groups; GMFCS III had significantly higher eGFR compared to GMFCS I/II. The pattern was similar for CKD-EPI derived eGFR. Conclusions According to widely used clinical assessment methods for renal function, higher severity of cerebral palsy among adults is associated with better renal function, which is incongruent with their other biological systems. This paradoxical relationship is likely driven by lower muscle rather than true renal function, and thus, sCr-based eGFR may overestimate renal function, especially for GMFCS IV/V. Further prospective studies are needed. Implications for rehabilitation Common methods of clinical assessment may over-estimate renal function for adults with cerebral palsy (CP), potentially giving a false positive for normal renal health due to their reliance on muscle mass. This study of a clinic-based sample of middle-aged adults with CP highlights the paradoxical relationship between severity of CP and renal function, which is likely driven by methodological limitations in the presence of low muscle mass rather than actual better renal function. It is recommended that clinicians have a high suspicion of abnormal renal function and the need for a nephrology consultation, especially with changes in creatinine levels, even within the normal range. Rehabilitation for adults with CP must have a strong focus on muscle and kidney health, especially for patients with more severe forms of CP.

Data on cerebral palsy in Vietnam will inform clinical practice and policy in low and middle-income countries

Purpose To document known risk factors, clinical severity, associated impairments and rehabilitation status of children presenting with cerebral palsy (CP) to the National Children’s Hospital (NCH) in Hanoi, Vietnam. Materials and methods Active prospective ascertainment of cases of CP presenting between June and November 2017 to the NCH using surveillance modelled on the Paediatric Active Enhanced Disease Surveillance system in Australia. Results Data were collected on 765 children with CP (mean age: 2 years 7 months (SD 2 y 6 mo). Mean age at diagnosis was 1 year 8 months (SD 1 y 9 mo). Children predominantly had spastic CP (95.2%, n = 729), most were quadriplegic (69.6%, n = 532) and 60.3% (n = 454) were Gross Motor Functional Classification System level III-V. Of the children 76.2% (n = 583) had one/more associated impairments. 36.3% (n = 276) had presumed perinatal asphyxia, 26.5% (n = 202) were preterm. Physiotherapy (94.3%, n = 663) was the most common form of intervention used. Only 2.6% (n = 12) of the children who would have benefitted from assistive devices had wheelchairs. Conclusion We established hospital-based surveillance of CP in Hanoi and confirmed a high burden and severity of CP with potentially preventable risk factors. These data will inform clinician training and health policy and identify need for evidence-based care and assistive devices. IMPLICATIONS FOR REHABILITATION We identified a high number of children with severe forms of cerebral palsy (CP) in Hanoi, Vietnam through hospital-based surveillance. There is an urgent need for clinician training and access to and use of evidence-based interventions including assistive technology. This study will inform local capacity building and health policy for improved diagnosis and care of children with CP in Vietnam and other low and middle-income countries.

Neuroimaging patterns of anatomical features in pediatric cerebral palsy patients at Ayder hospital, Mekelle, Ethiopia.

BackgroundNeuroradiological studies have greatly improved the knowledge and diagnoses of cerebral palsy with its underlying pathology, types and accompanying changes in brain morphology. However, there is no published study on cerebral palsy neuroimaging patterns in Ethiopia.MethodsRetrospective chart and neuroimaging reviews were conducted among pediatric patients, who attended Ayder Comprehensive Specialized Hospital between January 2016 and August 2019, fulfilling the study criteria. The magnetic resonance images and computed tomography scans reviewed by a neuroradiologist and/or pediatric neurologist were included. Data was collected using a structured checklist and analyzed using SPSS statistical software version 22. Results were represented using tables, graphs and images.ResultsThe median age at neuroimaging was 2 years. There were more males (54.5%) than females (45.5%) with a male: female ratio of 1.2:1. Majority of the patients had magnetic resonance (81.8%) as opposed to computed tomography scans (18.2%). Most of the patients (69.7%) had been born at term with spastic quadriplegia (33.3%) found to be the leading type of cerebral palsy. 30.3% of the patients had normal neuroimaging studies whereas 69.7% had neuroimaging abnormalities. Anomalies included pathologies of the white matter (18.2%), basal ganglia (15.2%), cortex and lobes (27.3%), corpus callosum (6.1%), lateral ventricles (12.1%), cysts (18.2%) and cerebellum (3%), respectively. Other findings were seen in 45.5% of the patients.ConclusionSevere forms of cerebral palsy (spastic quadriplegia) were most common with majorly cortical and subcortical brain involvement.

Silent sounding: Communicability, musicality, and the use of music with nonspeaking individuals with cerebral palsies and multiple disabilities

ABSTRACT Introduction This study explores the intersubjective potentials of nonspeaking young individuals with the more severe forms of cerebral palsy through their musicality and appropriation of music. Here, these forms are called cerebral palsies and multiple disabilities (CPMD). Method A pluralistic research approach, specifically a combined qualitative approach was applied due to the sensitive and unexplored population. The philosophical framework was IPA, suitable for studying unique persons or phenomena in given contexts. A three-interview series was applied. First, the communicability, musicality, and the musicking of six individuals with (CPMD) were studied through two semi-structured life world interviews with their parents: five Israeli women and one man, religious and non-religious Jews in their 40s. Musical home videos were viewed during every second interview. Grounded theory (GT) coding took place with the transcribed interviews and the researcher’s journal. GT was not aimed to generate theory, but gain an additional perspective and thicker data. Subsequently, the GT findings were discussed with the parents through a third interview, and the results were finalized with IPA analysis. Findings Three superordinate themes emerged in relation to the musicality, appropriation of music in everyday life, and the parents’ low awareness of their children’s potentials. Discussion Parental-professional collaboration and a consumer-led approach are recommended in order to improve the parents’ low awareness of their children’s potentials, and to encourage more aware use of music’s affordances. The study’s limitations are discussed and future directions suggested.

Influence of Robotic Mechanotherapy in Various Combinations with Non-Invasive Electrostimulation of Muscles and Spinal Cord on the Postural Balance in Children with Severe Forms of Cerebral Palsy

Introduction. Postural disorders are significant in severe forms of cerebral palsy (CP). The aim of the work was to study the effect of locomotor training in combination with transcutaneous electrical stimulation of the spinal cord and functional electrical stimulation (FES) of the muscles of the lower extremities on the restoration of the function of maintaining a vertical posture in children with III level of limitation of motor activity according to the GMFCS classification. Materials and methods. 20 patients with CP at the age from 8 to 12 years old were examined. Patients of the main group (10 children) received 15 sessions of 45 minutes rehabilitation in the ≪Lokomat≫ robotic simulator in the sequence: 1) ≪Lokomat≫ in combination with FES, 2) ≪Lokomat≫ in combination with transcutaneous electrical stimulation of the spinal cord, 3) ≪Lokomat≫ in combination with FES and transcutaneous electrical stimulation of the spinal cord. The intervals between courses were 6 months. Patients from the control group (10 children) underwent only locomotor training. Results. The dynamics of regaining control of the upright posture in children was evaluated by the method of stabilometry, which revealed the active response of the musculoskeletal system in patients of the main group only in the case of combined robotic mechanotherapy and FES. This was manifested in a significant increase in the amplitude of oscillations A of the pressure center, a clear increase in the variance of the parameters of the LFS parameter, and a decrease in the strength of the correlation between the parameters LFS and A towards normalization. However, with a combination of locomotor training with FES and transcutaneous electrical stimulation of the spinal cord, there were no convincing signs of improving the regulation of the vertical posture. Conclusion. It is suggested that multilevel neurostimulation of patients with CP is necessary, which may be more effective, since it will affect the central components of motor activity.

Gait biometrics in children with cerebral palsy before and after robotic mechanotherapy

Background. The improvement in existing methods and the development of new principles for treating children with cerebral palsy necessitates a quantitative assessment of the parameters of motor activity. However, because of the explicit and complex abnormalities in motor skills in patients with severe forms of cerebral palsy, an evaluation of their locomotor function dynamics using instrumental diagnostic methods remains a serious problem.
 Aim. This work aimed to study the walking function in patients with cerebral palsy before and after motor rehabilitation using a biomechanical method with biometric sensors.
 Materials and methods. We examined 14 patients with cerebral palsy aged 8 to 13 years with III level of restriction of motor activity according to the gross motor function classification system (GMFCS). All patients underwent rehabilitation in the Lokomat robotic simulator for three weeks. The course consisted of 15 sessions of 45 min each. The temporal and dynamic parameters of walking were studied in 14 patients with cerebral palsy before and after a course of locomotor training. The biometry of the step cycle was studied using the STEDIS hardware-software complex, including the Neurosens set of wireless biometric sensors. The temporal characteristics of the step cycle and the force interaction of the lower extremities with the supporting surface during walking were recorded. For comparison, we conducted a biomechanical examination of 18 healthy children of the same age who did not have signs of orthopedic disorders.
 Results. Although after a course of mechanotherapy, the indices of the support phases in biometry in children with cerebral palsy did not reach the level of healthy individuals, a physiological tendency to roll foot was observed in the phase of pushing and accelerating the foot. Active braking of the lower limb increased. The studied time parameters showed a relative improvement in the step structure because of the emerging tendency to normalize the ratio of the periods of the double support of the contralateral lower extremities.
 Conclusion. Robotic mechanotherapy helps to change the biomechanical pattern of walking of a child with a severe degree of cerebral palsy. An instrumental analysis of walking using wireless biometric sensors allows you to evaluate the results and effectiveness of rehabilitation measures in patients with severe motor impairment objectively.

In clinical practice, cerebral MRI in newborns is highly predictive of neurodevelopmental outcome after therapeutic hypothermia.

In the trials, a substantial proportion of newborns who underwent therapeutic hypothermia (TH) had an adverse outcome after hypoxic-ischaemic encephalopathy (HIE). Cooled babies were noted to have fewer cerebral lesions on MRI but when present lesions were predictive of adverse outcome. We investigate the predictive value of cerebral MRI in babies who undergo cooling in the clinical setting outside of the clinical trials in a prospective UK cohort. Of 75 babies recruited from four centres, neurodevelopment was available for 69 (92%) with 29% (20/69) being abnormal. The unfavourable MRI group (n=22) had significantly lower motor (p<0.001), language (p<0.001) and cognition (p<0.001) scores on Bayley-III assessment, compared to the favourable MRI group (n=47). On multiple regression there was a significant relationship between basal ganglia and thalami abnormality and motor (p=0.002), cognition (p=0.011) and language (p=0.013) outcomes. Half of the babies who had an MRI predictive of adverse outcome (11/22) had highest grade cerebral palsy. Cerebral MRI had 95% sensitivity, 94% specificity, 91% PPV and 98% NPV in predicting neurodevelopment. In this clinical cohort, fewer children had adverse neurodevelopment after TH compared to the TH trials. However, half the children who had an MRI predictive of adverse ND outcome had the most severe form of cerebral palsy. In this cohort, cerebral MRI was found to be highly predictive of neurodevelopmental outcome.

Long-term follow-up of achillotenotomy in patients with cerebral palsy

Introduction: The surgical solution of equinus deformity is one of the most important factors in the treatment of patients with cerebral palsy. We perform open Z achillotenotomy and percutaneus triple hemisection routinely in our department. Aim: The goal of our work was to analyze the long-term results of achillotenotomies in patients with cerebral palsy, to look for predisposing factors of major complications, and to compare the results of the performed operative methods. Method: Between 1990 and 2006, we performed 347 surgical Achilles tendon lengthenings. In 261 cases, the operations were performed percutaneusly, and in 86 cases we performed open Z achillotenotomy. The average follow-up time was 15 years. The long-term outcomes were analyzed based on the age at surgery, the topographic appearance and the severity of cerebral palsy. Analysis regarding functional outcome was based on the widely known Physician Rating Scale system. Results: Due to recurrent equinus deformity, re-achillotenotomy was performed in 74 cases (21.3%), and in 14 cases (4%) the re-achillotenotomy needed to be performed a second time. We encountered overcorrection and calcaneus deformity in 12 cases (3.5%). Recurrence rate was higher in patients operated at a younger age (<7 years) and in patients with a more severe cerebral palsy (GMFCS II-III, ~26%). Recurrence showed accumulation in patients 9-14 years old. Conclusion: The major complication we encountered was recurrence of the equinus deformity. The majority of relapses occured in patients who were operated at a younger age and suffered from a more severe form of cerebral palsy. We observed that recurrence showed an association with growth and accumulated in aldolescence. Orv Hetil. 2020; 161(8): 306-312.

Rehabilitation of spastic tetraplegia in pediatrics: advantages of hydro-kinesitherapy

Background: At the base of this study there is the rehabilitation of spastic tetraplegia observed in a pediatric setting. Spastic tetralgia is a severe form of cerebral palsy (PCI), including all four limbs and characterized by rigidity or permanent contraction of the affected muscles. The latter is a persistent but not immutable disorder of posture and movement due to alterations in brain function due to pre-, peri- or post-natal causes, before the growth and development of the central nervous system is completed. Objective: To demonstrate how a treatment of at least 6 months can give satisfactory results, even in pathological conditions such as tetraplegia. Attention is paid to treatment methods, and therefore to the rehabilitation of this pathology from the point of view of physio-kinesitherapy. Methodology: An investigation and an experimental study was conducted using interviews and treatments of referred patients 2-10 years old. The interviews were carried out with parents coming from Tirana and suburbs. Data collected showed us the specific needs of each child living with the family and it was created a tailored rehabilitation plan for each of them. Results: Despite suffering from a severe condition, there have been significant improvements in the generic framework, especially on the activities of daily life, thus alleviating the difficulties these children are facing. The handling of each child with empathy and personalized care is needed to obtain satisfactory results. Conclusion: Results showed how all the children taken in charge had an improvement in their quality of life. Their communication and even collaborative skills have improved.

Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika

ObjectiveTo describe the neurological and neurodevelopmental features at 1 year of age in children with cerebral palsy (CP) related to probable congenital Zika (CZ), followed in a referral neurorehabilitation hospital. MethodsData on 82 children with CP associated with probable CZ, who consecutively attended the neurodevelopmental and neurological assessment around one year of age, were collected. For neurodevelopmental evaluation, Bayley-III Scales of Infant and Toddler Development was used. Descriptive statistical analysis was performed. ResultsThe children were admitted into the rehabilitation program at a young age (mean age: 4.8 months, SD 3.1), followed beyond the first year of life (mean age of follow up: 13.2 months, SD 2.1), born to young mothers (mean age: 28.1 years, SD 5.9), in their first pregnancy (62.2%). The majority had severe congenital microcephaly (62.0%), spastic CP (96.3%), epilepsy (63.4%), absent expected postural reactions (93.2%), abnormal persistence of primitive reflexes (94.7%), and severe neuroimaging abnormalities, predominantly calcifications (97.6%). Extremely low performances on cognitive (95.1%), language (97.6%) and motor (97.6%) developmental composite scores were observed. There was a correlation between the cognitive score with the birth head circumference (HC) (r = 0.3, p = 0.01) and with the follow up HC (r = 0.4, p < 0.01), as well as between the follow up HC with the motor score (r = 0.2, p = 0.03). ConclusionCongenital Zika may be associated with a severe form of CP, mainly bilateral spastic, with a severe global neurodevelopmental impairment and early signs of a poor prognosis for independent walking. Head circumference may be a prognostic marker among those children. These results may help establish goals for the rehabilitation program and identify priority health services.

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.

Осложнения при паллиативных вмешательствах при вывихе бедра у пациентов с ДЦП

Introduction Hip dislocation is one of the most severe orthopedic complications among the problems in patients above 10 years of age with severe forms of cerebral palsy (CP), when reconstructive intervention is impossible. The purposes of palliative surgical orthopedic treatment in patients of this category consist in elimination or reduction of the pain syndrome, as well as elimination of the hip faulty position, possibility of limb free mobilization, improving the patient’s care conditions. Proximal femoral resection arthroplasty and valgus support osteotomy of the proximal femur combined with head resection are the main methods of palliative surgical treatment. Purpose To evaluate the encountered errors and complications, as well as to compare the authors’ own observations with the literature data. Materials and Methods The authors analyzed the complications encountered in the process of palliative surgical treatment (37 surgeries) of the hip dislocation in 22 patients which represented severe forms of motor disorders for spastic CP forms. Level V by GMFCS was observed in nine (9) cases, Level IV – in 13 cases. Proximal arthroplastic resection was performed in 11 cases (Group 1), proximal valgus support osteotomy – in 26 cases. Results The authors observed five (5) complications in Group 1 after 11 interventions (45.5%). Correction of the developed complications led to the full achievement of the desired result of treatment in five of six patients from this group (83.3%): disappearance or significant reduction of the pain syndrome, ease of hygiene, a comfortable sitting position. In Group 2 where the purpose of treatment aside from the pain syndrome elimination, the increase in the range of passive hip mobilization and achieving the proper postural management consisted in creating the conditions for passive verticalization with the lower limb support, seven (7) complications occurred after 26 interventions (26.9 %). The proper result of treatment was achieved in 24 of 26 hips after surgical correction of the complications (92,3%). Conclusion In most cases, surgical intervention is required in order to eliminate the complications after the palliative intervention, that allows, in general, achieving the desired result of treatment. When the severe pain syndrome develops due to mechanical conflict between the hip and pelvic bones through heterotopic ossifications and marked periosteal stratifications, the femoral arthroplastic resection after palliative interventions allows controlling the pain syndrome, restoring the hip passive mobility, providing postural management, but not to impart weight-bearing to the limb. It’s necessary to use only the plates with angular stability and without placing the screws in the direction of the acetabulum.

Pain report and musculoskeletal impairment in young people with severe forms of cerebral palsy: A population-based series

BackgroundWhile pain is reportedly more prevalent in more functionally impaired children with cerebral palsy, information is scant in those with poor communication skills. MethodsYoung people (4–27 years) with severe forms of cerebral palsy were recruited from a population-based register. The Child Health Questionnaire (CHQ) provided information on general health and bodily pain; the Paediatric Pain Profile (PPP) was used for participants with limited communication; and the Spinal Alignment and Range of Motion Measure (SAROMM) described musculoskeletal impairment. Results123 young people (GMFCS IV=55 and V=68) and their families/carers participated. Fourteen percent of CHQ responses (n=123) reported severe/very severe pain in recent weeks, whilst 7% reported pain every/almost every day. CHQ pain report was significantly higher for young people in GMFCS level V and correlated significantly with both global health and musculoskeletal impairment. High levels of pain were recorded on the PPP for non-communicating children but only a weak correlation between PPP and CHQ scores was detected. ConclusionManaging pain in young people with severe musculoskeletal and cognitive impairment presents a huge challenge to carers and professionals. The PPP may represent a useful adjunct in those young people with severe communication difficulties.