Spastic CP Research Articles

Research of the spatial-temporal gait parameters and pressure characteristic in spastic diplegia children.

Spastic diplegia is the most common form of cerebral palsy. It presents with symmetric involvement of the lower limbs and upper limbs. Children with spastic diplegia frequently experience problems with motor control, spasticity, and balance which lead to gait abnormalities. The aim of this study is twofold. Firstly, to determine the differences in spatial-temporal gait parameters and magnitude of plantar pressure distribution between children with spastic diplegia (CP) and typical children. Secondly, to compare and evaluate main changes of plantar pressure and spatial-temporal gait parameters instead of data between spastic diplegia children with prescribed ankle - solid foot orthosis (AFOs) and without using AFOs. The evaluation was carried out on 20 spastic diplegia children and 10 agematched children as a control group aged 6-15 years. Twenty children with spastic diplegia CP were divided into two groups: ten subjects with prescribed AFOs and ten subjects without use of assistive device. Patients used the AFOs orthosis for one year. Measurements included in-shoe plantar pressure distribution and spatial-temporal gait parameters. Spatial-temporal gait parameters showed meaningful difference between study groups in velocity, stride length, step length and cadence ( p < 0.05). However no significant differences between patients with and without AFOs were found ( p > 0.05). Significant differences between typical and spastic diplegia children with AFOs were observed in the magnitude of plantar pressure under the toes, the metatarsal heads, the medial arch, and the heel ( p < 0.05). For typical subjects, the highest pressure amplitudes were found under the heel and the metatarsal heads, while the lowest pressure distribution was under the medial arch. In CP patients the lateral arch was strongly unloaded. The peak pressure under heel was shifted inside. Collected data and calculated scores present a state of the gait in test groups, showed the difference and could be valuable for physicians in decision making by choosing qualitative therapy. Furthermore, it allows predicting probability of further possible changes in gait of spastic diplegia patients with AFOs and without it. In conclusion, our current results showed that the use of AFOs, prescribed on a clinical basis by doctors improves gait patterns and gait stability in children with spastic cerebral palsy.

Visual-Based Training Program for Motor Functions in Cerebral Palsied Children with Cortical Visual Impairment

Background /Aim: Cortical visual impairment (CVI) is a temporary or permanent visual dysfunction resulting from damage to the visual systems in the brain that deal with processing and integrating visual information. The aim of current study was to investigate the effect of visual- based training program on motor functions in CP children with CVI. Methods: Twenty six spastic CP children with CVI from both sex, ranged in age from 2 to 4 years, participated in this study. They were randomly assigned to two groups of equal number; control (I) and study (II) groups. Children in group I received the conventional physical and occupational therapy program inside the normally lighted room. Children in group II received the same program given to group I using visual stimulation modalities inside the sensory room. Treatment duration for both groups was 2½ hours, 3 days per week for a successive three months. Gross and fine motor functions were evaluated before and after treatment using Gross Motor Function Measure Scale (GMFM) and Peabody Developmental Motor Scale (PDMS) respectively. Findings: This study showed a statistically significant improvement of gross motor skills in both groups (P=0.001), however, a significant difference was seen between both groups, but in favor to group II (P=0.000). Regarding fine motor skills, no significant improvement was seen in group I (P=0.15) however, significant improvement was obtained in group II (0.001) after treatment. Conclusion: Training of gross and fine motor skills using visual stimulation modalities inside sensory room is effective for CP children with CIV to improve their gross and fine motor functions. Key words: Cerebral palsy, Cortical visual impairment, Visual stimulation, Occupational therapy

The effect of seizures on functional status of people with spastic forms of cerebral palsy

SummaryBackground.Cerebral palsy (CP) is the most common childhood motor impairment. Epilepsy affects approximately one third of patients with CP. It is characterized by earlier disclosure, it is more severe and shows greater resistance than that of the general epilepsy treatment, associated with necessity for polytherapy. Its presence can result in gradual loss of function, loss of posture in non-ambulant individuals with severe disabilities and cognitive impairment risk, behavioural disorders and reducing probability of walking.Aim.The aim of the study was to evaluate the functioning of people with CP with and without epilepsy.Material and Methods.The study included 210 patients with a diagnosis of CP, aged 0–18 years. The study was conducted among the patients using the physiotherapy services in centres in southern Poland. The study used the Paediatric Evaluation of Disability Inventory (PEDI) and the classification systems: GMFCS, MACS, and CFCS.Results.There were significant differences with regards to social functioning (53.7/67.4; W = 179, p = 0.006) and support in the social functioning (65.4/89.9; W = 185.5, p = 0.007) in patients with diplegia. However, mobility (19.55/29.00; W = 392, p = 0.018) and the social functioning (36.95/44.1; W = 418.5, p = 0.042) were lower in epileptic patients with tetraplegia. In patients with hemiplegia, there were no significant differences, although each domain with epilepsy subgroup had a lower rating than the subgroup without epilepsy.Conclusion.The presence of epilepsy is associated with lower levels of social function in patients with cerebral palsy; particularly, with regard to mobility and selfservice.Assessment of epilepsy impact on the level of social functioning of people with CP (diplegia, tetraplegia, hemi-plegia) is difficult because ambiguous relationship with mental retardation. The assessment should be undertaken separately for each group of spastic CP.

Clinical decision making in spastic bilateral CP – Planning interventions using clinical gait analysis: A case study

Strategy of development of the organization is the major factor influencing organizational structure of management. Design of organizational structure of management has to begin with the formulation of strategy of the organization. In article strategy of development of the organization are considered and the best are assumed for them types of organizational structure of management. It is connected with that certain mechanisms which are a part of a certain organizational structure are necessary for successful realization of strategy of development. In article strategy of development of the petrochemical enterprises of the Russian Federation are also analyzed.

OP33 – 2365: Treatment with botulinum toxin of children with cerebral palsy has no added therapeutical value or cost-effectiveness for gross motor function, everyday physical activity levels or quality of life when combined with intensive functional physiotherapy

Objective Since 20 years, children with spastic CP are increasingly treated with botulinum toxin typeA (BtA) followed by intensive physiotherapy (iPT). The added value of BtA remains unclear. We therefore compared (cost-)effectiveness of BtA+iPT versus only iPT treatment in a (partly) randomized controlled trial. Methods Sixty-five children aged 4–12 years participated, 41 received BtA+iPT and 24 only iPT. Measurements were performed after a 12-week iPT period (primary endpoint) and 12 weeks thereafter (24week follow-up). Primary outcome measures were: actual everyday physical activity levels measured with ambulatory monitoring devices (Actigraph-AG, 7day monitoring), (health related) quality of life measured with several questionnaires (Health Utility Index, Child Health Questionnaire, DISABKIDS-questionnaires), and gross motor function measured with the GMFM (item set version). Economic evaluation was performed according to Dutch guidelines taking a societal perspective. Results No statistically significant evidence was found for added value of BtA injections in BtA+iPT treatment for the primary outcomes. At primary endpoint, we found trends towards an intervention effect in favor of only iPT for improving gross motor function (GMFM; p=0.095, ES=1.12, 95%CI[-0.20:2.44]) and decreasing the % sedentary behavior during everyday physical activity (AG%sed; p=0.087, ES=–2.59, 95%CI[-5.58:0.39]). At 24week follow-up, we found a trend – also in favor of iPT – towards improving quality of life (DISABKIDS-smileys-proxy-version; p=0.066, ES=5.9, 95%CI[-0.40:12.20]). We found one trend in favor of BtA for improving everyday physical activity counts per minute (AGcpm; p=0.064, ES=91, 95%CI[-6:188]). Average treatment costs (including plaster and AFO) were significantly higher in BtA+iPT than in iPT (8.963 euro versus 6.182 euro, p=0.001). Conclusion We conclude that adding BtA to iPT in combined BtA+iPT treatment does not improve effectiveness (at the group level) and that adding BtA is also not cost-effective when treatment is aimed at improving gross motor function, everyday physical activity levels or quality of life.

Cerebral palsy in children in Kampala, Uganda: clinical subtypes, motor function and co-morbidities.

BackgroundCerebral palsy (CP) is a common chronic childhood disorder worldwide. There is limited information about the CP panorama in sub-Saharan Africa. Our aim was to describe the clinical subtypes, gross and fine motor functions and presence of co-morbidities in a group of children with CP attending a tertiary hospital in Uganda.MethodsChildren with CP in the age range of 2-12 years visiting the paediatric CP clinic at Mulago Hospital, Kampala, were enrolled. Screening and inclusion were based on a three-stage procedure: i) Two screening questions from the Ten Question Screen; ii) Clinical assessments adapted from the Surveillance for Cerebral Palsy in Europe (SCPE); iii) Clinical examinations and diagnoses of subtype, severity level and co-morbidities. Caregivers were interviewed using questionnaires to provide information on child’s medical history and co-morbidities. Co-morbidity scores were calculated for each child.ResultsOne hundred and thirty five children with CP were enrolled (72 males, 63 females, median age 3 years 5 months, IQR-2 years 4 months-5 years 6 months). Bilateral spastic type was commonest (45%); moderate impairment in gross motor function was present in 43%, with comparable numbers (37%) in the mild and severely impaired fine motor function groups. The severe gross and fine motor function levels were seen in the bilateral spastic and dyskinetic CP subtypes.Signs of learning disability (75%) and epilepsy (45%) were the commonest co-morbidities. Higher co-morbidity scores were obtained in children with dyskinetic CP and severe levels of gross and fine motor function. There was a significant difference in distribution of the co-morbidity scores between the CP subtypes, gross motor and fine motor function levels (p <0.001). Signs of speech and language impairments were associated with bilateral spastic CP and severe gross and fine motor dysfunction (p < 0.05).ConclusionsBilateral spastic CP was the main clinical subtype, with signs of learning disability and epilepsy as major causes of co-morbidity. The severity of gross and fine motor function levels was related to severity of clinical CP subtypes. Our findings imply a higher occurrence of birth asphyxia or post natally acquired infections. Improvement in emergency obstetric and postnatal care may reduce this burden.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1125-9) contains supplementary material, which is available to authorized users.

Interarticulator coordination in children with and without cerebral palsy

The current study investigates how interarticulator coordination changes across speaking tasks varying in articulatory and linguistic demands for children with CP and their typically-developing peers. Articulatory movements from 12 children with spastic CP (7M, 5F, 4–15 years of age) and 12 typically-developing age- and sex-matched peers were cross-correlated to determine the degree of spatial and temporal coupling between the upper lip and jaw, lower lip and jaw, and upper and lower lips. Spatial and temporal coupling were also correlated with intelligibility. Results indicated that children with CP have reduced spatial coupling between the upper and lower lips and reduced temporal coupling between all articulators as compared to their typically-developing peers. For all participants, sentences were produced with the greatest degree of interarticulator coordination when compared to the diadochokinetic and syllable repetition tasks. Measures of interarticulator coordination were correlated with intelligibility for the speakers with CP.

Reduced satellite cell number in situ in muscular contractures from children with cerebral palsy.

Satellite cells (SC) are quiescent adult muscle stem cells critical for postnatal development. Children with cerebral palsy have impaired muscular growth and develop contractures. While flow cytometry previously demonstrated a reduced SC population, extracellular matrix abnormalities may influence the cell isolation methods used, systematically isolating fewer cells from CP muscle and creating a biased result. Consequently, the purpose of this study was to use immunohistochemistry on serial muscle sections to quantify SC in situ. Serial cross-sections from human gracilis muscle biopsies (n = 11) were labeled with fluorescent antibodies for Pax7 (SC transcriptional marker), laminin (basal lamina), and 4',6-diamidino-2-phenylindole (nuclei). Fluorescence microscopy under high magnification was used to identify SC based on labeling and location. Mean SC/100 myofibers was reduced by ∼70% (p < 0.001) in children with CP (2.89 ± 0.39) compared to TD children (8.77 ± 0.79). Furthermore, SC distribution across fields was different (p < 0.05) with increased percentage of SC in fields being solitary cells (p < 0.01) in children with CP. Quantification of SC number in situ, without any other tissue manipulation confirms children with spastic CP have a reduced number. This stem cell loss may, in part, explain impaired muscle growth and apparent decreased responsiveness of CP muscle to exercise.

Asymmetric pelvic and hip rotation in children with bilateral cerebral palsy: Uni- or bilateral femoral derotation osteotomy?

Internal rotation gait is common among children with bilateral cerebral palsy. However, despite bilaterally increased femoral anteversion asymmetric internal rotation gait is often found. Femoral derotation osteotomy (FDO) is commonly performed bilaterally. Variable functional outcomes are reported especially in cases with mild internal hip rotation during gait and abnormal preoperative pelvic rotation. A major question is if a unilateral treatment of the more involved side in asymmetric cases leads to a comparable or even superior outcome.One hundred and nine children with spastic bilateral CP treated with FDO with pre- and 1-year postoperative 3D gait analysis were retrospectively collected. The asymmetry was calculated from the preoperative difference between both limbs in hip rotation obtained by 3D gait analysis. Twenty-eight children with asymmetry larger than 20° were selected and classified into two groups, according to whether they obtained a unilateral or bilateral FDO.Preoperative clinical examination and pre- and postoperative hip and pelvic rotation in gait analysis on the more and the less involved side did not differ significantly between both groups. Interestingly, in both groups, hip rotation did not change significantly in less-involved limbs, although intraoperative derotation averaged 25°. After unilateral FDO a significant change in pelvic rotation resulted, whereas this was not found after bilateral FDO.The results of this study suggest that unilateral FDO in children with asymmetric internal rotation gait leads to a comparable functional outcome compared to bilateral treatment. Furthermore, it was shown for the first time that considering the asymmetry has a positive effect on pelvic rotation.

Treatment of Spasticity with Baclofen Pump Implantation: A Clinical Prospective Study.

Background Data : The use of an implantable infusion pump for the treatment of spasticity is to provide the patient with lower dose that the patient is taking at the present time, and this small dose will be given in a steady fashion in the form of drip irrigation. The drip irrigation is through a small plastic catheter and in minute amounts continuously. Objective : to assess the efficiency of Baclofen pump implantation in patients with spasticity. Methods : This is a clinical prospective study of 20 patients with an implanted device of Intra thecal Infusion pump to treat cerebral and spinal spasticity (12 male age from 12 to 72 years, 8 female age from7 to 60 years) operated in the department of neurosurgery, Neurosciences hospital, Baghdad, Iraq, from October 2011 to December 2012.We evaluated the Presenting symptoms and sings before the operation and measured the outcome postoperatively. Results : The incidence of complications in ITB surgeries was 15% (3 of 20 patients) all of them were male. Satisfactory results was 90% (18 patients of 20), more obvious in pediatric age group (improvement in spasticity’s scale the postoperative complications were recorded are early emptiness of the infusion pump (withdrawal symptoms) The most common drawback that the patient had been seen in our practice is unavailability of the in our institutes nor in the private sectors and it is very expensive indeed and made a burden on their family. Conclusions : ITB is an excellent method of treating spastic CP generalized secondary dystonic CP, and patients with spinal cause of Spasticity (trauma, multiple sclerosis), with few complications.

The effects of Neuro-Developmental (Bobath) therapy based goal directed therapy on gross motor function and functional status of children with cerebral palsy

AIM: The aim was to investigate the effects of the neurodevelopmental based goal directed therapy (GD-NDT) on the motor functions, daily living activities of children with CP. METHOD: 26 children with spastic CP, 14 males (53.8%) and 12 females (46.2%) ,mean age 9.5 ± 3.2 years were included. GMFCS levels were, I in 42.3%, II in 3.8% level, III in 15.4%, IV in 11.5% and V in 26.9%. GD-NDT was applied 3 times a week for 12 weeks. RESULTS: Positive developments after therapy were identified in the gross motor functions of the children (p 0.05). The goals identified for the children before treatment were involved self-care 15.4%, physical activity 17.9%, locomotion and transfer 37.2%, social status and living activities 29.5%. 76.9% of the goals identified were reached; 23.1% were not reached. CONCLUSION: Improvements were found in gross motor functions, independence in daily life and health related quality of life of children with CP who were taken GD-NDT.

Hand use at home and in clinical settings by children with cerebral palsy: a qualitative study.

The purpose of this study was to understand the physical, attitudinal, and assistive characteristics of the home and the therapeutic settings that enable and/or hinder hand use by children with spastic hemiparesis CP. A qualitative study with 7 children with CP, their caregivers, and therapists was conducted. Children were observed at home and in their therapeutic settings to understand the supports and barriers from these environments regarding their use of the affected hand. Semi-structured interviews were conducted with caregivers and therapists. The transcribed interviews and field diaries were used for content analysis. The following thematic categories were drawn from the data analyses: (1) use when needed: from consistent to nonuse of the affected extremity; (2) making decisions: choosing to use or not use the affected extremity; and (3) responsibilities with activities: from complete dependence to independent performance. Discrepancies between caregivers and therapists' attitudes and actions towards children's hands use highlight the specific features from each context that facilitated or hindered children with CP's engagement in functional activities. Recommendations for future studies include investigating the relationship between the identified facilitators and improvements in children's effective hand use in home and clinical settings.

PS-248 Cerebral Mri Findings In Children With Cerebral Palsy (cp) In Norway

Background and aims CP is a clinical diagnosis caused by a brain anomaly or injury early in life. Cerebral MRI is increasingly used in the diagnostic work-up to demonstrate the location and extension of the lesion, and may in addition provide clues to aetiology and timing. The aim of this study was to describe the distribution of different MRI patterns in children with different subtypes of CP. Methods Data on 1178 children (684 boys) born 1999–2008 were retrieved from the CP Register of Norway (CPRN). On the CPRN record form, completed when the children are 5–6 years old, MRI findings are classified as ‘Normal’, white matter injury (WMI), focal or diffuse cortical lesions, lesions of the basal ganglia (BG) and malformations. Results Among the 711 (60.4%) children with CP and available cerebral MRI, 14.2% had ‘normal’ findings; while WMI was the most common lesion (48%), followed by focal cortical (18.6%), diffuse cortical (14.1%) and BG lesions (13.2%). Malformations were found in 8.2% of the children. Among those with WMI, 52% were born preterm and spastic bilateral CP was the most common subtype (47%). 80% with focal cortical lesions had unilateral CP. Among those with normal MRI the spastic bilateral subtype was most common (48.5%). Conclusions Cerebral MRI scans were performed in more than 60% of Norwegian children with CP at age six. Nearly 50% had lesions consistent with an injury associated with preterm birth (WMI), whereas only 13% had BG lesions considered to typically reflect intrapartum events.

Addressing muscle performance impairments in cerebral palsy: Implications for upper extremity resistance training

Study designCase study and literature review. IntroductionMuscle performance consists of not only strength but also muscle power, rate of force development, and endurance. Therefore, resistance training programs should address not only the force-generating capacity of the muscle but also the ability to produce force quickly. PurposeTo discuss the National Strength and Conditioning Association's resistance training guidelines for youth as specifically related to optimal dosing for muscle strength versus muscle power. Dosing parameters of frequency, volume, intensity, duration, and velocity are discussed independently for strength and power. MethodsWe describe how resistance training principles can be applied to the upper extremity in CP through a case study. The case describes an individual with spastic CP, who has a severe motor disability and is non-ambulatory, but has been able to perform resistance training focused on speed, power, and strength. DiscussionRecommendations to optimize the dosing of this individual's resistance training program are made.

Foot progression angle change in spastic diaplegia cp subjects following semls

s / Gait & Posture 39S (2014) S1–S141 S35 Fig. 1. X-ray showing the resected fibula. Fig. 2. X-ray showing the reconstructed mandibula. area as well as for large defects of long bones following trauma or tumor-related resection [2,3]. Several studies have evaluated the functional outcome and donor site complications following resection of the fibula e. a. [4,5]. Only one study performed a full three-dimensional gait analysis: one and three months postoperative [6]. The purpose of this study was to investigate possible gait disturbances after resection of the fibula using preoperative and one year postoperative gait analysis. Patients/materials and methods: In this study data of nine patients (mean age: 43.4 (14.8) years, four men, five women) were analysed. The fibula was used as donor site for the reconstruction of the face in seven patients and for the reconstruction of the humerus in two patients. Patients underwent a standardized clinical exam and three-dimensional gait analysis preand after 10.5 (5.3)months postoperatively. Kinematic, kinetic and time-distance parameters were calculated for the involved and non-involved leg. Statistical analyses were performed with non-parametric tests (Figs. 1 and 2). Results: The analysis of the kinematic parameters showed a significant increase in hip extension (∼6◦) and a decrease in hip flexion (∼6◦) in both legs during gait (p<0.038). For the involved leg a small decrease (∼3◦) in maximal plantarflexion was found (p=0.021), which led to a decrease in the maximal plantarflexion moment and power (p=0.051). No differences were found in the kinematics of the knee, kinetics of hip and knee or the time-space parameters (stride length, stride time and speed). Discussion and conclusions: The changes in the hip kinematics are likely the result of an offset in pelvic tilt induced by marker placement at the pelvis which is transferred as an offset onto the hip motion. Further, the results found in this study correspond to the work of Lee et al. [6], who found small differences one month postoperatively and a reduced peak plantarflexion in swing three monthspostoperatively. Thedifferenceswhichwere foundare clinically not relevant and the reduced plantarflexion can likely be Chart 1. Foot progression angle in spastic diaplegia CP subjects before surgical correction (blue) and at follow up (green), with normal values (orange) with 95% confidence intervals. normalized by therapy and training. This is also shown by a longterm follow-up studywhich showednodifferences in anklemotion and moments after 33 months [7]. In conclusion, resection of the fibula for reconstruction surgery does not influence gait one year after operation.

Comparison of Spatiotemporal Gait Parameters between Children with Normal Development and Children with Diplegic Cerebral Palsy.

[Purpose] The purpose of this study was to determine the differences in spatiotemporal gait parameters between children with spastic diplegic CP and children with normal development (ND). [Subjects and Methods] Sixteen children (eight children with spastic diplegic CP and eight ND children) were recruited for participation as volunteers in this study. The children with CP had a Gross Motor Function Classification (GMFC) System level of between I and II. [Results] Walking velocity, cadence, stride length, and step width of children with CP with a GMFC of between I and II were a level of 60%, 77%, 73%, and 160%, respectively, of those of ND children. The percentages of right and left double-limb support were 188% and 179% higher, respectively, and the proportion of single limb support was shorter by 83% and 82%. [Conclusion] Our results provide objective evidence of distinct differences in spatiotemporal gait parameters between children with spastic diplegic CP with a GMFC level I or II and ND children and would be helpful to persons involved in the care of these children.

To Determine effectiveness of Closed-Kinetic Chain Exercise on Motor Control and Function as Compared to Open-Kinetic Chain Exercise in Children with Spastic Diplegic CP

Background and purpose : Traditionally, rehabilitation program emphasize strengthening training under close loop exercises. This study is designed to compare the effectiveness of closed-kinetic chain exercise v/s open-kinetic chain on motor function in children with spastic diplegic CP. Method : 30 subjects with mild spastic diplegia (GMFCS level I-II) were selected on the basis of inclusion criteria and randomly assigned in two groups. Group A performed the loaded STS exercises 3 days a week, and 3 sets per day for 6 weeks. Group B performed progressive exercise training for 6 weeks, with three sessions per week, and at least one day's rest between sessions. 10-RM was calculated for the muscle selected. Result : Student's t test while discrete data (Sex and GMFCS level) were analyzed with Fisher's exact est. The pre-test and post-test outcome measures (SCALE score, GMFM dimension D and GMFM dimension E) of two independent groups were compared by repeated measures analysis of variance (RM ANOVA) using general linear models (GLM) and the significance of mean difference within and between the groups was done by Newman-Keuls post hoc test. Conclusion : study revealed that Progressive resisted lower limb strength training was found to be slightly (insignificant) more effective than Loaded sit-to-stand exercise. The SCALE score, GMFM Dimension D and GMFM Dimension E scores improved 1.08, 1.10 and 1.05 times more respectively in children those who received Progressive resisted lower limb strength training than those who received Loaded STS training.

The growth and the development of gastro-soleus contracture in cerebral palsy

Introduction: The development of contractures in children with spastic cerebral palsy is an important clinical as well as scientific issue. A common model for the development of contractures suggests that increased muscle tone shortens muscles, which leads to reduced growth of sarcomeres and tighter noncontractile muscle and tendon tissue. However, the spasticity is not the only factor influencing the contracture development. Based on our clinical observation we hypothesize that the body growth might play a key role in development of gastrocnemius contracture. Patients/materials and methods: We performed a retrospective cross-sectional analysis of 3D gait data of 244 children (385 legs) with spastic diplegic CP and equinus gait. Children were subdivided according to age into 6 subgroups (5–6, 7–8, 9–10, 11–12, 13–14 and 15–18 years) to show the changes during the whole period of growth. The height of all the participants at each visit was recorded. A formerly trained Generalized Dynamic Neuronal Network (GDNN) [1], a reliable method of automatic gait pattern recognition and classification, was used to discriminate between dynamic and fixed contracture of gastro-soleus muscle based on the ankle and knee kinematics and moments. The Spearman correlation coefficient was used to show the relationship between the growth and gastro-soleus contracture development. Results: The relative increase of fixed contracture of the gastrosoleus muscle between the age groups correlates positively with the relative increase in height (r=0.9; p<0.05). Therefore, the development of equinus contracture is tightly correlated with growth velocity in children with diplegic spastic CP. Discussion & conclusions: The range of ankle motion is decreasing during childhood [2]. It might sound contradictory but the spasticity of gastrosoleus muscle is decreasing between the ages 6–12 [3] as well. It seems that contracture development is not only moderated by spasticity and the reduction in tone does not prevent the development of contractures in CP [4]. We proved that the development of equinus contracture is tightly correlated with growth velocity in CP. Thereforewewould like to stress the growth spurt as an important period for contracture development as well as prevention.

Static proximal muscle shortening is present already in very young children with spastic bilateral CP

Static proximal muscle shortening is present already in very young children with spastic bilateral CP

Distribution of gait abnormalities in very young children with bilateral spastic cp according to the modified amsterdam gait classification

enced by goal oriented treatment with increased involvement of the physiotherapist. Patients/materials and methods: Ten CP children, with a history of at least four lower limb BTX-A treatments, were included. For these children, the new BTX-A was set-up according to a targeted goal oriented treatment. Treatment goals were carefully selected, based on gait analysis and clinical evaluation. Innovative for this new treatment was that these specific treatment goals and the resulting muscle selection for injection were clearly documented to and discussedwith the child’s physiotherapist, whowas encouraged to give special attention to these goals during the two months post BTX-A period. Achievement of treatment goals was scored based on comparison of pre and two months post BTX-A gait analysis. Goals were linked to specific gait parameters, automatically extracted fromgait continuouswaveforms. Z-scoreswere determined for each extracted parameter, based on pediatric typical reference data (Z= (mean CP child–mean typical children)/SD typical children). The median |Z-score| was calculated separately for goals related to psoas, hamstrings and gastrocnemius injection. Subsequently, a percentage of change scorewas calculated for each median Z-score (=(|Zpre|-|Zpost|)/|Zpre|). Wilcoxon signed ranked test was used to compare the percentage of change score of the last with the previous treatment. Results: Overall, the effect of the last treatment did not significantly change with respect to the previous. For eight of the nine patients injected in the hamstrings, we could compare the results of the targeted treatment with the previous injection. Six of these eight patients were injected bilaterally. The mean percentage of change score increased from −5% to 8%, suggesting an improved effect of BTX-A for the last compared to the previous treatment. However, due to large intersubject variability, this increasewas not significant (p=0.36). The gastrocnemiusmusclewas injected infive patients. For three patients (one injected bilaterally, two unilaterally), we had gait analysis results of their previous injection in this muscle. The mean percentage of change score increased from 25% to 33%, indicating that they had still benefited from injections. For three of the seven patients injected in the psoas muscle, results of previous BTX-A treatment in thismusclewere available. Theywere all injected bilaterally. Themean percentage of change score significantly decreased from 11% to −17%, indicating decreased effect of BTX-A (p=0.03). The percentage of change score did not correlate with age and the presence of contractures. Discussion and conclusions: The current results suggest that four or more repeated injections in the hamstrings and gastrocnemius can still be effective when the physiotherapists are involved in the treatment plan and are well informed about the treatment goals. For the psoas, the modified treatment strategy did not result in an improved effect.