Regional Disparities in Growth Patterns of Children with Cerebral Palsy: A Comparative Analysis of Saudi Arabian, UK, and US Data.

AIM: In order to understand the global variations in the growth trajectories of cerebral palsy patients, this study aimed to compare the growth patterns of cerebral palsy patients in Saudi Arabi with United States and United Kingdom counterparts. METHOD: Anthropometric data from 107 participants with cerebral palsy in Saudi Arabia were collected, including age, gender, cerebral palsy type, Gross Motor Function Classification System level, birth weight, weight at assessment, height at assessment, body mass index, and head circumference at assessment. RESULTS: This study found discrepancies between the growth patterns of Saudi Arabian children with cerebral palsy and United Kingdom and the United States growth charts, particularly among those with severe cerebral palsy. Significant differences were observed in weight, height, and body mass index z-scores when comparing Saudi Arabian data with the United kingdom and United States reference data. INTERPRETATION: These findings emphasize the importance of validating growth charts across different populations to ensure accurate monitoring and clinical management of children with cerebral palsy. Additionally, this study highlights the need for region-specific growth references to better address the diverse needs of individuals with cerebral palsy worldwide.

Modified desk height helps children with cerebral palsy perform sit-to-stand.

AIM: Children with cerebral palsy (CP) have difficulties performing activities that require the use of fundamental motor skills such as sit-to-stand (STS). In this study, we used a height adjustable chair and desk to investigate the role of desk support in STS and how it might benefit children with CP. METHODS: Seventeen typically developing children (TDC), average age = 9.7 years, and 28 children with CP (Gross Motor Function Classification System [GMFCS] I and II), average age = 10.3 years, participated in the test. Elapsed time and body sway were measured using a pressure mat and load cell while each child performed a STS task. Two different desk heights were tested for time consumption and sway under the condition of hands-on-desk and arms-crossed. RESULTS: We found that the elapsed time of hands-on-desk with the elbow flexion height was the shortest (p < 0.05). Sway amount was also significantly reduced for all children when they used the table for STS (p < 0.05). CONCLUSION: Results of this study may be a useful reference in rehabilitation training and designing a desk height beneficial for children with CP.Implications for RehabilitationBetter performance of sit-to-stand for a child with cerebral palsy could be made by a desk supportElapsed time during preparation period for sit-to-stand could be reduced by desk support for all CP childrenSway amount during sit-to-stand could be reduced by desk support, especially for the CP children with GMFCS level IIDesk height is an important parameter and should be studied in detail.

Hip Displacement in Cerebral Palsy: The Role of Surveillance.

INTRODUCTION: Hip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment. HIP SURVEILLANCE PROGRAMMES: Several population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients' age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement. CONCLUSION: Despite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.

Microsurgical DREZotomy in Spastic Cerebral Palsy: Poor Man's Baclofen Pump.

BACKGROUND: Using an intrathecal baclofen (ITB) pump for severe refractory spastic cerebral palsy is not a viable option in resource-constraint settings. Therefore authors assessed the role of microsurgical dorsal root entry zone-otomy (MDT) as an alternative for patients in whom the circumstances did not allow ITB pump placement. METHODS: A prospective clinical study was conducted from August 2016 to July 2020. All patients of spastic cerebral palsy (with III-IV Ashworth grade) who underwent MDT were included. Preoperative and postoperative Ashworth grade and Gross Motor Function Classification System level were assessed along with any change in power, sensation, and bladder functions postoperatively. At last follow-up, the patients' main care providers were asked to rate the effect of surgery (on scale of 0-5) on ease of providing care related to 6 activities of daily living. RESULTS: Seven patients (5 males, 2 females) of spastic cerebral palsy with an age range of 6-21 years underwent MDT over the study period. Six patients had spastic diplegia, and 1 had spastic hemiplegia. Preoperative Ashworth grade in all patients was 3-4 in various involved muscle groups. Four patients with spastic diplegia underwent MDT at L3-S1 level bilaterally, 2 patients with spastic diplegia and spastic bladder underwent MDT at L3-S4 level bilaterally, and 1 patient with right-sided spastic hemiplegia underwent MDT at C5-T1 level and L3-S1 level on the right side. Postoperative Ashworth grade in all patients improved to 0-1. The improvement in mean Ashworth grade was from 3.14 ± 0.378 preoperatively to 0.29 ± 0.488 (P value = 0.000). Most care providers reported improvement in their ability to do physiotherapy, position, clothe, ambulate, and maintain patient's personal hygiene. Care providers of 6 patients reported that they were likely to recommend MDT to another similar patient. CONCLUSIONS: MDT is a cost-effective tool in deceasing limb spasticity in spastic cerebral palsy, especially for those who cannot afford ITB placement.

[Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years]. / Izmenenie patternov spastichnosti u detei s tserebral'nym paralichom s III urovnem dvigatel'nogo razvitiya po sisteme klassifikatsii bol'shikh motornykh funktsii (GMFCS III).

Spastic muscles in the pathological motor patterns may change at different ages that leads to the changes in anti-spastic treatment. OBJECTIVE: To study the specific patterns of spasticity in CP patients with level III according to the Gross Motor Function Classification System (GMFCS) in different age periods. MATERIAL AND METHODS: A retrospective analysis of injection protocols of Abobotulinum toxin A for 99 patients with bilateral spastic CP GMFCS III at the age of 2 to 12 years was performed. Spasticity patterns were evaluated according to the frequency of target muscle selection for the botulinum toxin A (Abobotulinum toxin A) injections. RESULTS: The equinus foot deformity (89.7%, 95%CI 72.8-97.2) and its combination with internal hip rotation (79.3%, 95% CI 61.3-90.5) and/or hip adduction (65.5%, 95% CI 47.3-80.2) were the main lower extremity spasticity pattern for the patients aged 2 to 4 years. Between 4 and 6 years, there was the decrease in injections to the gastrocnemius muscle (75%, 95% CI 52.8-89.2), and less to the m. gracilis (70%, 95% CI 47.9-85.7) and hip adductors (55% 95 CI 34.2-74.2). In the 6-12 year old patients, the predominant spasticity patterns were internal hip rotation (80%, 95% CI 66.8-88.9), adduction (54%, 95% CI 40.4-67.0) and knee flexion (66%, 95% CI 52.1-77.6). The leading upper extremity patterns at all observed ages were forearm pronation (70.7%, 95% CI 61.1-78.8) and elbow flexion (47.5%, 95% CI 37.9-57.2). The frequency of injections to these muscles slightly decreased in elder groups. CONCLUSIONS: CP GMFCS III patients demonstrate age-related changes of the spasticity patterns both in lower and upper extremities. These changes and typical spastic muscles should be taken into account during the rehabilitation and botulinum toxin treatment planning, as well as in the detection and prevention of the orthopaedic complications.

Brain lesion scores obtained using a simple semi-quantitative scale from MR imaging are associated with motor function, communication and cognition in dyskinetic cerebral palsy.

Purpose: To characterise brain lesions in dyskinetic cerebral palsy (DCP) using the semi-quantitative scale for structural MRI (sqMRI) and to investigate their relationship with motor, communication and cognitive function. Materials and methods: Thirty-nine participants (19 females, median age 21y) with DCP were assessed in terms of motor function, communication and a variety of cognitive domains. Whole-head magnetic resonance imaging (MRI) was performed including T1-MPRAGE, T2 turbo spin echo (axial plane), and fluid attenuated inversion recovery images (FLAIR). A child neurologist visually assessed images for brain lesions and scored these using the sqMRI. Ordinal, Poisson and binomial negative regression models identified which brain lesions accounted for clinical outcomes. Results: Brain lesions were most frequently located in the ventral posterior lateral thalamus and the frontal lobe. Gross (B = 0.180, p < .001; B = 0.658, p < .001) and fine (B = 0.136, p = .003; B = 0.540, p < .001) motor function were associated with global sqMRI score and parietal involvement. Communication functioning was associated with putamen involvement (B = 0.747, p < .028). Intellectual functioning was associated with global sqMRI score and posterior thalamus involvement (B = -0.018, p < .001; B = -0.192, p < .001). Selective attention was associated with global sqMRI score (B = -0.035, p < .001), parietal (B = -0.063, p = .023), and corpus callosum involvement (B = -0.448, p < .001). Visuospatial and visuoperceptive abilities were associated with global sqMRI score (B = -0.078, p = .007) and medial dorsal thalamus involvement (B = -0.139, p < .012), respectively. Conclusions: Key clinical outcomes in DCP are associated with specific observable brain lesions as indexed by a simple lesion scoring system that relies only on standard clinical MRI.

Early Predictors and Correlates of Communication Function in Children With Cerebral Palsy.

Birth characteristics and developmental milestones were evaluated as early predictors/correlates of communication in children with cerebral palsy. The hypothesis was that maternal report of child's age for vocal play and first words would predict current functional communication. A case series of 215 children, 2 to 17 years (mean age = 8.2 years, SD = 3.9) with cerebral palsy was recruited from medical practices in 3 Michigan cities. Early developmental data were collected by maternal interview. The child's Communication Function Classification System (CFCS) level was obtained from parent. Predictors of less functional communication included gestational age >32 weeks, number of comorbidities, age of first words after age 24 months, and use of communication methods other than speech. Several birth characteristics and developmental language milestones were predictive of later communication performance for children with cerebral palsy. These characteristics and milestones should trigger referrals for communication evaluations, including speech, language, hearing, and/or augmentative and alternative communication.

Correlation between the Gait Deviation Index and gross motor function (GMFCS level) in children with cerebral palsy.

AIM: The Gait Deviation Index (GDI) is a score derived from three-dimensional gait analysis (3DGA). The GDI provides a numerical value that expresses overall gait pathology (ranging from 0 to 100, where 100 indicates the absence of gait pathology). The aim of this study was to investigate the association between the GDI and different levels of gross motor function [defined as the Gross Motor Function Classification System (GMFCS)] and to explore if age, height, weight, gender and cerebral palsy (CP) subclass (bilateral and unilateral CP) exert any influence on the GDI in children with unilateral and bilateral spastic CP. METHODS: We calculated the GDI of 109 children [73 % boys, mean age 9.7 years (standard deviation, SD 3.5)] with spastic CP, classified at GMFCS levels I, II and III. Twenty-three normally developing children were used as controls [61 % boys, mean age 9.9 years (SD 2.6)]. Multiple linear regression analysis was performed. RESULTS: The mean GDI in the control group was 100 (SD 7.5). The mean GDI in the GMFCS level I group was 81 (SD 11), in the GMFCS level II group 71 (SD 11) and in the GMFCS level III group 60 (SD 9). Multiple linear regression analysis showed that gender, age and CP subclass had no significant correlation with the GDI, whereas height and weight had a slight impact. CONCLUSION: This study showed a strong correlation between the GDI and GMFCS levels. The present data indicate that calculation of the GDI is a useful tool to characterise walking difficulties in children with spastic CP.