Quality of life of families and siblings of children with cerebral palsy treated at a reference neurorehabilitation center in Brazil

Abstract Objectives To investigate the associations between caregivers' burden, family quality of life (QoL), and siblings' QoL in Brazilian families of children with cerebral palsy, and to analyze siblings' QoL using as a parameter the QoL of typically developed Brazilian children. Methods It was a cross-sectional study. The 212 families, 212 caregivers and 131 siblings completed the Family Quality of Life Scale, Burden Interview, and KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires at a neurorehabilitation center in southeast Brazil. Univariable and multivariable models were used. Results Family QoL significantly worsened as caregivers' burden increased (95 % CI -0.66 to -0.38). Caregivers' burden was significantly lower with increasing family QoL scores (95 % CI -0.52 to -0.30). Self-reported siblings' QoL was significantly worse than that of their typically developed peers (95 % CI -7.6 to -3.6). Self-reported siblings' QoL was significantly lower as siblings' age (95 % CI -2.52 to -0.59) and caregivers' burden (95 % CI -0.35 to -0.05) increased. Parent-reported siblings' QoL was significantly lower with increasing caregivers' burden (95 % CI -0.45 to -0.16) and higher as family QoL increased (95 % CI 0.09 to 0.37). Conclusions The cross-sectional nature of these data precludes any statement of causality. Family QoL worsened with higher caregivers' burden levels. Lower caregivers' burden scores were associated with a higher family QoL. Siblings' QoL was impaired as compared to typically developed peers, worse among older siblings, and as caregivers' burden increased and better with higher family QoL levels. Future multicenter studies may validate the generalizability of the present findings.

Representaciones sociales de la parálisis cerebral en madres de niños que asisten a un centro de neurorrehabilitación en Cali-Colombia / Social representations of cerebral palsy in mothers of children who attend a neurological rehabilitation center in Cali-Colombia / Representações sociais da paralisia cerebral em mães de crianças que frequentam um centro de reabilitação neurológica em Cali-Colômbia

Resumen Objetivo: en Colombia, existe una brecha importante entre la reglamentación relacionada con el reconocimiento de derechos, inclusión y mecanismos para la protección de los niños con discapacidad y la implementación de la norma. En este contexto, el objetivo de este estudio fue explorar las representaciones sociales de la parálisis cerebral en madres de niños con parálisis cerebral. Metodología: se realizó un estudio cualitativo bajo el enfoque estructuralista de las representaciones sociales para caracterizar el contenido y la organización de las representaciones sociales de la parálisis cerebral de madres de niños con parálisis cerebral que consultaron a un centro de neurorrehabilitación en Cali, Colombia entre enero y febrero de 2022. Como técnicas de recolección se utilizaron el listado libre y el cuestionario de pares. Resultados: para las madres la parálisis cerebral es la alteración de movimiento que junto con la dificultad de aprendizaje y comunicación generan gran demanda de atención por parte del cuidador acompañado de sentimientos de resignación ante las secuelas de la lesión en el cerebro y la discriminación social percibida. Conclusiones: las representaciones sociales sobre la parálisis cerebral dejan percibir una visión negativa y poco esperanzadora de recuperación, así como resiliencia por parte de los cuidadores.

Abstract Objective: In Colombia, there is a significant gap between the regulations related to the recognition of rights, inclusion, and mechanisms for the protection of children with disabilities and the implementation of the law. In this context, the aim of this study was to explore the social representations of cerebral palsy in mothers of children with cerebral palsy. Methodology: We collected information from mothers with children with cerebral palsy who consulted a neurorrehabilitation center in Cali, Colombia between January and February 2022 using the free list and the peer questionnaire. Results: For mothers, cerebral palsy is a movement disorder that, together with learning and communication difficulties, generates a great demand for care by the caregiver, accompanied by feelings of resignation in the face of the consequences of the brain injury and perceived social discrimination. Conclusions: The social representations on cerebral palsy reveal a negative and hopeless view of recovery, as well as resilience on the part of caregivers.

Resumo Objetivo: Na Colômbia, existe uma brecha importante entre a regulamentação relacionada ao reconhecimento de direitos, inclusão e mecanismos para a proteção dos meninos com deficiência e a implementação da norma. Neste contexto, o objetivo deste estúdio pode explorar as representações sociais da paralisia cerebral em mães de crianças com paralisia cerebral. Metodologia: Recolha a informação das madres com crianças com paralisia cerebral que consulte um centro de neurorreabilitação em Cali, Colômbia entre enero e febrero de 2022 usando o listado livre e o guia de pares. Resultados: Para as mães a paralisia cerebral é a alteração de movimento que se junta com a dificuldade de aprendizagem e comunicação gera grande demanda de atenção por parte do cuidador acompanhado de sentimentos de resignação antes das seqüelas da lesão no cérebro e na discriminação percepção social. Conclusões: Las representaciones sociales sobre la paralisis cerebral dejan ver una visão negativa y poco esperanzadora de recuperação, así como resiliência de parte de los cuidadores.

Neurodevelopmental disorder associated with NARS1 gene mutation in a child with cerebral palsy

Cerebral palsy is the most common cause of chronic motor disability in children. CP has a multitude of causes, including developmental, genetic, metabolic, ischemic, infectious, and acquired, all of which result in comparable neurologic symptoms. As of right now, the cause of CP remains unclear. Research has found a substantial link between low birth weight, birth hypoxia, and poor fetal position and placenta. When diagnosing children with cerebral palsy and determining its cause, brain imaging is crucial. The final diagnosis should consider many factors, including physiological, topographic, ICF/functional, and neuroradiological categorization, origin, time of injury, concomitant disorders, sequelae, and nutritional status. This assists with planning, management, counseling, progress tracking, and prognosis. We present a case of a 5-year-old child with cerebral palsy who has a complicated clinical presentation including delayed psychomotor development, dysmorphia, and a verified pathogenic variation in the NARS1 gene linked to a neurodevelopmental condition. The child has been receiving frequent monitoring and multimodal therapies, such as physical therapy, defectologist sessions, and omega fatty acid supplements. Genetic testing found a pathogenic variant in the NARS1 gene, emphasizing the significance of genetic screening for parents to prevent recurrence in future pregnancies. Collaboration with special education instructors and speech therapists remains active to meet the child's communicative and cognitive requirements.

A study on risk factors, clinical profile, spectrum of comorbidities in children with cerebral palsy and efficacy of early intervention by rehabilitation units on neurodevelopmental outcome in these children

Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burden found in developing countries. This study is undertaken as there is limited data available regarding CP children in the Andhra Pradesh region. This study was done to evaluate the clinical spectrum, risk factors, and comorbidities associated with CP that will help in better understanding of etiology and for early intervention by District early intervention centers.Methods: This is a hospital-based prospective observational study conducted over 18 months among children from 6 months to 5 years of age visiting a tertiary care hospital.Results: Among 65 enrolled children majority of the children (74%) were between 2 to 5yrs with a male-to-female ratio of 4:1. Consanguinity was observed in 33.8% and the majority were from rural areas (71%). The most frequent presenting complaint was delayed milestones (33.4%). 67.6% of subjects were born at term with the most common risk factor being birth asphyxia (27.6%). The most common type was spastic CP (87%) in whom the Developmental quotient (DQ) was severely affected (56.7%) and 32.3% of children belong to GMFCS level III. Comorbidities like feeding difficulties and GERD (47.6%), visual problems (24.8%), and hearing problems (30%) were commonly associated. At the time of enrollment, only 21.5% of children had normal nutritional status which improved to 30.7% after 12 months of follow-up.Conclusions: Efforts should be made to increase awareness among parents regarding the availability of encouraging utilization of the services to relieve the burden of disorder.

Tratamiento de la contractura en flexión de rodilla en parálisis cerebral / Treatment for knee flexion contracture in cerebral palsy

La extensión completa de la rodilla es esencial para la marcha. Los pacientes con parálisis cerebral infantil con frecuencia pueden tener déficit de extensión de distinta magnitud, lo que compromete la marcha e incluso la bipedestación. El tratamiento de la contractura en flexión de rodilla parte por tratar la espasticidad de los músculos comprometidos y con fisioterapia. Cuando el flexo es estructurado, el tratamiento es quirúrgico mediante distintas técnicas, dependiendo de la magnitud de la contractura y de la edad del paciente. Las técnicas sobre partes blandas incluyen alargamientos funcionales de isquiotibiales y transferencias musculares. Cuando la contractura es capsular, es preferible realizar cirugía ósea, la cual extiende el fémur proximal, ya sea en forma progresiva, mediante fisiodesis anterior en pacientes pediátricos, o en forma aguda, mediante osteotomía extensora del fémur distal. Con frecuencia existe una patela alta, la cual hay que corregir en el mismo acto quirúrgico para mantener la eficiencia del aparato extensor

Full knee extension is essential for gait. Patients with cerebral palsy frequently have extension deficits of different magnitudes, which compromise walking and even standing up. The treatment of knee flexion contracture begins by addressing the spasticity of the involved muscles and includes physical therapy. For structured extension deficits, the treatment is surgical, using different techniques depending on the magnitude of the contracture and the patient's age. Soft tissue techniques include functional hamstring lengthening and muscle transfers. For capsular contracture, bone surgery is preferable and extends the proximal femur either progressively, through anterior physiodesis in pediatric patients, or acutely, by extensor distal femoral osteotomy. A high patella is common and requires correction during the same surgical procedure to maintain the efficiency of the extensor apparatus

Significado de cuidar niños con parálisis cerebral / Meanings of caring for children with cerebral palsy / Significado de cuidar crianças com paralisia cerebral

Resumen (analítico) Existe insuficiente evidencia acerca de lo que significa ser cuidador de niños o niñas con parálisis cerebral en Colombia. Nuestra investigación se aborda desde un enfoque hermenéutico, utilizando el método de la teoría fundamentada, con 13 entrevistas semiestructuradas a adultos cuidadores de niños y niñas con parálisis cerebral. Emergen cuatro categorías: amor incondicional, cuidando como mujer, atravesando el duelo e interminable lucha por los derechos del menor. Se concluye que existe una decidida forma de afrontamiento de las cuidadoras, pues están dispuestas a renunciar a sus propias vidas, a sus relaciones personales y sociales, a sufrir un constante duelo, a aprender nuevas formas de cuidar y transformar sus hogares, hasta luchar por la atención digna de sus hijos. El amor sin condiciones les permite reconocerse como mujeres cuidadoras únicas.

Abstract (analytical) There is insufficient evidence regarding meanings developed by caregivers of children with Cerebral Palsy in Colombia. The methodology involved adopting a hermeneutic approach, which was combined with the grounded theory method. A total of 13 semi-structured interviews were conducted with adult caregivers of children with cerebral palsy. Following an analysis of the results, four categories emerged: unconditional love; caring as a woman; experiencing grief; and the endless fight for their child's rights. It was concluded that the caregivers of children with Cerebral Palsy have developed determined coping skills. This is because they are willing to give up their own lives, sacrifice their personal and social relationships, experience constant grief and learn new ways of caring and transforming their homes in their struggle to provide dignified care for their children. Unconditional love allows these caregivers to recognize themselves as unique caring women.

Resumo (analítico) Não há evidências suficientes sobre o que significa ser cuidador de crianças com paralisia cerebral na Colômbia. Pesquisa abordada a partir de uma abordagem hermenêutica, utilizando como método da teoria fundamentada, com 13 entrevistas semiestruturadas com adultos cuidadores de crianças com paralisia cerebral. Emergem quatro categorias: amor incondicional, cuidado como mulher, vivência do luto e luta incessante pelos direitos da criança. Conclui-se que existe uma determinada forma de enfrentamento para os cuidadores, pois estão dispostos a abdicar de sua própria vida, de suas relações pessoais e sociais, a sofrer lutos constantes, a aprender novas formas de cuidar e transformar seus lares, a lutar por cuidado digno de seus filhos. O amor incondicional permite que elas se reconheçam como mulheres únicas e carinhosas.

Clinical characteristics and associated factors of cerebral palsy in pediatric population: a tertiary care centre clinicoepidemiological study

Background: Although, a highly prevalent disease, the etiology of cerebral palsy is still poorly understood thereby eluding a definitive prevention strategy. Our study aimed to evaluate the etiological, clinical and prognostic factors associated with cerebral palsy in children of western Rajasthan. Methods: All cases of non-progressive neurological disorder in the age group of 6 months to 14 years were enrolled in the present study. Detailed assessment, CNS examination and related neuroimaging were performed. Statistical analysis was done by standard statistical methods. Results: Maximum number of patients in current study were in the age group of 1-3 years. In our study according to sex, 40 (66.67%) were males and 20 (33.33) were females. Most of the patient in the present study were spastic quadriplegic type (40%) followed by spastic diplegia in 20% cases. As per gross motor function classification system (GMFCS) grading, maximum number of cases were 16 (26.67%) from grade 4. The most common sequelae in cerebral palsy were speech delay in 49 (81.66%) patients. Cortical atrophy was the most commonly (71.73%) seen abnormality on neuroimaging with CT-scan. Conclusions: Cerebral palsy is a non-progressive CNS disorder which has a major physical as well as psychological effects on the children as well as their families. The present study highlights the importance of understanding epidemiological and etiological aspects of the disease in Indian scenario.

Efectividad de la Terapia Acuática en la Función Motora Gruesa en Población Infantojuvenil con Parálisis Cerebral. Una Revisión Narrativa / Effectiveness of Aquatic Therapy on Gross Motor Function in Children and Young People with Cerebral Palsy. A Narrative Review

Introducción. La parálisis cerebral (PC) es una de las principales causas de discapacidad en la población infantil, afectando diversas áreas del desarrollo como la función motora gruesa; equilibrio y marcha. Hay evidencia de los beneficios de la terapia acuática y de cómo puede complementar la rehabilitación. Objetivo. Describir la efectividad de las intervenciones acuáticas en personas con PC, determinar mejoras en la función motora gruesa uso de métodos, protocolos y dosificación. Métodos. Se analizaron 9 estudios aleatorizados controlados desde el 2012 a la fecha, seleccionados por un experto y cuyos sujetos tenían PC espástica, Gross Motor Function Classification System (GMFCS) I a IV, entre los 2 y 20 años. Post intervención acuática se reportan mejoras significativas en el promedio de los ítems medidos por Gross motor function measure (GMFM). De los métodos que contribuyeron a mejoras se encuentra Halliwick y ejercicios acuáticos sin un programa específico. Resultados. Se obtuvieron mejoras de 35 a 100 minutos, y de 12 a 30 sesiones en total. No se logra concluir el tipo de terapia más efectiva, ya que las medidas de resultado y las características de los sujetos eran diversas. Conclusión. Una dosificación mínima de 2 veces por semana, 35 minutos de intervención en un total de 16 sesiones (9,3 horas en total) pareciera mejorar la función motora gruesa, cuyos resultados son transferibles a las actividades en tierra inmediatamente, sin embargo, no se obtiene información si se mantienen a mediano o largo plazo.

Background. Cerebral palsy (CP) is one of the main causes of disability in the child population, affecting various areas of development such as gross motor function; balance and gait. There is evidence of the benefits of aquatic therapy and how it can complement rehabilitation. Objective. to describe the effectiveness of aquatic interventions in people with CP, to determine improvements in gross motor function using methods, protocols, and dosage. Methods. Nine randomized controlled studies were analyzed from 2012 to date, selected by an expert and whose subjects had spastic CP, Gross Motor Function Classification System (GMFCS) I to IV, between 2 and 20 years of age. Results. After the aquatic intervention, significant improvements were reported in the average of the Gross motor function measure (GMFM) items measured. Of the methods that contributed to improvements, there is Halliwick and aquatic exercises without a specific program. Results. Improvements were obtained from 35 to 100 minutes, and from 12 to 30 sessions in total. It is not possible to conclude the most effective type of therapy, since the outcome measures and the characteristics of the subjects were diverse. Conclusion. A minimum dosage of 2 times per week, 35 minutes of intervention in a total of 16 sessions (9.3 hours in total) seems to improve gross motor function, the results of which are immediately transferable to activities on land, however, it is not obtains information if they are maintained in the medium or long term.

Evaluación y tratamiento kinésico motor de una niña con diagnóstico de parálisis cerebral luego de una rizotomía dorsal selectiva: reporte de un caso / Physical therapy evaluation and treatment of a girl diagnosed with cerebral palsy after selective dorsal rhizotomy: a case report

RESUMEN Introducción: La parálisis cerebral (PC) es la causa más frecuente de espasticidad en la infancia. Una alternativa de tratamiento es la rizotomía dorsal selectiva (RDS). La selección de los candidatos para esta cirugía requiere una evaluación exhaustiva, y la rehabilitación es fundamental para lograr los mejores resultados. El objetivo de este estudio es describir la evaluación y el tratamiento kinésico motor de una niña con PC que fue sometida a una RDS. Presentación del caso: Una niña de siete años con PC fue sometida a una RDS como parte del manejo de la espasticidad en los miembros inferiores. Se describió la evaluación antes de la RDS y seis meses después de esta. Se registraron el grado de espasticidad, el rango articular, las pruebas de longitud muscular, la alineación ósea, la fuerza, el desempeño funcional y la marcha. El tratamiento consistió en una etapa de internación postquirúrgica y una etapa ambulatoria. Conclusión: Se describieron la evaluación y el tratamiento kinésico motor de una niña con PC sometida a una RDS. Observamos disminución de la espasticidad, ausencia de actividad refleja patológica, mejor control motor selectivo, aumento del rango articular, mayor fuerza distal y mejora en el puntaje en la escala de videoanálisis de la marcha y en la escala de movilidad funcional. La niña logró la bipedestación al quinto día postquirúrgico y aumentó las distancias recorridas.

ABSTRACT Introduction: Cerebral palsy (CP) is the most common cause of spasticity in childhood. An alternative treatment is selective dorsal rhizotomy (SDR). The selection of candidates for this surgery requires a thorough evaluation, and rehabilitation is essential to achieve the best results. The aim of this study is to describe the physical therapy evaluation and treatment of a girl with CP who underwent RDS. Case presentation: A seven-year-old girl with CP underwent RDS as part of the management of spasticity in her lower limbs. The patient was evaluated before RDS and at six months. The degree of spasticity, range of motion, muscle length tests, bone alignment, strength, functional performance, and gait were recorded. The treatment included a post-surgical inpatient stage and an outpatient stage. Conclusion: The physical therapy evaluation and treatment of a girl with CP who underwent RDS were described. We observed decrease in spasticity, absence of pathological reflex activity, improvement in selective motor control, increase in range of motion, greater distal strength, and improvement in the score on the video-based gait analysis scale and functional mobility scale. The girl achieved standing on the fifth post-surgical day and showed an increase in distances covered.

An Analysis of YU Hai-Bo's Experience in Treating Paediatric Cerebral Palsy by Using"Jianpi Yishen Triple-Needle Grouping Acupoints" / 广州中医药大学学报

This article introduces the clinical approach and acupuncture characteristics of the traditional Chinese medicine practitioner Professor YU Hai-Bo in treating paediatric cerebral palsy using the"Jianpi Yishen Triple-Needle Grouping Acupoints".Guided by the theory of growth and development of"viscera-meridian-brain"growth and development,Professor YU believed that"insufficiency of spleen and kidney"is the core pathogenesis of paediatric cerebral palsy,and the treatment concept of"treating from the spleen and kidney"was proposed.He inherited and innovated the triple-needle grouping acupoints therapy and establishing the system of"Jianpi Yishen Triple-Needle Grouping Acupoints".Before regular acupuncture,the abdomen and dorsum are pricked to freely regulate the middle energizer,and the upper limbs are selected as"Hegu(LI4),Waiguan(SJ5),Quchi[(LI11),three acupoints on the hand]+ Neiguan(PC6)";the lower limbs are selected as"Zusanli(ST36),Sanyinjiao(SP6),Taichong[(LR3),three acupoints on the foot];"Shenmai(BL62),Zhaohai(KI6),Yongquan(KI1)",spleen and kidney are regulated simultaneously,and the head acupoints include Sishencong(EX-HN1),intelligence tri-needling,cerebral tri-needling,temporal tri-needling,mind-calming needling and bilateral Fengchi(GB20).In order to regulate the spirit and benefit the intellect,the matching acupoints are modified according to the disease and the syndromes.At the same time,it is supplemented with music therapy and auricular point seed-pressing.Emphasis is placed on the simultaneous regulation of"child-parent-doctor"and"treating the person"rather than the"treating the disease".

Three-dimensional magnetization prepared rapid acquisition gradient echo for evaluation on the corpus callosum morphological alterations in children with spastic cerebral palsy / 实用放射学杂志

Objective To analyze the morphological alterations of corpus callosum in children with spastic cerebral palsy(SCP)using three-dimensional magnetization prepared rapid acquisition gradient echo(3D-MPRAGE)technology and to investigate the correlation between morphological indexes and gross motor function.Methods Sagittal T1WI 3D-MPRAGE data was collected from 136 children with SCP(SCP group)and 132 age-and gender-matched healthy controls(HC)(HC group),and the gross motor function measure-88(GMFM-88)was applied to assess the gross motor function.Independent sample t-test was used to compare the corpus callosum surface area,volume,maximum anterior-posterior diameter,median sagittal area(total area and area of Ⅰ-Ⅴ zone)between the two groups.Partial correlation analysis was performed to calculate the correlation between morphological indexes of the corpus callosum and GMFM-88 with age as a covariate.Results Children under 3 years old,the corpus callosum surface area of the SCP group(3 914.51 mm2±1 207.97 mm2)was lower than that of the HC group(5 725.51 mm2±1 412.66 mm2).The volume of the corpus callosum(6 108.46 mm3±2 803.97 mm3)in the SCP group was lower than that of the HC group(11 297.96 mm3±4 109.02 mm3).Also,the maximum anterior-posterior diameter of the corpus callosum in the SCP group(53.40 mm±6.31 mm)was lower than that of the HC group(57.74 mm±6.04 mm)(all P<0.05).Children over 3 years old,the corpus callosum surface area of the SCP group(4 970.06 mm2±1 191.31 mm2)was lower than that of the HC group(6 372.55 mm2±1 445.59 mm2).The volume of the corpus callosum(8 330.20 mm3±2 888.20 mm3)in the SCP group was lower than that of the HC group(13 599.82 mm3±3 429.81 mm3)(all P<0.05).Partial correlation analysis showed significant correlation between corpus callosum volume,median sagittal area and gross motor score(P<0.01)with age as a covari-ate.Conclusion The 3D-MPRAGE technology can be useful for the comprehensive assessment of morphological alterations of the corpus callosum in SCP.The corpus callosum volume,and median sagittal area may become neuroimaging references for the assess-ment of motor development in cerebral palsy(CP).

Effects on different frequencies of whole body vibration on gross motor function and walking function in children with dyskinetic cerebral palsy / 实用医学杂志

Objective To provide reference for the subsequent clinical application of WBV,based on the impacts of whole body vibration(WBV)with different frequencies on gross motor function and walking function in children with dyskinetic cerebral palsy.Methods 60 children aged 6～12 with dyskinetic cerebral palsy,who had been treated at the department of rehabilitation medicine in the Affiliated Southwest Medical University from October 2021 to November 2022,were selected.They were randomly divided into a control group(n = 20),(25±5)Hz group(n = 20),and(35±5)Hz group(n = 20).All the three groups received conventional rehabilitation,while the(25±5)Hz group received additional WBV with(25±5)Hz and the(35±5)Hz group received WBV with(35±5)Hz.They were treated for eight weeks.The scores on D and E domains of GMFM-88,TUGT,the score on Berg Balance Scale,and footprint analysis were used for assessment of the efficacy after treatment.Results As compared with the baselines,the scores were improved in the three groups after treatment(P＜0.001).BBS(F = 12.502),TUGT(F = 8.211),scores on D and E domains of GMFM-88(F = 12.802 and 8.505),stride length(F = 12.279),1MWT distance(F = 12.619),and step width(F = 13.582)were better in the(35±5)Hz group than in the(25±5)Hz group and the control group(P＜0.05 and P＜0.01);and the efficacy was better in the(25±5)Hz group than in the control group,the difference was statistically significant(P＜0.05 and P＜0.01).Conclusion WBV can improve trunk control,lower limb gross motor function,and walking function in children with involuntary motor type cerebral palsy.(35±5)Hz is better than(25±5)Hz for the efficacy of WBV.

Effect of Speech Organ Correction Combined with Language Training on Children with Cerebral Palsy and Language Disorder / 听力学及言语疾病杂志

Objective To investigate the effect of pronunciation organ correction combined with language training on rehabilitation in children with cerebral palsy and language disorder.Methods A total of 120 cases of pe-diatric cerebral palsy and language disorder treated with rehabilitation in our hospital from January 2015 to March 2018 were divided into routine group and study group by a random digital table,with 60 cases in each group.The routine group was given language training alone,while the study group was given pronunciation organ correction combined language training.The assessment results of children with dysarthria and language retardation before and after treatment were compared respectively,and the efficacy and family satisfaction were compared between the two groups.Results There were statistical differences in the assessment results of children with dysarthria and lan-guage retardation in both groups after treatment compared with before treatment(P＜0.05),and there were statis-tical differences between the two groups after treatment(P＜0.05).The overall clinical efficiency was 75％in the study group,which was higher than that of 60％in the routine group(P＜0.05).The total satisfaction rate was 90％in the study group,which was higher than that of 75％in the routine group(P＜0.05).Conclusion Giving pronunciation organ correction combined language training in the rehabilitation treatment of pediatric cerebral palsy and language disorder can improve treatment efficacy and the satisfaction of child family members.

Relationship between lumbar spine development and hip development in children with spastic cerebral palsy / 中国组织工程研究

BACKGROUND:Most scholars now believe that children with cerebral palsy who have severe spinal deformities in early childhood(<15 years of age)may have a higher risk of progression of spinal deformities,which may result from imbalances in movement due to pelvic tilt,pain,etc. OBJECTIVE:To investigate the relationship between lumbar spine development and hip joint development in children with spastic cerebral palsy. METHODS:A retrospective analysis was performed in 102 children with spastic cerebral palsy admitted at Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from January 2014 to December 2021.All admitted children had X-rays of the pelvic position and the lumbar lateral position.Anteroposterior X-ray of the pelvis was performed to measure femoral head migration percentage,central edge angle,neck-shaft angle,and acetabular index.The sagittal Cobb angle,sacral slope,arch-top distance,and lumbar lordosis index were measured by the lateral X-ray of the lumbar spine.Correlation of the two sets of indicators was further analyzed.All children were divided into normal group,risk group,hip subluxation group and total hip dislocation group according to their femoral head migration percentage,and the differences in lumbar spine indexes between groups were evaluated. RESULTS AND CONCLUSION:Pearson correlation analysis showed that the femoral head migration percentage was moderately positively correlated with sagittal Cobb angle and arch-top distance,and weakly positively correlated with lumbar lordosis index;the central edge angle was moderately negatively correlated with the arch-top distance and weakly negatively correlated with the sagittal Cobb angle;the neck-shaft angle was weakly positively correlated or not correlated with the sagittal Cobb angle and lumbar lordosis index;and the acetabular index was weakly positively correlated with the sagittal Cobb angle and arch-top distance.No statistically significant correlation was found between the remaining indicators.According to the femoral head migration percentage,the children were divided into four groups,including 25 cases in the normal group,41 cases in the risk group,27 cases in the hip subluxation group,and 9 cases in the total hip dislocation group.The sagittal Cobb angle was significantly increased in the risk group,the hip subluxation group and the total hip dislocation group compared with the normal group,showing an increasing trend group by group,and there were significant differences between groups(P<0.05).Compared with the normal group,the lumbar lordosis index in the risk group and the hip subluxation group increased significantly,and there were significant differences between groups(P<0.05).There was an increase trend in the lumbar lordosis index of the total hip dislocation group compared with the normal group.Compared with the normal group,the arch-top distance in the hip subluxation group and the total hip dislocation group increased significantly(P<0.05),and there was a stepwise increasing trend.There was no significant difference in sacral slope between groups.To conclude,the development of the lumbar spine in children with cerebral palsy is closely related to the development of the pelvic hip joint,and the most obvious relationship is between lumbar lordosis and hip dislocation.

Shujin Jiannao Prescription alleviates inflammation in the cerebral cortex of rats with hypoxic-ischemic cerebral palsy / 中国组织工程研究

BACKGROUND:Shujin Jiannao Prescription is an empirical formula for the treatment of cerebral palsy in Dongzhimen Hospital,Beijing University of Chinese Medicine,with clear clinical efficacy,but the specific mechanism needs to be elucidated. OBJECTIVE:To explore the possible mechanism of Shujin Jiannao Prescription in treating cerebral palsy. METHODS:Sixty-four 7-day-old Sprague-Dawley rats were randomly divided into a normal group(n=12)and a model group(n=52).An animal model was established by the Rice-Vannucci method.After successful modeling,52 model rats were randomly divided into control model group(n=12),minocycline group,and the low-,medium-,and high-dose groups of the Shujin Jiannao Prescription(n=10 per group).Rats in the minocycline group were given 40 mg/kg·d minocycline by gavage;rats in the low-,medium,and high-dose groups were given 4,8,and 16 g/kg·d Shujin Jiannao Prescription granules by gavage,respectively;and rats in the normal group and control model group were given an equal dose of normal saline by gavage.Medication in each group was given once a day for 1 week.The rats in each group were evaluated behaviorally using suspension test,abnormal involuntary movement score,and Bederson score.The pathological changes of the cerebral cortex were observed by hematoxylin-eosin staining.The levels of tumor necrosis factor α,interleukin 1β,and interleukin 10 in the cerebral cortex were determined using ELISA.The positive expressions of Janus kinase 2(JAK2),phosphorylated Janus kinase 2(p-JAK2),phosphorylated signal transducer and activator of transcription 3(p-STAT3)in the cerebral cortex were detected using immunohistochemistry.The protein expression levels of JAK2,p-JAK2,and p-STAT3 were detected using western blot. RESULTS AND CONCLUSION:Compared with the normal group,the suspension test score and involuntary movement score were decreased in the control model group(P＜0.01 or P＜0.05).The pathological results showed structural disruption of nerve cells,formation of large numbers of vacuoles,cell swelling,and increased intercellular space in the control model group.In addition,the expressions of tumor necrosis factor α and interleukin 1β in the cerebral cortex were significantly increased(P＜0.01),the expression of interleukin 10 was decreased(P＜0.05),and the protein expressions of JAK2,p-JAK2,and p-STAT3 in the cerebral cortex were significantly increased(P＜0.01)in the control model group compared with the normal group.Compared with the model group,minocycline and Shujin Jiannao Prescription at each dose could improve the behavioral indexes of rats(P＜0.01 or P＜0.05)and ischemic-hypoxic pathological changes were attenuated,with only a small amount of necrotic nerve cells and a few vacuoles,and reduced intercellular space.Moreover,the expressions of tumor necrosis factor α and interleukin 1β in the cerebral cortex were decreased in each drug group compared with the control model group(P＜0.05),while the protein expressions of JAK2,p-JAK2,and p-STAT3 in the cerebral cortex were significantly decreased(P＜0.01).The most obvious improvement was observed in the high-dose Shujin Jiannao Prescription group.To conclude,Shujin Jiannao Prescription can inhibit inflammation in the cerebral cortex of rats with hypoxic-ischemic brain injury.The mechanism may be related to the regulation of the JAK2/STAT3 signaling pathway.

Effects of Shujin Jiannao Prescription on cell apoptosis in rats with hypoxic-ischemic brain injury / 中国组织工程研究

BACKGROUND:Perinatal hypoxic-ischemic brain injury is one of the most common causes of cerebral palsy.Shujin Jiannao Prescription is an experienced formula for treating cerebral palsy and improving blood supply to the brain developed by the Dongzhimen Hospital,Beijing University of Chinese Medicine. OBJECTIVE:To explore the possible mechanism of Shujin Jiannao Prescription in treating hypoxic-ischemic cerebral palsy. METHODS:Sixty-four 7-day-old Sprague-Dawley rats were randomly divided into six groups.There were 12 rats in each of the control and model groups as well as 10 animals in each of the minocycline group,and the low-,medium-,and high-dose groups of Shujin Jiannao Prescription.The neonatal rat ischemic-hypoxic cerebral palsy model was established in all groups except for the control group.After successful modeling,rats in each drug group were respectively gavaged with minocycline and Shujin Jiannao Prescription at a dose of 4,8,and 16 g/kg per day for 1 week.Body mass of rats was measured and behavioral changes were detected before and after drug administration.Hematoxylin-eosin staining was used to observe the histomorphology of hippocampal CA1 region of rat brain tissue,and immunohistochemistry and western blot were used to detect the expression levels of Bcl-2,Bax,and Caspase-3 in the brain tissue of rats. RESULTS AND CONCLUSION:Compared with the model group,medium-and high-dose Shujin Jiannao Prescription significantly increased the body mass of rats(P<0.05).Compared with the model group,minocycline effectively prolonged the suspension time of ischemic-hypoxic cerebral palsy rats(P<0.05),while medium-and high-dose Shujin Jiannao Prescription significantly prolonged the suspension time,shortened the inclined plane test time,and increased the Longa score of rats(P<0.05).The pathological results showed that after drug intervention,only a small number of neuronal cells in the brain tissue of rats were necrotic,the cells were more neatly arranged,the cell structure was more complete,and only part of the cell nuclei became smaller.Compared with the model group,minocycline and medium-and high-dose Shujin Jiannao Prescription reduced the expression of Bax Caspase-3(P<0.05),medium-and high-dose Shujin Jiannao Prescription increased the expression of Bcl-2(P<0.05),and Bcl-2/Bax protein expression was increased in minocycline and three Shujin Jiannao Prescription groups(P<0.05).In addition,the protein expression was increased in a dose-dependent manner after intervention with Shujin Jiannao Prescription,and there was no significant difference between the minocycline and three Shujin Jiannao Prescription groups(P>0.05).To conclude,the mechanism by which Shujin Jiannao Prescription treats ischemic-hypoxic cerebral palsy in rats may be to enhance the expression of anti-apoptotic protein Bcl-2,inhibit the expression of pro-apoptotic protein Bax,and reduce the expression of Caspase-3,ultimately inhibiting the apoptosis of hippocampal neuronal cells in rats with cerebral palsy.Within a certain range,the higher dose of Shujin Jiannao Prescription indicates the better therapeutic effect,and the high-dose Shujin Jiannao Prescription is as effective as minocycline.

Study of cognitive functional changes in children with spastic cerebral palsy using diffusion tensor imaging based graph theory analysis / 中华放射学杂志

Objective:To explore brain network properties and their relationship with cognitive function in children with spastic cerebral palsy (SCP) using diffusion tensor imaging (DTI) based graph theory analysis.Methods:The study was a cross-sectional study. Clinical and imaging data of 21 children with SCP (SCP group) and 32 healthy children (control group) who underwent cranial MRI at the Affiliated Hospital of Zunyi Medical University from August 2020 to April 2022 were analyzed retrospectively. 3D-T 1WI, DTI and Wechsler Intelligence Scale were assessed for all subjects. The Wechsler Intelligence Scale included the verbal comprehension index (VCI), the processing speed index (PSI), the work memory index (WMI), and the perceptual reasoning index (PRI), etc., and ultimately the full scale intelligence quotient (FSIQ) scores were obtained based on the indices of each subscale. Independent samples t-test was used to analyze the differences in the small world attributes [small-world index (σ), normalized shortest path length (λ), normalized clustering coefficients (γ)], global attributes [global efficiency (Eglob), local efficiency (Eloc), characteristic path length (Lp), clustering efficiency (Cp)] and node attributes [degree centrality(DC), nodal efficiency (Ne), betweeness centrality (Bc), nodal shortest path length (NLp), nodal clustering efficiency, nodal local efficiency] between two groups of children′s brain networks. Brain network indicators with statistically significant differences between the 2 groups were correlated with Wechsler Intelligence Scale scores using Spearman. Results:The FSIQ scores on the Wechsler Intelligence Scale and the VCI, WMI, PSI, and PRI were lower in the SCP group than in the control group, and the differences were all statistically significant (all P<0.05). Both groups of children′s brain networks had small world properties. Compared with the control group, Eglob decreased, Lp and λ increased in the SCP group (all P<0.05). Compared with the control group, DC and Ne in multiple brain regions decreased, NLp increased in the SCP group (all P<0.05, FDR corrected). Correlation analysis showed that DC in the right parsopercularis was positively correlated with FSIQ, VCI, WMI and PRI( r=0.53, 0.47, 0.47, 0.60, P=0.019, 0.045, 0.044, 0.020, respectively); NLp in the right parsopercularis was negatively correlated with PRI( r=-0.56, P=0.030); Ne in left paracentral, the right parsopercularis, right precentral, right postcentra were positively correlated with PRI( r=0.62, 0.56, 0.53, 0.54, P=0.015, 0.031, 0.044, 0.039, respectively); Ne in the right precentral was positively correlated with WMI ( r=0.48, P=0.039) in the SCP group. Conclusions:There are changes in the topological attributes of global and multiple regional brain networks in SCP. The changes in the attributes of nodes in the right parsopercularis, right precentral, right postcentral, and left paracentral could reflect cognitive dysfunction in children with SCP.

Evaluation of the efficacy of proximal femoral varus derotational osteotomy in conjunction with modified triple innominate osteotomy for the management of hip dislocation in cerebral palsy / 中华骨科杂志

Objective:To assess the effectiveness and postoperative stability of proximal femoral varus derotational osteotomy combined with modified triple innominate osteotomy in treating hip dislocation in cerebral palsy.Methods:A total of 28 hips (11 left, 17 right) from 23 patients with cerebral palsy-induced hip dislocation who underwent the said surgical procedures were retrospectively examined between November 2018 and September 2022. The median age at the time of surgery was 7.7 years. Preoperatively, 29% of hips exhibited pain. Intraoperatively, a three-dimensional subtrochanteric osteotomy was performed with internal fixation using a Pediatric Hip Plate, alongside a modified triple innominate osteotomy via the Smith-Petersen and perineal approaches. Clinical assessments included pre- and postoperative evaluations of hip pain and joint mobility, as well as imaging evaluations, including migration percentage, acetabular index, acetabular offset, neck shaft angle, and femoral neck anteversion.Results:With a median follow-up of 15 months (range: 12 months to 20 months), all patients were successfully monitored. The median surgery duration was 6.1 hours, with blood loss averaging 400±153 ml (range 200-800 ml). The difference between the median postoperative (1 week after operative) MP 0% (0%, 0%) and the median preoperative MP 50.5% (38.2%, 75.8%) was statistically significant ( Z=4.624, P<0.001). The difference between the median postoperative AI 1.0° (-3.3°, 11.8°) and the median preoperative AI 29.4° (26.3°, 38.0°) was statistically significant ( Z=4.623, P<0.001). The difference between the median postoperative AO 69.8 (66.0, 76.0) mm and the median preoperative AO 72.3 (69.1, 81.1) mm was statistically significant ( Z=4.099, P<0.001). The difference between the median postoperative NSA 124.3° (118.7°, 129.9°) and the median preoperative NSA 145.6° (139.6°, 153.5°) was statistically significant ( Z=4.541, P<0.001). The difference between the median postoperative FNA 13.0° (5.4°, 24.1°) and the median preoperative FNA 33.6° (27.8°, 39.8°) was statistically significant ( Z=4.407, P<0.001). The pain was relieved postoperatively in 7 hips (88%) and residual hip pain in 1 hip. The postoperative range of motion was preserved. No case of avascular necrosis of the femoral head was observed. There were 2 hips (7%) with nonunion in the iliac arcuate line. No case of redislocation was observed at the last follow-up, and no revision was performed recently. There was no significant difference between the median MP at the last follow-up of 0% (0%, 10.0%) and the median postoperative MP ( Z=0.561, P=0.575). Conclusion:The modified triple innominate osteotomy proved to be an effective intervention for correcting acetabular deformity in cerebral palsy-induced hip dislocation. The combination of proximal femoral varus derotational osteotomy with the modified triple approach not only significantly corrected hip dislocation but also alleviated pain and maintained joint mobility in pediatric patients with cerebral palsy.

Effects of an exoskeleton rehabilitation robot on the lower limb motor function of children with spastic cerebral palsy / 中华物理医学与康复杂志

Objective:To observe any effect of using the KidGo exoskeleton rehabilitation robot on the lower limb motor function of children with spastic cerebral palsy.Methods:Thirty children with spastic cerebral palsy were sorted at random into a control group and a robotics group, each of 15. Both groups received conventional rehabilitation 5 days a week for 12 weeks, but the robotics group also spent 30 minutes daily training with the KidGo exoskeleton robot. Before and after the intervention, the lower limb muscle tone and strength, gross motor function, balance, and functional independence of both groups were assessed using surface electromyography, a handheld muscle strength tester, the gross motor function measure, the Berg Balance Scale, and the Wee-functional independence measure.Results:After the intervention great improvements in average lower limb muscle tone and strength, gross motor function, balance, and functional independence were observed in both groups, but the improvements in the robotics group were significantly greater, on average.Conclusion:Supplementing conventional rehabilitation with training using the KidGo exoskeleton rehabilitation robot can better improve muscle tone, strength, gross motor functioning, balance, and the functional independence of children with spastic cerebral palsy.

Transcranial magnetic stimulation can alleviate sleep disorders in children with cerebral palsy / 中华物理医学与康复杂志

Objective:To observe any effect of repetitive transcranial magnetic stimulation (rTMS) on sleep disorders among children with cerebral palsy (CP).Methods:A total of 102 children with CP and disordered sleep were randomly divided into an experimental group and a control group, each of 51. All were given routine rehabilitation and sleep health education, but the experimental group additionally received rTMS for two weeks. The polysomnography (PSG) results of the two groups were recorded and analyzed.Results:The PSG parameters had improved greatly in both groups after the treatment. The percentage of N2 sleep (depth of sleep during light sleep) in the severe cerebral palsy group and of N3 sleep (depth of sleep during deep sleep) in the moderate cerebral palsy group had increased significantly more than in the mild cerebral palsy group, on average. After the intervention the percentages of N2 and N3 in those with mixed cerebral palsy and of N3 in those with involuntary motor cerebral palsy had increased significantly more than in those with spastic cerebral palsy, on average.Conclusion:rTMS treatment can improve the sleep disorders of children with cerebral palsy, especially N2 sleep among children with moderate to severe cerebral palsy, N3 sleep in cases of mixed or dyskinetic CP.