Transcutaneous Spinal Neuromodulation Reorganizes Neural Networks in Patients with Cerebral Palsy.

Spinal neuromodulation and activity-based rehabilitation triggers neural network reorganization and enhances sensory-motor performances involving the lower limbs, the trunk, and the upper limbs. This study reports the acute effects of Transcutaneous Electrical Spinal Cord Neuromodulation (SCONE™, SpineX Inc.) on 12 individuals (ages 2 to 50) diagnosed with cerebral palsy (CP) with Gross Motor Function Classification Scale (GMFCS) levels ranging from I to V. Acute spinal neuromodulation improved the postural and locomotor abilities in 11 out of the 12 patients including the ability to generate bilateral weight bearing stepping in a 2-year-old (GMFCS level IV) who was unable to step. In addition, we observed independent head-control and weight bearing standing with stimulation in a 10-year-old and a 4-year old (GMFCS level V) who were unable to hold their head up or stand without support in the absence of stimulation. All patients significantly improved in coordination of flexor and extensor motor pools and inter and intralimb joint angles while stepping on a treadmill. While it is assumed that the etiologies of the disruptive functions of CP are associated with an injury to the supraspinal networks, these data are consistent with the hypothesis that spinal neuromodulation and functionally focused activity-based therapies can form a functionally improved chronic state of reorganization of the spinal-supraspinal connectivity. We further suggest that the level of reorganization of spinal-supraspinal connectivity with neuromodulation contributed to improved locomotion by improving the coordination patterns of flexor and extensor muscles by modulating the amplitude and firing patterns of EMG burst during stepping.

Aponeurotic release of semimembranosus: A technical note to increase correction gained with hamstring lengthening surgery in cerebral palsy.

OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP). METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group. RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications. CONCLUSION: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.

Effects of three kinds of head acupuncture therapies on regulation of brain microenvironment and rehabilitation of nerve function in rats with cerebral palsy.

OBJECTIVE: To compare and observe the effects of three kinds of cephalic acupuncture therapies commonly used in the clinic on promoting nerve function rehabilitation in the brain microenvironment of rats with cerebral palsy. METHODS: A negative control group, positive control group, and three cephalic acupuncture groups based on the administration of three cephalic acupuncture therapies were established. Ten experimental rats were selected from each group at 1, 2, and 3 weeks after modeling. Neuromotor function after treatment was rated according to the Basso, Beattie, and Bresnahan method. White matter fiber bundles were evaluated by head diffusion tensor imaging. The expression levels of neuron-specific enolase, microtubule-associated protein 2, and myelin basic protein in the brain tissue extract were detected by Western blot analysis and the activities of ATPases were determined using a fixed phosphorus method. RESULTS: The pathological changes in brain tissue were restored and motor function scores were increased in the mice in each cephalic acupuncture group, and the expression of neuronal growth-related proteins in the brain tissue extract was significantly increased. Additionally, the activities of ATPases in the lesion area were significant enhanced (P < 0.05). Diffusion tensor imaging revealed that the white matter fiber bundles of mice in each cephalic acupuncture group gradually increased and recovered. The nervous system structure was significantly improved. CONCLUSIONS: All three acupuncture methods promoted the rehabilitation of nerve function damaged by cerebral palsy. These effects are likely related to the improved expression of nerve growth-related proteins, enhancement of ATPase activities, and regulation of the brain microenvironment.

Influence of Chest and Diaphragm Manual Therapy on the Spirometry Parameters in Patients with Cerebral Palsy: A Pilot Study.

OBJECTIVE: To evaluate the influence of manual therapy of the chest and diaphragm on the spirometry parameters in patients with cerebral palsy (CP). METHOD: The study was carried out on 20 youths with CP. All participated in 6 sessions (3 sham and 3 actual), with measurements of spirometry at baseline, postsham therapies 1 and 3, before actual therapy, and postactual therapy sessions 1 and 3. Two manual techniques were included: soft tissue mobilization of the chest and the diaphragm. RESULTS: After the first actual therapy, there was a significant (p < 0.01) improvement in forced vital capacity (FVC) by 0.23 L (8% of the average predicted value) and forced expiratory volume in one second (FEV1) by 0.18 L (7% of the average predicted value) as compared to results before the therapy. Change in FVC parameter was clinically significant, whereas change in FEV1 was not clinically significant. After sham therapy, there was no improvement in spirometry parameters as compared to baseline results. CONCLUSION: Single-time manual therapy of the chest and diaphragm has a positive effect on FVC and FEV1.

The effect of therapeutic instrumental music performance method on upper extremity functions in adolescent cerebral palsy.

The aim of the study is to investigate the improvement of upper extremity functions with piano training of adolescent cerebral palsy. Nine adolescent cerebral palsy patients admitted to the Pediatric Disability Clinic between 2018 and 2020 and 9 healthy adolescent volunteers as control group were included. Therapeutic Instrumental Music Performance method was applied 2 days a week, 3 months in 40-min sessions. Before/after intervention, MACS, Box Block Test, Nine-Hole Peg Test, Jamar hand dynamometer and key pressing force of fingers were evaluated with Cubase MIDI program. Five of our patients included in the study were spastic hemiplegic and 4 were spastic diplegic cerebral palsy. All measurements made after intervention were found to be statistically significant compared to the measurements made before piano training (p < 0.05). The fingers that improved the most in the key pressing force of the fingers were found as the right hand 4th, left hand the 4th and 5th fingers (p < 0.01). A significant strong negative relationship was detected between the Box Block Test and the Nine-Hole Peg Test (p < 0.001). With therapeutic instrumental music performance method, functional gains can be achieved in the grip strength, strengths of the fingers, gross and fine motor skills of adolescent cerebral palsy patients. Further studies are needed to establish a piano training protocol in neurological music therapy.

Effectiveness and safety of pure acupuncture and moxibustion in the treatment of children with cerebral palsy: A protocol for systematic review and meta analysis.

BACKGROUND: Infantile cerebral palsy refers to brain damage in infants and young children during their development, causing brain dysfunction, mainly manifested as dyskinesia, which may be complicated by mental retardation, epilepsy, and bone and joint developmental disorders. Clinical practice shows that acupuncture can effectively treat children with cerebral palsy, but it needs to be proven. This research will systematically evaluate the clinical effectiveness and safety of acupuncture and moxibustion in the treatment of children with cerebral palsy, and provide evidence-based evidence for it. METHOD: Search the following databases, including CNKI, WANFANG, China Biomedical Database, VIP, PubMed, Embase, the Cochrane Library, Web of Science. The retrieval time is from the establishment of the databases to October 2020, collecting all clinical randomized controlled studies of acupuncture and moxibustion treatment of children with cerebral palsy. Two investigators independently extract and evaluate the data of the included studies, and use RevMan V.5.3 software to conduct meta-analysis of the included literature. RESULT: This study evaluates the effectiveness and safety of acupuncture and moxibustion in the treatment of children with cerebral palsy through indicators such as Gross Motor Function Measure Scale, the Modified Ashworth Scale, and so on. CONCLUSION: This study will provide reliable evidence-based evidence for the clinical application of acupuncture and moxibustion in the treatment of children with cerebral palsy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/7GUF5.

Treatment with the essential amino acid L-tryptophan reduces masticatory impairments in experimental cerebral palsy.

Purpose Children with cerebral palsy (CP) often exhibit difficulties in feeding resulting from deficits in chewing. This study investigates the therapeutic potential of L-tryptophan (TRI) to reduce deficits in chewing in rats subjected to an experimental model of CP.Methods A total of 80 Wistar albino rats were used. Pups were randomly assigned to 4 experimental groups: Control Saline, Control TRI, CP Saline, and CP TRI groups. The experimental model of CP was based on the combination of perinatal anoxia associated with postnatal sensorimotor restriction of the hind limbs. TRI was administered subcutaneously during the lactation period. Anatomical and behavioral parameters were evaluated during maturation, including body weight gain, food intake, chewing movements, relative weight and the distribution of the types of masseter muscle fibers.Results The induction of CP limited body weight gain, decreased food intake and led to impairment in the morphological and functional parameters of chewing. Moreover, for a comparable amount of food ingested, CP TRI animals grew the most. In addition, supplementation with TRI improved the number of chewing movements, and increased the weight and proportion of type IIB fibers of the masseter in rats subjected to CP.Conclusion These results demonstrate that experimental CP impaired the development of mastication and that TRI supplementation increased masticatory maturation in animals subjected to CP.

Goals of children with unilateral cerebral palsy in a brain stimulation arm rehabilitation trial.

AIM: To explore relationships between category classifications for children's rehabilitation goals, outcomes, and participant characteristics. METHOD: Children with hemiparetic cerebral palsy due to perinatal stroke rated self-selected goals with the Canadian Occupational Performance Measure (COPM) and completed the Assisting Hand Assessment (AHA) and Box and Block Test (BBT), at baseline and 6 months, in a randomized, controlled 10-day neuromodulation rehabilitation trial using repetitive transcranial magnetic stimulation. Goals were classified with the Canadian Model of Occupational Performance and Engagement and the International Classification of Functioning, Disability and Health. Analysis included standard linear regression. RESULTS: Data for 45 participants (mean age 11y 7mo, SD 3y 10mo, range 6-19y, 29 males, 16 females) on 186 goals were included. Self-care goal percentage corresponded with baseline BBT by age (standardized ß=-0.561, p=0.004). Leisure goal percentage corresponded with baseline BBT (standardized ß=0.419, p=0.010). AHA change corresponded with productivity goals (standardized ß=0.327, p=0.029) and age (standardized ß=0.481, p=0.002). COPM change corresponded with baseline COPM and age by AHA change (p<0.05). INTERPRETATION: Younger children with lower motor function were more likely to select self-care goals while those with better function tended to select leisure goals. Functional improvement corresponded with older age and productivity goals. COPM change scores reflected functional improvement among older children. Children chose functionally and developmentally appropriate goals. Consequently, children should be free to set goals that matter to them. WHAT THIS PAPER ADDS: Children in a brain stimulation trial chose divergent upper extremity functional goals. Younger children with lower ability chose more self-care goals. Children with higher ability chose more leisure goals. Older children's goal ratings reflected objective functional motor gains. Children chose goals appropriate to their function and level of development.

Proteomic changes in the hippocampus and motor cortex in a rat model of cerebral palsy: Effects of topical treatment.

Cerebral palsy (CP) is a non-progressive motor-impairment disorder related to brain injury early in development. To gain new insights into the mechanisms of CP and the therapeutic efficacy of Baimai ointment, we used a high-throughput quantitative proteomic approach to evaluate proteomic changes in the hippocampus and motor cortex in a rat model of CP induced by lipopolysaccharide (LPS) combined with hypoxia/ischemia (H/I). More than 2000 proteins were identified in each brain region with high confidence. Quantitative analysis demonstrated profound disturbances in the proteomes of the hippocampus and motor cortex after LPS + H/I, in addition to the disruption of the motor system. In contrast, the topical application of Baimai ointment not only alleviated the motor deficit in the CP model rats, but also restored the proteomes in the brain cortex. Furthermore, astrocytes in the hippocampus were strongly activated in the Baimai-treated CP rat brains, associated with an increase in neurotrophic factors. Proteomic analysis demonstrated that the CP model induced neuroinflammatory responses in the brain which were reversed by the topical application of Baimai ointment. This study highlights the unexpected roles of hippocampus and motor cortex neurons in CP progress and treatment, thus providing potentially novel therapeutic targets for CP.

Lateralized EEG mu power during action observation and motor imagery in typically developing children and children with unilateral Cerebral Palsy.

OBJECTIVE: During motor execution (ME), mu power is diminished over the contralateral hemisphere and increased over the ipsilateral hemisphere, which has been associated with cortical activation of the contralateral motor areas and inhibition of the ipsilateral motor areas respectively. The influence of action observation (AO) and motor imagery (MI) on mu power is less clear, especially in children, and remains to be studied in children with unilateral cerebral palsy (uCP). METHODS: We determined mu power during ME, AO, and MI of 45 typically developing (TD) children and 15 children with uCP over both hemispheres, for each hand. RESULTS: In TD children, over the left hemisphere mu power was lowered during ME when the right hand was used. In line, over the right hemisphere mu power was lowered when the left hand was addressed. In addition, during AO and MI increased mu power was observed when the right hand was addressed. In children with uCP, over the spared hemisphere mu power was diminished during ME when the less-affected hand was used. However, over the lesioned hemisphere, no mu changes were observed. CONCLUSIONS: The results of TD children fit the activation/inhibition model of mu power. SIGNIFICANCE: The results of children with uCP suggest that the lesioned hemisphere is unresponsive to the motor tasks.

Effect of "Tonifying Kidney and Invigorating Brain" acupuncture in children with spastic cerebral palsy analyzed by multi-modality MRI combined with dynamic electroencephalogram.

INTRODUCTION: Cerebral palsy is the most common motor disability of childhood. Spastic cerebral palsy accounts for 60% to 70% of cases. Research has shown that acupuncture can improve the quality of life of children with cerebral palsy, but the mechanism of action remains unclear. This study aims to determine the effectiveness of acupuncture for treatment of children with spastic cerebral palsy and to assess the value of multimodal magnetic resonance imaging (MRI) and ambulatory electroencephalogram (EEG) for evaluation of treatment effect. METHODS AND ANALYSIS: This randomized controlled trial will enroll a total of 72 children with CP from 2 hospitals-Jiangsu Province Hospital of Chinese Medicine and Nanjing State Hospital of Pediatric-with 36 participants from each hospital. Patients will be randomly assigned (1:1 ratio) to receive "Tonifying Kidney and Invigorating Brain" acupuncture treatment plus standardized physical rehabilitation treatment (treatment group) or only standardized physical rehabilitation (control group). All participants will receive 3 treatment sessions per week for 3 consecutive months; they will then be followed up for another 3 months. The primary outcome measures will include multimodal magnetic resonance imaging (MRI), ambulatory electroencephalogram (EEG), and Gesell Developmental Diagnostic Schedules. The secondary outcome measures will include Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Functional Independence Measure (WeeFIM), and Modified Ashworth Scale score. Outcome measures (including primary and secondary outcome measures) were collected at the baseline, 3 months and 6 months prior to the intervention.Ethics and dissemination PATIENTS CONSENT:: Obtained. ETHICS APPROVAL: The central independent ethics committee of Jiangsu Province Hospital of Traditional Chinese Medicine approved the protocol (2017NL-115-02). SAFETY CONSIDERATIONS: Routine blood tests and liver and kidney function tests will be conducted to exclude patients with severe heart, liver, or kidney diseases. The same examinations will be performed again at the end of the study to detect any possible side effects. Possible acupuncture-related adverse events (e.g., fainting, needle stick injury, local infection, subcutaneous hematoma, and low-grade fever) will be documented. Serious adverse events will be reported to the principal investigator immediately. All unexpected and unintended responses, even those not necessarily related to the acupuncture intervention, will be documented as adverse events. CASE DROPOUT MANAGEMENT: Participants have a right to withdraw from the study at any time if they feel uncomfortable upon receiving the treatments or being diagnosed with serious complications or diseases. They will then be referred to the preferred department for further treatment and management. If cases of dropout, the researcher need to contact the participant to reason the problem out, collect and record all the necessary assessments on the last visit as well as the date of last visit. All data available until the date of withdrawal will be stored for further statistical analysis. DISCUSSION: This research is being conducted to assess the value of acupuncture as an intervention for rehabilitation of children with spastic cerebral palsy and also to evaluate the usefulness of multimodal MRI and ambulatory EEG for identifying changes in brain function. TRIAL REGISTRATION: This trial is registered with Chinese Clinical Trials Register, ChiCTR 1900024546 (registered 15 July 2019; retrospective registration, http://www.chictr.org.cn/showproj.aspx?proj=35763).

Gait training for adults with cerebral palsy following harmonic modification in rhythmic auditory stimulation.

This study aimed to investigate the differences in gait outcomes of young adults with cerebral palsy (CP) following rhythmic auditory stimulation (RAS) with different types of cueing. A total of 13 ambulatory adults with CP were recruited. The participants were assigned to receive either RAS with simple chords or RAS with complex chords. Each participant received 30-min individual sessions three times per week for 4 weeks. In the simple RAS group, basic chords were used for cueing. In the complex RAS group, the diversified chords were adopted from patients' preferred music. At pre- and posttest, spatiotemporal and kinematic parameters and the range of motion (ROM) for each joint during a gait cycle were collected. After RAS, cadence, velocity, and stride length significantly increased, but no significant group effect was found. Meanwhile, regarding kinematic parameters, a significant interaction effect between time and group was observed with the angle of plantar flexion in the preswing phase and ROM in the ankle. The complex RAS group showed increased maximal ankle plantar flexion in the preswing phase. These results demonstrated that the primary agent for gait control is rhythm, while perception of music facilitates patient engagement in walking differently depending on the level of musical elements.

The effects of traditional massage on spasticity of children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To examine the effects of traditional massage on spasticity of children with cerebral palsy. METHODS: The randomised control trial was conducted at the National Institute of Rehabilitation Medicine, Islamabad, Pakistan, from September 2016 to August 2018, and comprised children with spastic cerebral palsy aged 2-10 years who were randomly allocated to control and intervention groups. Both the groups received routine physical therapy once daily, five times a week for three months. The intervention group additionally received traditional massage. Spasticity was evaluated using the Modified Ashworth Scale at baseline, and after 6th and 12th weeks of intervention. Data analysed using SPSS 20.. RESULTS: Of the 86 subjects enrolled, 75(87.2%) completed the study; 37(49.3%) in the control group with a mean age of 6.81±2.31 years, and 38(50.6%) in the intervention group with a mean age of 7.05±2.47 years. There were 25(68%) boys among the controls and 22(58%) in the intervention group. There was no statistically significant difference in baseline scores between the groups (p>0.05). At 6th week, reduction in scores was statistically significant in the right upper limb (p<0.05), and in the right lower limb (p<0.05) after the 12th week. CONCLUSIONS: Traditional massage was found to have significant effect on the right side compared to the routine physical therapy for reduction of spasticity in children with cerebral palsy.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy.

BACKGROUND: Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination. AIMS: We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy. METHODS AND PROCEDURES: Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months. OUTCOMES AND RESULTS: Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention. CONCLUSIONS AND IMPLICATIONS: Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

Botulinum Toxin Type A Injections Impact Hamstring Muscles and Gait Parameters in Children with Flexed Knee Gait.

The aim of this study was to determine if botulinum toxin type A (BoNT-A) injection into the medial hamstring can improve gait kinematics and muscle-tendon length in spastic cerebral palsy (CP) with a flexed knee gait (FKG). Twenty-nine children with spastic CP (Gross Motor Function Classification System I-III) with FKG were recruited for this prospective study. BoNT-A was injected into the semitendinosus and semimembranosus (SM) muscles under ultrasonography guidance. Assessments included Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), 3-dimensional computerized gait analysis, calculated SM muscle-tendon length and lengthening velocity during gait using musculoskeletal modeling at baseline, 4 and 16 weeks after the injection. Compared to baseline data, significant improvements in GMFM, MAS, and MTS were demonstrated at weeks 4 and 16, and also a significant increase in maximum knee extension during the stance phase was observed at week 4. In addition, the mean lengthening velocity during the swing phase was increased at week 16 without a change in the SM muscle length. Furthermore, there was a significant increase in anterior pelvic tilt at week 4, compared to baseline data. The significant decrease in hip internal rotation after injection was observed only in children with excessive hip internal rotation at initial contact before injection. BoNT-A injection into hamstrings leads to a significant increase in knee extension and anterior pelvic tilt with an increase in lengthening velocity of SM in spastic CP with FKG.

Evaluation of a Magic Camp for Children with Hemiparesis: A Pilot Study.

This single-group open trial was designed to evaluate the effectiveness of a two-week magic camp as a means of hand-arm motor skills training to improve upper limb motor function (unilateral and bilateral) in children with hemiparesis. Seven children with hemiparesis participated in a magic camp program which met 3 days a week, 4 hours each day, for two consecutive weeks for a total of 24 hours. Participants completed three assessments at the beginning of the camp, post-camp, and at a three-month follow-up: the Jebsen Hand Function Test (JHFT), Children's Hand Experience Questionnaire (CHEQ), and a box opening task that required coordination of both upper limbs. A Wilcoxon signed-rank test revealed significant improvement in JHFT composite scores of the affected limb at post-camp (p = .04) and three-month follow-up (p = .04). In addition, a significant improvement in the number of activities performed using two hands from baseline to three-month follow-up was observed (p = .03). This pattern of improvement was also observed in the speed of completion for the box opening task. The improvement in motor function seems related to the participants' continuing performing daily activities with the affected hand and two hands after the magic camp.

Benefits of a Dance Intervention on Balance in Adolescents with Cerebral Palsy.

AIMS: Cerebral palsy (CP) impacts motor functions such as balance, limits of stability and walking, and may also affect other functions such as attention and rhythm production. Motor and non-motor deficits lead to difficulties in daily life activities. The main objective of this study was to evaluate the effects of a dance intervention on balance in adolescents with CP. The secondary objectives were to evaluate the effects of this intervention on walking speed, attention, and rhythm production. METHODS: A pre-post design study with a double baseline was conducted on ten adolescents with CP in order to assess the effects of a 10-week dance intervention. The dance intervention focused on improving balance and limits of stability. Outcomes on static and dynamic balance were evaluated with clinical and laboratory tests before and after the intervention. Walking speed, attention, and rhythm production were also evaluated before and after the intervention. RESULTS: Balance improved after the dance intervention as assessed with both the clinical tests and a laboratory test. Rhythm production also improved after the dance intervention. CONCLUSIONS: Results suggest that a 10-week dance intervention is an effective activity to improve static and dynamic balance as well as rhythmic production in adolescents with CP.

Complicated Muscle-Bone Interactions in Children with Cerebral Palsy.

PURPOSE OF REVIEW: The goal of this review is to highlight the deficits in muscle and bone in children with cerebral palsy (CP), discuss the muscle-bone relationship in the CP population, and identify muscle-based intervention strategies that may stimulate an improvement in their bone development. RECENT FINDINGS: The latest research suggests that muscle and bone are both severely underdeveloped and weak in children with CP, even in ambulatory children with mild forms of the disorder. The small and low-performing muscles and limited participation in physical activity are likely the major contributors to the poor bone development in children with CP. However, the muscle-bone relationship may be complicated by other factors, such as a high degree of fat and collagen infiltration of muscle, atypical muscle activation, and muscle spasticity. Muscle-based interventions, such as resistance training, vibration, and nutritional supplementation, have the potential to improve bone development in children with CP, especially if they are initiated before puberty. Studies are needed to identify the muscle-related factors with the greatest influence on bone development in children with CP. Identifying treatment strategies that capitalize on the relationship between muscle and bone, while also improving balance, coordination, and physical activity participation, is an important step toward increasing bone strength and minimizing fractures in children with CP.

Comparison of Electroacupuncture and Body Acupuncture on Gastrocnemius Muscle Tone in Children with Spastic Cerebral Palsy: A Single Blinded, Randomized Controlled Pilot Trial.

OBJECTIVE: To compare the immediate effects of electroacupuncture (EA) and body acupuncture (BA) on gastrocnemius muscle tone in children with spastic cerebral palsy (CP). METHODS: Children with spastic CP, age from 24 to 60 months, who all received rehabilitation treatment in the Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University from April 2016 to May 2017 were enrolled in this trial and assigned to EA group and BA group through a random number table. Both EA and BA therapies were performed on acupoints of Zusanli (ST 36), Shangjuxu (ST 37), Sanyinjiao (SP 6), and Xuanzhong (GB 39) for 30 min once. The root mean square (RMS), integrated electromyogram (iEMG) of the gastrocnemius of surface electromyography (sEMG), and Modified Tardieu Scale (MTS) of the two groups were evaluated before and after treatment. All adverse events were accurately recorded. RESULTS: Thirty-six children with spastic CP completed the study (18 cases and 32 legs in the EA group; 18 cases and 31 legs in the BA group). There was no significant difference in RMS, iEMG and MTS between the two groups before treatment (P>0.05). After treatment, compared with before treatment, RMS and iEMG significantly reduced and MTS (R2-R1) significantly increased in both EA and BA groups (P<0.05), and EA was more effective than BA in RMS and MTS (P<0.05). However, the iEMG between the two groups were not statistically significant after treatment (P>0.05). There was no serious adverse event during this clinical trial. CONCLUSION: Both EA and BA could significantly relieve the gastrocnemius muscle tone in spastic CP, and EA was more effective than BA. (Registration No. ChiCTRONC-15007633).

The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review-Part B diffusion imaging and tractography.

BACKGROUND: Diffusion magnetic resonance imaging (dMRI) is able to detect, localize and quantify subtle brain white matter abnormalities that may not be visible on conventional structural MRI. Over the past years, a growing number of studies have applied dMRI to investigate structure-function relationships in children with cerebral palsy (CP). AIMS: To provide an overview of the recent literature on dMRI and motor function in children with CP. METHODS: A systematic literature search was conducted in PubMed, Embase, Cochrane Central Register of Controlled trials, Cinahl and Web of Science from 2012 onwards. RESULTS: In total, 577 children with CP in 19 studies were included. Sixteen studies only included unilateral CP, while none included dyskinetic CP. Most studies focused on specific regions/tracts of interest (n = 17) versus two studies that investigated the whole brain. In unilateral and bilateral CP, white matter abnormalities were widespread including non-motor areas. In unilateral CP, consistent relationships were found between white matter integrity of the corticospinal tract and somatosensory pathways (e.g. thalamocortical projections, medial lemniscus) with upper limb sensorimotor function. The role of commissural and associative tracts remains poorly investigated. Also results describing structure-function relationships in bilateral CP are scarce (n = 3). CONCLUSIONS: This review underlines the importance of both the motor and somatosensory tracts for upper limb sensorimotor function in unilateral CP. However, the exact contribution of each tract requires further exploration. In addition, research on the relevance of non-motor pathways is warranted, as well as studies including other types of CP.