Single-leg vertical jumping in young adults with spastic cerebral palsy.

BACKGROUND: Maximum-strength tests are commonly used to detect muscle weakness in persons with cerebral palsy (CP). Tests of explosive strength (power) in the lower extremities, such as vertical jump tests, are more uncommon but might supplement maximum-strength testing by providing additional information about motor function. RESEARCH QUESTION: Is it feasible and useful to measure single-leg vertical jumping in young adults with CP? METHODS: Eleven persons with spastic CP (18-30 years), able to walk without support, were compared with a reference group. Jump height and power generation in jumping were measured using a 3D motion-analysis system and force plates. Maximum strength in plantarflexors was measured on the same occasion. Data were analysed using non-parametric statistics. RESULTS: Jump height was significantly greater in the reference group than in the group with CP, both relative to the less-involved leg of the participants with CP (p = .007) and relative to their more-involved leg (p < .001). In the group with CP, jump height was twice as great for the less-involved leg than for the more-involved leg (p = .008). Power generation at the hip joint was similar between the groups but differed for the knee and ankle joints (p = .001-.033). In the reference group, most of the power was generated at the ankle joint, while the hip was the dominant power generator for the more-involved leg in the group with CP. Muscle strength in the group with CP showed a high correlation with jump height (rho = .745, p < .001) and power generation at the ankle (rho = .780, p = .001). SIGNIFICANCE: The single-leg vertical jump test proved capable of measuring jump height and power generation in participants with CP. It also identified explosive muscle weakness both relative to a reference group and between legs. Hence the jump test may provide information additional to common tests of maximal muscle strength in persons with CP.

Follow-up of brace-treated scoliosis in children with cerebral palsy and spina bifida.

PURPOSE: This study aimed to describe brace use, progression of scoliosis, and surgery in children with cerebral palsy (CP) and spina bifida (SB) who were initially treated with a brace. METHODS: Medical records were retrospectively analysed for brace compliance, treatment complications, curve size measurements with and without the brace at both start and at follow-up, and number of patients undergoing spine surgery. RESULTS: Sixty-eight children were included (CP 47, SB 21), 37 of whom were girls, with a mean age at start of treatment of 11.1 (CP) and 8.2 (SB) years. Most had severe motor problems; only four children with CP and five with SB were able to walk. Thirty-five in the group with CP and 11 in the group with SB had a curve size over 40°.Forty used the brace full-time, 19 half-time and nine for a varying proportion of time. Transient complications of brace treatment were seen in 28%. The yearly progression of curve-size was 4.2° in CP and 2.3° in SB.Twenty-eight patients underwent surgery and complications were present in 75% of these patients. Twenty-seven out of 46 patients with severe scoliosis did not undergo surgery. CONCLUSION: Brace treatment was possible, even in patients with severe scoliosis. Bracing can delay the progression of scoliosis.

Objective measurement of sitting - Application in children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) and a severe motor impairment, have limited ability to perform volitional movements due to spasticity, involuntary postures and movements and reduced ability to maintain antigravity head and trunk control. A stable sitting position is a prerequisite for participation in daily life, but there is a lack of objective measurement methods for this population. RESEARCH QUESTION: Is it feasible to measure a stable sitting position with pressure mapping and 2D motion analysis, and can it detect differences to a) a reference group, b) between subgroups of CP and c) before and after treatment with intrathecal baclofen (ITB)? METHODS: Pressure mapping, and a 2D motion analysis system, were used to capture movements of centre of pressure (CoP), and movements of head, hand and leg, sitting on a bench for 90 s. Twenty-two children with dyskinetic or bilateral spastic CP, GMFCS III-V, mean age 9.0, and 30 children with typical development (TD) mean age 10.7, were recruited between 2010 and 2019. Seventeen children were treated with ITB. Parents were interviewed regarding aspect of sitting. Non-parametric methods were used for statistical analysis. RESULTS: Differences in CoP and kinematics were detected with more movements in children with CP compared to children with TD (p < 0.001). There were more movements in children with dyskinetic CP compared to children with bilateral spastic CP as captured with the pressure mapping system (CoP distance p = .005 and Anterio-Posterior sway p = .014). After treatment with ITB, involuntary movements had decreased (CoP p = 0.006-0.035, kinematics p = 0.002-0.020). Parents reported improvement in sitting. The two measurement systems showed consistent results (rho 0.500-0.771, p = <0.001-0.049). SIGNIFICANCE: It was feasible to objectively measure sitting position in children with a moderate-to-severe motor impairment with differences to a reference group and after an intervention. CoP and head movements were the variables that were easiest to capture.

Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments.

Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments. Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37-58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews. Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043). Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV-V, or intellectual disability, is recommended.

Arm Muscle Strength in Children with Bilateral Spastic CP.

AIMS: To assess arm-muscle strength related to motor function in children with bilateral spastic cerebral palsy, 5-15 years old. METHODS: Muscle strength was measured for shoulder abductors, elbow extensors and flexors, wrist extensors, and grip strength. The children were grouped according to the Manual Ability Classification Scale (MACS). RESULTS: Forty-two children were included. The majority of the children at MACS levels I-II were within the normal range; shoulder abductors were weakest (mean 60-80% of predicted value), and variation was greatest for wrist extensors.Children at MACS level II showed lower values than children at level I, with significant differences for shoulder abductors (p=.028) and wrist extensors (p<.001). Differences between the dominant and non-dominant side was greater in children at MACS level II and statistically significant for wrist extensors (p=.024).Of 15 children tested for grip strength, nine were within the 2 SD range. The three children at MACS level II, all walking with a walker, had a higher mean value than those at MACS level I. CONCLUSIONS: Muscle strength was lower and differences were greater between sides in children at MACS level II. Wrist extensors showed a decreasing trend with age as compared with normal development.

Cerebral palsy prevalence, subtypes, and associated impairments: a population-based comparison study of adults and children.

AIM: To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP. METHOD: CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), and with the most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males). RESULTS: Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01). INTERPRETATION: Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed. WHAT THIS PAPER ADDS: Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.

PARÁLISIS CEREBRAL, PREVALENCIA SUBTIPOS Y DISCAPACIDADES ASOCIADAS: UN ESTUDIO DE BASE POBLACIONAL COMPARATIVO DE NIÑOS Y ADULTOS: OBJETIVO: Describir la prevalencia de parálisis cerebral (PC), distribución de subtipos, discapacidad intelectual y motora, y, epilepsia, en adultos con PC comparados con niños con PC. MÉTODO: Se utilizaron la base de datos de los subtipos de PC y discapacidad del registro Sueco Occidental y los datos poblacionales de Suecia para comparar los adultos vivos (n= 581; 244 mujeres, 337 hombres) nacidos entre 1959 y 1978, con la misma cohorte de niños (n= 723; 307 mujeres, 416 hombres), y con la más reciente cohorte, nacidos entre el 2007 y el 2010 (n= 205; 84 mujeres, 121 hombres). RESULTADOS: La prevalencia de PC en adultos nacidos entre 1959 y 1978 fue de 1,14 por 1000. La presencia de discapacidad varía entre los diferentes subtipos. La discapacidad motora e intelectual, estuvo estrechamente relacionada, independientemente del subtipo. La distribución entre los subtipos en los vivos, difiere significativamente de la cohorte orgiinal (p=0,002), de la cohorte más reciente (p<0,01), la PC tipo tetraplejía y disquinesia fue menos común entre los vivo. La discapacidad motora severa, la discapacidad intelectual y la epilepsia, fueron menos comunes en los vivos, que los de la cohorte original (p=0,004, p=0,002, p=0,037) y que en la cohorte más reciente (p=0,004, p=0,008, p<0,01). INTERPRETACIÓN: Los datos de la prevalencia, en la distribución de los subtipos y la discapacidad en niños con PC, no son aplicables a los adultos con PC. Son necesarios estudios de base poblacional en adultos con PC.

PREVALÊNCIA, SUBTIPOS E COMPROMETIMENTOS ASSOCIADOS A PARALISIA CEREBRAL: UM ESTUDO POPULACIONAL DE COMPARAÇÃO ENTRE ADULTOS E CRIANÇAS: OBJETIVO: Comparar a prevalência da paralisia cerebral (PC), a distribuição de cada subtipo, os comprometimentos motores e intelectuais, e a epilepsia entre adultos e crianças com PC. MÉTODO: Foram utilizados os dados oriundos do sistema de registro de PC do oeste da Suécia e os dados populacionais da Statistics Sweden para comparar o subtipo de PC e as alterações da PC entre adultos sobreviventes (n = 581; 244 mulheres, 337 homens) nascidos entre 1959 e 1978, com a mesmo coorte quando crianças (n = 723; 307 mulheres, 416 homens), assim como com a coorte mais recente composto por crianças nascidas entre 2007 e 2010 (n = 205; 84 mulheres, 121 homens). RESULTADOS: A prevalência de adultos nascidos entre 1959 e 1978 foi de 1,14 por 100. A ocorrência de alterações foi diferente entre os tipos de PC. As alterações motoras e intelectuais foram bem relacionadas, independente do subtipo. A distribuição do subtipo de PC foi estatisticamente diferente ente as coortes originais (p=0,002) e a coorte mais recente (p<0,01), sendo a tetraparesia e a discinesia menos frequente nos sobreviventes. O comprometimento motor severo, a deficiência intelectual e a epilepsia foram menos comuns no grupo de sobreviventes quando comparado aos coortes originais (p=0,004, p=0,002, p=0,037) e ao coorte mais recente (p=0,004, p=0,008, p<0,01). INTERPRETAÇÃO: Os dados de prevalência, distribuição de subtipo e alterações em criança com PC não podem ser aplicados em adultos com PC. Estudos populacionais de adultos com PC são necessários.

The effect of spinal bracing on sitting function in children with neuromuscular scoliosis.

BACKGROUND:: Scoliosis is common in children with neuromuscular deficits. It is often associated with an asymmetric sitting position and with poor balance. Many children with neuromuscular scoliosis spend most of their day sitting. OBJECTIVES:: To describe how sitting function is affected by treatment with a modified custom-moulded Boston brace in children with neuromuscular scoliosis. STUDY DESIGN:: Retrospective review of medical records. METHODS:: A review of medical records from children fitted with scoliosis braces, including analysis of sitting, using a pressure-mapping system. RESULTS:: A total of 106 children with a median age of 11.3 (1.7-17.7) years were included. The most frequent diagnoses were cerebral palsy ( n = 33) and myelomeningocele ( n = 17). Around 56 children could sit without support and 24 children were independent walkers. The Cobb angle was between 19° and 126°. Sitting function as noted in medical records improved in 73/105 children and deteriorated in five. The pressure mapping showed that symmetry was improved in 44/86 children, while three deteriorated. Stability improved in 20/40 children and seven decreased. CONCLUSION:: Bracing had a positive effect on sitting function in children with neuromuscular scoliosis. CLINICAL RELEVANCE: Bracing can reduce the need for support in sitting. Children with severe scoliosis can get a better sitting function with a brace. Sitting analysis with pressure mapping can identify sitting problems needing correction of the brace and adaptations of the chair.

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity.

AIM: To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP). METHOD: A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured. RESULTS: Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB. INTERPRETATION: After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved. WHAT THIS PAPER ADDS: Intrathecal baclofen can affect specific aspects of functioning in dyskinetic cerebral palsy. Sitting, communication, and fine motor function improved. Dystonia and spasticity were reduced. Pain was reduced and sleep improved.

Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole.

The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. RESULTS: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.

No Decrease in Muscle Strength after Botulinum Neurotoxin-A Injection in Children with Cerebral Palsy.

Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with botulinum neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with CP. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic CP were included in the study, 8 girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around 6 weeks after at the peak effect of BoNT-A, and at 6 months after treatment, with measurement of muscle strength, gait analysis, and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions.