The effect of selective dorsal rhizotomy on the improvement of the quality of life of children with stage GMFCS IV and V cerebral palsy: Pain, nursing, positioning, and dressing.

AIM: The objective of this study is to evaluate the benefit of selective dorsal rhizotomy on the quality of life of patients with severe spasticity with significant impairment of gross motor functions (GMFCS stages IV and V) according to 4 items: pain, nursing care, positioning, and dressing. MATERIALS AND METHODS: We conducted a monocentric retrospective cohort study including patients who underwent selective dorsal rhizotomy between March 2008 and May 2022 at the University Hospital of Marseille. RESULTS: Seventy percent of patients showed an improvement in quality of life criteria: dressing, nursing, positioning, and pain at the last follow-up. A small proportion of patients still showed a worsening between the first 2 follow-ups and the last follow-up. Postoperatively, 27.3% of patients were free of joint spasticity treatment, and we have shown that there was a significant decrease in the number of children who received botulinum toxin postoperatively. However, there was no significant reduction in the number of drug treatments or orthopaedic procedures following RDS. For the CPCHILD© scores, an overall gain is reported for GMFCS IV and V patients in postoperative care. The gain of points is more important for GMFCS IV patients. Improvement was mainly observed in 2 domains, "comfort and emotions" and "hygiene and dressing". For the "quality of life" item, only 3 parents out of the 8 noted a positive change. CONCLUSION: Our study shows an improvement in nursing care, positioning, and dressing which are associated with a reduction in pain in children with a major polyhandicap GMFCS IV and V who have benefited from a selective dorsal rhizotomy.

Pain and self-pressure relief in adolescents with cerebral palsy.

Adolescents with CP classified as Gross Motor Functional Classification System Level V attend school up to 8 h daily with limited ability to self-reposition. Despite pain reported within this population, perceived pain and self-pressure relief during prolonged classroom sitting is unknown. A case series design was used with a convenience sample of six students (13-18 years) with CP. Pain assessments were taken every 30 min for 5 h. Self-relief assessments using the SensiMATTM were recorded while students were in their wheelchairs. One student self-reported pain and three students proxy reported pain movements. All students had unrelieved pressure or did not self-relieve pressure for at least 1.5 consecutive hours. Four students increased their self-pressure relief movements after 3.5 h. This study provided preliminary data regarding perceived pain and self-pressure relief during prolonged sitting and demonstrated that the SensiMATTM can capture pressure relief movements in sitting of students with severe CP. Although there was no trend of reported pain, students may either be moving enough, as demonstrated by recorded pressure relief movements, to independently relieve pressure and pain, or current pain assessments may not be sensitive enough for those with the most severe disabilities.

Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study.

PURPOSE: Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). METHODS: This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. RESULTS: Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients. CONCLUSIONS: SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.

Pain in children with cerebral palsy as reported by parents.

BACKGROUND: Pain in children with cerebral palsy (CP) is a problem that has not received adequate attention in developing countries. The aim of this study was to explore the presence of pain and common sites of pain in children with CP based on age, gender and ambulatory status as determined by the Gross Motor Function Classification System (GMFCS) level. METHODS: This was a cross-sectional study based on data from a CP registry (CPUP-Jordan). Participants were 310 children with CP (mean age: 3.3 ± 2.9 years, range: 5 months to 15.9 years), 77.1% were below 5 years of age, 56.8% were boys and 49% were classified as Levels IV and V of the GMFCS. Parents were asked to indicate whether their child is currently experiencing pain (yes/no); if yes, they were asked to report the sites of pain. RESULTS: Seventy-nine (25.5%) children experienced pain (34.1% had pain in the stomach, 15.2% at the hips and knees and 12.7% in their feet). The presence of pain did not significantly differ by age or gender. More children in GMFCS Levels V (34.7%) and IV (31.6%) experienced pain. Compared with Level V on the GMFCS (non-ambulant children), children in Level I and children in Level III experienced less pain (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.087-0.727, p = 0.011; OR = 0.42, 95% CI = 0.18-0.98, p = 0.045, respectively). Pain sites differed with age and GMFCS. CONCLUSIONS: Pain was reported to be less than previous studies. Non-ambulant children experienced more pain. Pain monitoring and management should be a regular practice in rehabilitation for this population, with special attention for non-ambulant children.

Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers’ perceptions in children with hemiplegic cerebral palsy: A cross-sectional study / Exploración de la relación entre los niveles de rendimiento motor funcional y de la comunicación y la cantidad de uso de la extremidad superior más afectada, basada en las percepciones de los cuidadores de niños con parálisis cerebral hemipléjica: estudio transversal

Objective: To investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. Material and methods: The study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6–15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). Results: A strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=−0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=−0.549 and r2=−0.567). Conclusion: The amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.(AU)

Objectivo: Investigar las relaciones entre la cantidad de uso de la extremidad superior más afectada y los sistemas de clasificación del rendimiento motor funcional y de la comunicación. Material y métodos: El estudio incluyó a 95 niños con parálisis cerebral (PC) hemipléjica congénita de 6 a 15 años de edad (52 varones, 43 mujeres; edad media 9,53, DE 3,1) y a sus padres/cuidadores. La cantidad de uso de la extremidad superior más afectada se evaluó utilizando la subescala Pediatric Motor Activity Log-Revised-How Often (PMAL-R HO). Los niveles funcionales de los niños incluidos fueron definidos por los padres/cuidadores utilizando Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) y Communication Function Classification System (CFCS). Resultados: Se encontró una correlación fuerte y negativa entre la puntuación de la subescala PMAL-R HO y MACS (r=-0,819), lo cual sugiere que los niños con menores niveles de MACS tienen mayor probabilidad de utilizar su extremidad superior más afectada de manera espontánea. Además, se revelaron asociaciones negativas y moderadas entre la puntuación de la subescala PMAL-R HO y GMFCS y CFCS (r1=-0,549 y r2=-0,567). Conclusión: La cantidad de uso de la extremidad superior más afectada es más sensible a MACS que a GMFCS-E&R y CFCS. Los niños con un nivel dado de MACS reflejaron un rango más amplio en la puntuación de la subescala PMAL-R HO. Además de MACS, debería incluirse una puntuación en la subescala PMAL-R HO relacionada con la extremidad superior más afectada, como criterio de inclusión en los ensayos clínicos, para evitar efectos confusos de los enfoques de intervención, de cara a mejorar la cantidad de uso de la extremidad superior más afectada en niños con PC hemipléjica congénita.(AU)

Interpretable classification for multivariate gait analysis of cerebral palsy.

BACKGROUND: The Gross Motor Function Classification System (GMFCS) is a widely used tool for assessing the mobility of people with Cerebral Palsy (CP). It classifies patients into different levels based on their gross motor function and its level is typically determined through visual evaluation by a trained expert. Although gait analysis is commonly used in CP research, the functional aspects of gait patterns has yet to be fully exploited. By utilizing the gait patterns to predict GMFCS, we can gain a more comprehensive understanding of how CP affects mobility and develop more effective interventions for CP patients. RESULT: In this study, we propose a multivariate functional classification method to examine the relationship between kinematic gait measures and GMFCS levels in both normal individuals and CP patients with varying GMFCS levels. A sparse linear functional discrimination framework is utilized to achieve an interpretable prediction model. The method is generalized to handle multivariate functional data and multi-class classification. Our method offers competitive or improved prediction accuracy compared to state-of-the-art functional classification approaches and provides interpretable discriminant functions that can characterize the kinesiological progression of gait corresponding to higher GMFCS levels. CONCLUSION: We generalize the sparse functional linear discrimination framework to achieve interpretable classification of GMFCS levels using kinematic gait measures. The findings of this research will aid clinicians in diagnosing CP and assigning appropriate GMFCS levels in a more consistent, systematic, and scientifically supported manner.

Effectiveness of Sensory Integration Therapy on Functional Mobility in Children With Spastic Diplegic Cerebral Palsy.

Background  A set of non-progressive brain abnormalities and nervous system dysfunctions are referred to as cerebral palsy (CP). Due to this, the child's mobility, eyesight, learning, and thought processes are affected. It can evolve before, through birth, or the first year of a child's life. The activity through which the brain organizes and analyses external sensations like touch, motion, body awareness, vision, hearing, and gravity is indicated as sensory integration. The use of sensory integration therapy (SIT) necessitates that the sensorimotor exercises target the specific parts of difficulties that the child experiences daily. This study aims to study the effectiveness of SIT on functional mobility in children with spastic diplegic CP. Methods In this study, 40 children of CP with spastic diplegic who met the inclusion and exclusion criterion were enlisted and were separated into two groups, with Group A (n=20) receiving SIT for 25 minutes along with conventional physiotherapy for 20 minutes, and Group B (n=20) were given conventional physiotherapy for 45 minutes. A four-week therapy plan was followed. Short sensory profile (SSP) and Gross Motor Function Classification System (GMFCS), Pediatric mini-mental state examination (MMSE), and Modified Ashworth Scale were taken as outcome measures. Results SIT along with traditional treatment is described in the study protocol which aids CP children to improve themselves. Following a four-week protocol, combined therapy of SIT and conventional physiotherapy show an effect on the motor function of the children. After therapy, scores in GMFCS and SSP improved. By using Student's paired t-test, a statistically significant difference was found in GMFCS score at pre and post-test treatment in group A (7.28, p=0.0001) and group B (4.48, p=0.0001), in SSP score at pre and post-test treatment in group A (27.91, p=0.0001) and group B (11.31, p=0.0001), in MMSE score at pre- and post-test treatment in group A (6.89, p=0.0001) and group B (6.32, p=0.0001). The significance threshold was p<0.0001. Conclusion Under the study's experimental conditions, both groups showed substantial improvements in the functional mobility of children. When the efficacy of SIT along with conventional physiotherapy was examined, the impact resulted in a significantly greater improvement in the functional mobility of spastic diplegic CP children.

Can developmental trajectories in gait variability provide prognostic clues in motor adaptation among children with mild cerebral palsy? A retrospective observational cohort study.

Aim: To investigate whether multiple domains of gait variability change during motor maturation and if this change over time could differentiate children with a typical development (TDC) from those with cerebral palsy (CwCP). Methods: This cross-sectional retrospective study included 42 TDC and 129 CwCP, of which 99 and 30 exhibited GMFCS level I and II, respectively. Participants underwent barefoot 3D gait analysis. Age and parameters of gait variability (coefficient of variation of stride-time, stride length, single limb support time, walking speed, and cadence; as well as meanSD for hip flexion, knee flexion, and ankle dorsiflexion) were used to fit linear models, where the slope of the models could differ between groups to test the hypotheses. Results: Motor-developmental trajectories of gait variability were able to distinguish between TDC and CwCP for all parameters, except the variability of joint angles. CwCP with GMFCS II also showed significantly higher levels of gait variability compared to those with GMFCS I, these levels were maintained across different ages. Interpretation: This study showed the potential of gait variability to identify and detect the motor characteristics of high functioning CwCP. In future, such trajectories could provide functional biomarkers for identifying children with mild movement related disorders and support the management of expectations.

Characteristics of Children with Cerebral Palsy and Their Utilization of Services in Saudi Arabia.

The recent emergence of research on cerebral palsy (CP) in developing countries aims to improve knowledge on affected children and the utilization of the available services. This study seeks to describe children with CP in Saudi Arabia and service utilization as per Gross Motor Function Classification System (GMFCS) levels and geographic regions. A cross-sectional survey of 227 children with CP (Mean age 6.3, SD 3.9 years) was conducted. Parents reported on children's demographics, impairments, and service utilization. Half of the children (n = 113, 49.8%) had ≥3 impairments with speech, visual and learning impairments being the most frequent. The total number of impairments differed significantly by GMFCS, F (4, 218) = 8.87, p < 0.001. Most of the children (n = 86, 83.4%) used 2-5 services. Moreover, 139 (62.3%) did not attend school, 147 (65.9%) did not receive occupational therapy, and only 32 (14.3%) received speech therapy. More children in GMFCS level I did not receive neurologist services. Profiles of children and services were described by GMFCS and by regions. This was the first study to describe children with CP and service utilization in Saudi Arabia. Although many impairments affected the children, there was low utilization of related services. Data on service utilization and on unmet needs support a comprehensive approach to rehabilitation and the proper service allocation.

"It is something that gives us hope": Lived experience among parents to children with cerebral palsy who are non-ambulant of the phenomenon physical activity, with or without the use of a novel dynamic standing device.

Introduction: Regular physical activity confers health benefits for all. Parents commonly want their children to be physically active, and want to be physically active themselves, but children with cerebral palsy (CP) who are non-ambulant face challenges, and they need support to be physically active. Dynamic standing in the novel motorized assistive device Innowalk has positive effects in children who are non-ambulant-it gives them a chance to be physically active. The aim of this study was to explore the lived experience of physical activity of parents themselves and for their children with cerebral palsy who are non-ambulant. Methods: A descriptive inductive design with a hermeneutic phenomenological approach was used for the analysis of interviews with 11 parents of children with CP who are non-ambulant who participated in a study of exercise effects of dynamic standing. Results: The parents experienced physical activity for their children as being important but difficult, especially for their child, as described in Theme 1: "Being aware of health benefits while struggling with family time." The children were perceived as being dependent on other people, the environment, and equipment for participating in physical activity, referring to Theme 2: "Being dependent." The opportunity for their children to become physically active on a regular basis through an assistive device gave the parents hope for a better life, which formed Theme 3: "Getting hope in a challenging life situation." Conclusion: Physical activity for children with CP who are non-ambulant is possible through an elaborate network of social relations and environmental conditions. Limiting the degree of dependence and containing the negative consequences of high a degree of dependence are vital in the support of physical activity. Relations, support, and assistive devices that strengthen empowerment and autonomy should be prioritized, and if this works, the experience of physical activity can be positive, giving families hope.

The association between isometric strength and cognitive function in adults with cerebral palsy.

Background: The literature supports quantifying the maximum force/tension generated by one's forearm muscles such as the hand grip strength (HGS) to screen for physical and cognitive frailty in older adults. Thus, we postulate that individuals with cerebral palsy (CP), who are at higher risk for premature aging, could benefit from tools that objectively measure muscle strength as a functional biomarker to detect frailty and cognitive decline. This study assesses the clinical relevancy of the former and quantifies isometric muscle strength to determine its association with cognitive function in adults with CP. Methods: Ambulatory adults with CP were identified from a patient registry and were enrolled into this study. Peak rate of force development (RFD) and maximum voluntary isometric contraction of the quadriceps were measured using a commercial isokinetic machine, while HGS was collected with a clinical dynamometer. Dominant and non-dominant side were identified. Standardized cognitive assessments, including the Wechsler Memory and Adult Intelligence Scales IV, Short Test of Mental Status, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) were used to evaluate cognitive function. Results: A total of 57 participants (32 females; mean age 24.3 [SD 5.3]; GMFCS levels I-IV) were included in the analysis. Although dominant and non-dominant RFD and HGS measures were associated with cognitive function, non-dominant peak RFD showed the strongest associations with cognitive function. Conclusion: RFD capacity may reflect age-related neural and physical health and could be a better health indicator than HGS in the CP population.

Disability and caregiver burden: Unique challenges in a developing country.

PURPOSE: This study aimed to identify factors, including degree of disability, that contribute to the caregiver burden of raising children with cerebral palsy in Sri Lanka. METHODS: Participants were caregivers of children with cerebral palsy attending the pediatric neurology clinic of the only tertiary care center in southern Sri Lanka. The locally validated Caregiver Difficulties Scale (CDS) was administered, and demographic information was obtained in a structured interview. Disability data was accessed through the medical record. RESULTS: Of 163 caregivers who participated in this study, 133 (81.2%) demonstrated a moderate to high level of burden, and 91 (55.8%) were at high risk for psychological burden. In the bivariate analysis, caregiver burden significantly correlated with degree of physical disability based on the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), the presence of medical co-morbidities, and having two or more children. However, only the GMFCS level and number of children remained significant predictors of caregiver burden after controlling for confounding effects. CONCLUSION: Raising a child with cerebral palsy in Sri Lanka is likely to cause caregiver burden, particularly if they have a high level of disability or one or more siblings. Monitoring caregiver burden as part of routine cerebral palsy management is important, which allows targeting psychosocial support to families most in need.

Predicting Gross Motor Function in Children and Adolescents with Cerebral Palsy Applying Artificial Intelligence Using Data on Assistive Devices.

Data obtained from routine clinical care find increasing use in a scientific context. Many routine databases, e.g., from health insurance providers, include records of medical devices and therapies, but not on motor function, such as the frequently used Gross Motor Function Measure-66 (GMFM-66) score for children and adolescents with cerebral palsy (CP). However, motor function is the most common outcome of therapeutic efforts. In order to increase the usability of available records, the aim of this study was to predict the GMFM-66 score from the medical devices used by a patient with CP. For this purpose, we developed the Medical Device Score Calculator (MDSC) based on the analysis of a population of 1581 children and adolescents with CP. Several machine learning algorithms were compared for predicting the GMFM-66 score. The random forest algorithm proved to be the most accurate with a concordance correlation coefficient (Lin) of 0.75 (0.71; 0.78) with a mean absolute error of 7.74 (7.15; 8.33) and a root mean square error of 10.1 (9.51; 10.8). Our findings suggest that the MDSC is appropriate for estimating the GMFM-66 score in sufficiently large patient groups for scientific purposes, such as comparison or efficacy of different therapies. The MDSC is not suitable for the individual assessment of a child or adolescent with CP.

Changes in the Status of Spastic Diplegic Children in Terms of Gross Motor Function Classification System and Functional Mobility Scale Following Surgical Intervention: A Single Centre Experience.

Introduction Most centers in low- to mid-income countries (LMICs) lack facilities for a comprehensive instrumented gait analysis (IGA) which is often considered the preferred method for assessment of the functional results of surgery in children with spastic diplegia. We aimed to study if there were any changes in the Gross Motor Function Classification System (GMFCS) levels and Functional Mobility Scale (FMS) scores after surgery and whether they can be used as an indirect indicator of change in the functional status of a child. Methods This prospective study was conducted at the Pediatric Orthopedic unit of a teaching hospital on spastic diplegic children requiring surgical intervention. GMFCS levels and FMS scores were recorded before the surgery and at each follow-up visit, with the latest record being two years post-surgery. The change in the scores was indicated as an improvement, deterioration, or no change from the baseline and compared to the score of the preceding visit. In addition, it was examined whether the age at surgery had any effect on the temporal change in the scores. Results A total of 25 children were included for analysis after excluding those who failed to fulfill the predefined inclusion and exclusion criteria. Both the GMFCS levels and FMS scores improved from the third month to one-year post-surgery, after which a few patients had a worsening of their scores at the two years follow-up visit. The age at which surgery was performed had no significant effect on the pattern of change in the scores. Most children sought consultations with the physical therapy department only when they visited the surgical team for follow-up. Conclusion This study shows that surgical interventions do improve the functional outcomes in children with spastic CP when assessed using FMS scores while maintaining an undeteriorated GMFCS level in most children. While a peak improvement can be expected one year after surgery in most patients, possible of worsening from baseline scores do exist, and the parents must be informed of the same. Any decision for surgery must involve the parents, and the usefulness of postoperative physical therapy must be impressed upon them before the surgery and during each follow-up visit too.

Exploration of the relationship between functional motor and communication performance levels and amount of use of the more affected upper extremity based on the caregivers' perceptions in children with hemiplegic cerebral palsy: A cross-sectional study.

OBJECTIVE: To investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems. MATERIAL AND METHODS: The study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6-15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS). RESULTS: A strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=-0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=-0.549 and r2=-0.567). CONCLUSION: The amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.

Morphological Medial Gastrocnemius Muscle Growth in Ambulant Children with Spastic Cerebral Palsy: A Prospective Longitudinal Study.

Only cross-sectional studies have demonstrated muscle deficits in children with spastic cerebral palsy (SCP). The impact of gross motor functional limitations on altered muscle growth remains unclear. This prospective longitudinal study modelled morphological muscle growth in 87 children with SCP (age range 6 months to 11 years, Gross Motor Function Classification System [GMFCS] level I/II/III = 47/22/18). Ultrasound assessments were performed during 2-year follow-up and repeated for a minimal interval of 6 months. Three-dimensional freehand ultrasound was applied to assess medial gastrocnemius muscle volume (MV), mid-belly cross-sectional area (CSA) and muscle belly length (ML). Non-linear mixed models compared trajectories of (normalized) muscle growth between GMFCS-I and GMFCS-II&III. MV and CSA growth trajectories showed a piecewise model with two breakpoints, with the highest growth before 2 years and negative growth rates after 6-9 years. Before 2 years, children with GMFCS-II&III already showed lower growth rates compared to GMFCS-I. From 2 to 9 years, the growth rates did not differ between GMFCS levels. After 9 years, a more pronounced reduction in normalized CSA was observed in GMFCS-II&III. Different trajectories in ML growth were shown between the GMFCS level subgroups. These longitudinal trajectories highlight monitoring of SCP muscle pathology from early ages and related to motor mobility. Treatment planning and goals should stimulate muscle growth.

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas.

Hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy. Hip surveillance programs have been implemented in many countries to detect hip displacement early when it is usually asymptomatic. The aim of hip surveillance is to monitor hip development to offer management options to slow or reverse hip displacement, and to provide the best opportunity for good hip health at skeletal maturity. The long-term goal is to avoid the sequelae of late hip dislocation which may include pain, fixed deformity, loss of function and impaired quality of life. The focus of this review is on areas of disagreement, areas where evidence is lacking, ethical dilemmas and areas for future research. There is already broad agreement on how to conduct hip surveillance, using a combination of standardised physical examination measures and radiographic examination of the hips. The frequency is dictated by the risk of hip displacement according to the child's ambulatory status. Management of both early and late hip displacement is more controversial and the evidence base in key areas is relatively weak. In this review, we summarise the recent literature on hip surveillance and highlight the management dilemmas and controversies. Better understanding of the causes of hip displacement may lead to interventions which target the pathophysiology of hip displacement and the pathological anatomy of the hip in children with cerebral palsy. We have identified the need for more effective and integrated management from early childhood to skeletal maturity. Areas for future research are highlighted and a range of ethical and management dilemmas are discussed.

Obesity in ambulatory children with cerebral palsy in Turkey: A cross-sectional study.

PURPOSE: Obesity prevalence and the relationship between obesity and motor function in children with ambulatory cerebral palsy (CP) were investigated. METHODS: This was a cross-sectional study. The obesity profile of 75 children aged 2-18 years with ambulatory CP was investigated. GMFCS levels were recorded, and BMI was calculated using height and weight data and converted into Z-scores. Age- and gender-specific growth charts were used for children and adolescents. RESULTS: The mean BMI of the participants was 17.78, with an obesity rate of 18.67% and an overweight rate of 16%. Gross motor function was found to be associated with height, weight, and BMI (p < 0.05). No relationship was found between obesity + overweight and gender and CP subtype (p > 0.05). CONCLUSION: Turkish children with CP had a higher rate of obesity compared to typically developing peers and also their counterparts in other countries. There is a need for studies to identify the causes of obesity and to develop effective intervention programs for prevention of it in children with CP.

Can items on the TIMP aide in determining the motor performance of children with severe cerebral palsy? A pilot study.

BACKGROUND: Assessing the functional level of children with severe cerebral palsy (CP) requires sensitive tools. In this study, an 'assessment tool' was developed based on the Test of Infant Motor Performance (TIMP) for this population and the reliability and validity evaluated. METHODS: Five physical therapists administered the 'assessment tool' to six children (3-6 years old with a diagnosis of CP, GMFCS Level V). Subtest I of the Gross Motor Function Measure (GMFM-88) was also administered. Intra- and inter-rater reliability were assessed, and the concurrent validity between the 'assessment tool' and GMFM-88 calculated. RESULTS: The intra-rater reliability, a comparison of the total scores on the 'assessment tool' (live test) and the videotaped rescoring of the same test one month later showed consistency among four of the five therapists (ICC = 0.7545 to 0.979). The inter-rater reliability varied on some of the items but the total score on the 'assessment tool' showed good reliability (ICC2,5 0.816). Scores of children with dyskinesia were less stable. The Spearman's rank correlation coefficient was not significant. Therapists provided recommendations for item revisions. CONCLUSION: Further development of an 'assessment tool' appears justified; a larger study using a version with revised administration guidelines and items should be undertaken to re-verify the psychometrics properties of the 'assessment tool.'

Determinants of functional mobility in children with cerebral palsy in three different environments: A registry-based study.

BACKGROUND: Functional mobility in children with cerebral palsy (CP) varies widely and is affected by many factors related to the child and environment. Understanding this variability in child's natural environments: home, school, and community; and its determinants are important for effective child management. METHODS: This cross-sectional study aims to investigate the functional mobility of children with CP within home, school, and community, and explore its determinants. Participants were 107 children with CP (aged 6.4 ± 2.9 years). Functional Mobility Scale was the outcome variable. Potential determinants included child-associated impairments and interventions. Three ordinal logistic regression analyses were conducted. RESULTS: Children in Gross Motor Functional Classification System-Expanded and Revised level I walked without assistive devices in all environments, while children in levels II/III used different mobility methods in different environments. Children in levels IV/V used a wheelchair or had no form of functional mobility in all environments. Determinants of mobility varied across different environments but included impairments (visual impairments, scoliosis) and interventions (Botox, medications for spasticity, orthoses). CONCLUSIONS: Child impairments and interventions received should be considered when exploring mobility options for children with CP in different environments. Further research is needed to examine other environmental and personal factors affecting mobility.