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1.
Bone Joint J ; 102-B(9): 1242-1247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862682

RESUMO

AIMS: Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth. METHODS: We retrospectively analyzed 61 hips in 32 CP children who underwent proximal femoral hemi epiphysiodesis between July 2012 and September 2017. The hips were divided into two groups according to the transphyseal position of the screw in the coronal plane: across medial quarter (Group 1) or middle quarter (Group 2) of the medial half of the physis. We compared pre- and postoperative radiographs in head-shaft angle (HSA), Reimer's migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA), as well as incidences of the physis growing-off the screw within two years. Linear and Cox regression analysis were conducted to identify factors related to HSA correction and risk of the physis growing-off the screw. RESULTS: A total of 37 hips in Group 1 and 24 hips in Group 2 were compared. Group 1 showed a more substantial decrease in the HSA (p = 0.003) and the MP (p = 0.032). Both groups had significant and similar improvements in the AI (p = 0.809) and the FAVA (p = 0.304). Group 1 presented a higher incidence of the physis growing-off the screw (p = 0.038). Results of the regression analysis indicated that the eccentricity of screw position correlated with HSA correction and increases the risk of the physis growing-off the screw. CONCLUSION: Guided growth is effective in improving coxa valga and excessive femoral anteversion in CP children. For younger children, despite compromised efficacy of varus correction, we recommend a more centered screw position, at least across the middle quarter of the medial physis, to avoid early revision. Cite this article: Bone Joint J 2020;102-B(9):1242-1247.


Assuntos
Parafusos Ósseos , Coxa Valga/cirurgia , Lâmina de Crescimento/cirurgia , Paralisia Cerebral/complicações , Criança , Coxa Valga/etiologia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Resultado do Tratamento
2.
S Afr Med J ; 110(8): 767-776, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880305

RESUMO

Spinal deformities are common in people with cerebral palsy (CP), and there is a concern of an increase during the adult ageing period. There is especially a worry about the increase of scoliosis, thoracic hyperkyphosis, lumbar hyperlordosis, spondylolysis and spondylolisthesis incidence, though supporting literature is lacking. Therefore, the aim of this narrative review is to provide a scientific overview of how spinal curvatures should be measured, what the norm values are and the incidence in people with CP, as well as a description of the risk factors and the treatment regimens for these spinal abnormalities. This review can be used as a guideline relevant for a range of clinicians, including orthopaedic and neurosurgeons, radiologists, physiotherapists, and biokineticists, as well as academics.


Assuntos
Paralisia Cerebral/complicações , Doenças da Coluna Vertebral/complicações , Humanos , Incidência , Radiografia , Fatores de Risco , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Coluna Vertebral/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(32): e21634, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769929

RESUMO

INTRODUCTION: Arginineemia, also known as arginase deficiency, is a rare autosomal recessive metabolic disease. The diagnosis sometimes may be delayed due to atypical clinical manifestations. Confirmation of arginineemia depends on genetic testing. PATIENT CONCERNS: We reported a Chinese male child presenting with hyperargininemia and progressive spastic diplegia, who has a novel compound heterozygous mutation in the arginase-1 (ARG1) gene (c.263-266delAGAA, p.K88Rfs45;c.674T>C,p.L216P), respectively, coming from his mother and father. DIAGNOSIS: The patient was diagnosed with argininemia with a novel compound homozygous mutation of the ARG1 gene at the age of 12 years. INTERVENTIONS: The patient had a low-protein diet (0.8 g/kg/day). Baclofen, eperisone hydrochloride, botulinum toxin, and rehabilitation training were used to improve his spastic diplegia symptoms for 3 months. OUTCOMES: The patient's blood arginine was still high after 3 months' low-protein diet. His spastic diplegia symptoms had not aggravated after 3 months' treatment. CONCLUSIONS: Argininemia should be considered in a patient with slowly progressive neurologic manifestations, especially spastic diplegia. This case also suggests that tandem mass spectrometry should be used as an effective tool in the validity of neonatal screening for early diagnosis.


Assuntos
Arginase/genética , Hiperargininemia/complicações , Arginase/sangue , Arginase/urina , Baclofeno/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Paralisia Cerebral/complicações , Paralisia Cerebral/tratamento farmacológico , Criança , China , Dieta com Restrição de Proteínas/métodos , Humanos , Hiperargininemia/genética , Hiperargininemia/fisiopatologia , Masculino , Propiofenonas/uso terapêutico
4.
PLoS One ; 15(7): e0235069, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628682

RESUMO

BACKGROUND: Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. METHODS: This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. RESULTS: Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. CONCLUSIONS: The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.


Assuntos
Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Nomogramas , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/epidemiologia , Doença Aguda , Adolescente , Fatores Etários , Asma/diagnóstico , Asma/fisiopatologia , Paralisia Cerebral/complicações , Paralisia Cerebral/mortalidade , Criança , Pré-Escolar , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/mortalidade , Lesão por Pressão/diagnóstico , Lesão por Pressão/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/fisiopatologia , Fatores Sexuais , Análise de Sobrevida , Taiwan/epidemiologia
5.
PLoS One ; 15(6): e0233706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502157

RESUMO

Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics. Limbs with short gastrocnemius lengths that received a gastrocnemius lengthening surgery as part of a SEMLS (case limbs) were 2.2 times more likely than overtreated limbs (i.e., limbs who did not have short lengths, but still received a lengthening surgery) to have a good surgical outcome at the follow-up gait visit (good outcome rate of 71% vs. 33%). Case limbs were 1.2 times more likely than control limbs (i.e., limbs that had short gastrocnemius lengths but no lengthening surgery) to have a good outcome (71% vs. 59%). Three-fourths of the case limbs with a good outcome at the follow-up gait visit maintained this outcome over time, compared to only one-half of the overtreated limbs. Our results caution against over-prescription of gastrocnemius lengthening surgery and suggest gastrocnemius lengths can be used to identify good surgical candidates.


Assuntos
Paralisia Cerebral/complicações , Pé Equino/etiologia , Pé Equino/cirurgia , Marcha , Músculo Esquelético/cirurgia , Criança , Humanos , Perna (Membro)/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
6.
Fisioterapia (Madr., Ed. impr.) ; 42(3): 136-144, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-191003

RESUMO

ANTECEDENTES Y OBJETIVO: Los niños con parálisis cerebral suelen presentar afectación del sistema respiratorio por debilidad muscular. Varios enfoques terapéuticos se han introducido para mejorar este problema, destacando el uso ergonómico en los sistemas de posicionamiento para mejorar el deterioro neuromuscular debido al mal posicionamiento y que conduce a alteraciones respiratorias. El objetivo de este estudio es analizar la evidencia existente sobre el efecto de diferentes sistemas de posicionamiento en la función respiratoria de niños con parálisis cerebral. MATERIAL Y MÉTODOS: Revisión sistemática de ensayos clínicos siguiendo las recomendaciones PRISMA en las bases de datos PubMed, PEDro, SciELo y Science Direct. Se utilizó la escala PEDro para la validez interna de los estudios y la herramienta propuesta por Cochrane para la valoración de los riesgos de sesgo. La búsqueda fue electrónica y manual. RESULTADOS: Se identificaron 26 estudios, de los que 7 fueron seleccionados para la revisión. Se encontraron resultados significativos en la función pulmonar al emplear asiento adaptado anterior, órtesis de tobillo y pie y sistema de posicionamiento nocturno. El empleo de una silla de ruedas con diferentes adaptaciones supuso mejoras en la función respiratoria, sin resultados estadísticamente significativos. CONCLUSIONES: Los sistemas de posicionamiento pueden mejorar la función respiratoria de los niños con parálisis cerebral. Existen diferentes procedimientos de intervención y de evaluación de los sistemas de posicionamiento destinados a la función respiratoria


BACKGROUND AND OBJECTIVE: Children with cerebral palsy usually have respiratory system involvement due to muscle weakness. Several therapeutic uses have been introduced to solve this problem, including the use of ergonomics in positioning systems to improve neuromuscular deterioration due to poor positioning and leading to respiratory disorders. The objective is to analyse the evidence on the effect of different positioning systems on the respiratory function of children diagnosed with cerebral palsy. MATERIAL AND METHODS: Systematic review of clinical trials following the PRISMA recommendations in PubMed, PEDro, SciELo and Science Direct databases. The PEDro scale was used for the internal validity of the studies and the tool proposed by Cochrane for the assessment of risk of bias. RESULTS: Twenty-six studies were identified, of which 7 were selected for review. Significant results were found in lung function using anterior adaptive seating, ankle foot orthosis and a night positioning system. By contrast, the use of a wheelchair with different adaptations resulted in improvements in respiratory function without statistically significant results. CONCLUSIONS: Positioning systems can improve the respiratory function of children with cerebral palsy. There are different procedures for intervention and evaluation of positioning systems for respiratory function


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Postura , Taxa Respiratória , Paralisia Cerebral/complicações , Sistema Respiratório/fisiopatologia , Prática Clínica Baseada em Evidências , Análise de Dados
7.
J Pediatr Orthop ; 40(6): e454-e459, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501914

RESUMO

BACKGROUND: ε-Aminocaproic acid (EACA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion requirements in several populations undergoing various surgical procedures. However, the efficacy of EACA has not been assessed in pediatric patients with cerebral palsy undergoing bilateral varus rotational femoral osteotomies. The purpose of this study was to assess the efficacy of intravenous EACA in reducing calculated intraoperative blood loss and transfusions in this population. METHODS: Patients aged 18 years or younger were eligible. Patients were randomized to receive EACA or placebo (saline), and randomization was stratified based on sex and whether or not additional soft tissue or osseous procedures were performed. On the basis of retrospective data, the calculated sample size was 12 patients per arm to detect a difference of 250-mL blood loss. The primary outcome was calculated intraoperative blood loss. Secondary outcomes included transfusion requirements, 24-hour drain output, length of stay, and incidence of complications. RESULTS: The mean age of patients in this study was 8 years (SD: 2.4 y). There were no differences in age, sex, height, weight, type of anesthesia, operative time, and associated procedures between the EACA and placebo groups (P>0.05). Preoperative hematocrit was lower in the EACA group (37.1 vs. 40.0, P=0.04). Calculated intraoperative blood loss was 536 mL in the EACA group and 628 mL in the placebo group (P=0.45). Transfusions were required in 62% of patients in the EACA group and 67% of patients in the placebo group (P=0.68). Total 24-hour drain output was 72.5 mL in the EACA group and 103.3 mL in the placebo group (P=0.37). Length of stay was similar between both groups, and there were no drug or placebo-related complications in either group. CONCLUSIONS: There was no difference in blood loss or transfusion requirements associated with EACA compared with placebo; however, this study is underpowered to detect smaller differences in blood loss. Additional studies with larger sample sizes are needed to confirm these findings and further elucidate the indications for antifibrinolytic agents in pediatric patients. LEVEL OF EVIDENCE: Level I.


Assuntos
Ácido Aminocaproico/administração & dosagem , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Osteotomia/métodos , Administração Intravenosa , Adolescente , Paralisia Cerebral/complicações , Criança , Método Duplo-Cego , Feminino , Fêmur/cirurgia , Hematócrito , Humanos , Masculino , Estudos Prospectivos
8.
AJR Am J Roentgenol ; 214(6): 1389-1397, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32228327

RESUMO

OBJECTIVE. Any combination of abnormal positioning of the ankle, hindfoot, midfoot, and forefoot is possible in the context of cerebral palsy, but some patterns are more common than others. The purpose of this article is to discuss the radiographic manifestations and surgical management of the following common conditions: equinus, equinoplanovalgus, equinocavovarus, vertical talus, oblique talus, hallux valgus, and ankle valgus. CONCLUSION. CP is defined by abnormalities of the developing fetal or infant brain that result in permanent central motor dysfunction. Foot and ankle deformities are very common in the patients with CP, occurring in up to 93% of such patients as a result of underlying abnormal muscle tone, impaired motor control, and dynamic muscle imbalance. Radiologists must develop knowledge of the most common changes in alignment and basic techniques for correction to better recognize abnormalities and improve communication with orthopedic colleagues.


Assuntos
Paralisia Cerebral/complicações , Deformidades do Pé/diagnóstico por imagem , Deformidades do Pé/etiologia , Criança , Humanos
10.
Bone Joint J ; 102-B(3): 383-387, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114804

RESUMO

AIMS: The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with cerebral palsy (CP) in Scotland before and after the initiation of a hip surveillance programme. PATIENTS: A total of 2,155 children with CP are registered in the Cerebral Palsy Integrated Pathway Scotland (CPIPS) surveillance programme, which began in 2013. Physical examination and hip radiological data are collected according to nationally agreed protocols. METHODS: Age, Gross Motor Function Classification System (GMFCS) level, subtype of CP, migration percentage (MP), and details of hip surgery were analyzed for all children aged between two and 16 years taken from a time of census in March 2019 and compared to the same data from the initial registration of children in the CPIPS. Displacement of the hip was defined as a MP of between 40% and 99%, and dislocation as a MP of 100%. RESULTS: A total of 1,646 children were available for analysis at the time of the census and 1,171 at their first registration in CPIPS. The distribution of age, sex, and GMFCS levels were similar in the two groups. The prevalence of displacement and dislocation of the hip before surveillance began were 10% (117/1,171) and 2.5% (29/1,171) respectively, and at the time of the census were 4.5% (74/1,646) and 1.3% (21/1,646), respectively. Dislocation was only seen in GMFCS levels IV and V and displacement seen in 90.5% (67/74) of these levels and 9.5% (7/74) in levels I to III. In total, 138 children had undergone hip surgery during the study period. The hip redisplaced after the initial surgery in 15 children; seven of these had undergone a second procedure and at the time of the census the hips in all seven had a MP < 40. CONCLUSION: Hip surveillance appears to be effective and has reduced the prevalence of hip displacement by over half and dislocation almost by half in these children. Cite this article: Bone Joint J 2020;102-B(3):383-387.


Assuntos
Paralisia Cerebral/complicações , Luxação do Quadril/epidemiologia , Articulação do Quadril/diagnóstico por imagem , Vigilância da População , Sistema de Registros , Adolescente , Criança , Pré-Escolar , Feminino , Luxação do Quadril/diagnóstico , Luxação do Quadril/etiologia , Humanos , Masculino , Prevalência , Radiografia , Estudos Retrospectivos , Fatores de Risco , Escócia/epidemiologia
11.
Spine (Phila Pa 1976) ; 45(14): 993-999, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32150131

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: The aim of this study was to determine whether major postoperative complications ("complications") are associated with 2-year improvements in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores after scoliosis surgery, and whether complications and preoperative characteristics predict 2-year improvements in CPCHILD Total score. SUMMARY OF BACKGROUND DATA: Spinal arthrodesis can halt the progression of spinal deformity in patients with cerebral palsy (CP)-related scoliosis. However, these patients are prone to postoperative complications. METHODS: Using a multicenter CP registry, we identified 222 patients aged ≤21 years who underwent spinal fusion from 2008 to 2015 and had ≥2-year follow-up. We compared CPCHILD score improvement between 71 patients who had 1 or more complications ("complications group") versus 151 who did not ("no-complications group"). Complications were deep infections, thromboembolic events, and cardiopulmonary, gastrointestinal, and neurologic complications. Multiple linear regression was used to identify predictors of 2-year postoperative CPCHILD score improvement (alpha = 0.05). RESULTS: At 2-year follow-up, the complications group had similar mean improvement in CPCHILD score across all domains compared with the no-complications group (P > 0.05). When stratifying by complication type, deep infection was associated with less improvement in CPCHILD Comfort and Emotions (P = 0.02), Quality of Life (P < 0.01), and Total (P = 0.04) scores. When controlling for Gross Motor Function Classification System subcategory, age, and body mass index, only preoperative CPCHILD Total score and postoperative deep infection (F[4, 176] = 14; P < 0.0001; R = 0.24) predicted 2-year improvement in CPCHILD Total score. Higher preoperative Total score and postoperative deep infection independently predicted less improvement in Total score. CONCLUSION: Postoperative deep infection and higher preoperative CPCHILD Total score independently predicted less improvement in CPCHILD Total score. Other major postoperative complications were not associated with differences in 2-year postoperative improvements in CPCHILD scores across all domains. LEVEL OF EVIDENCE: 3.


Assuntos
Paralisia Cerebral , Qualidade de Vida , Fusão Vertebral , Infecção da Ferida Cirúrgica , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/cirurgia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/fisiopatologia
12.
Dev Med Child Neurol ; 62(3): 283-289, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32010976

RESUMO

Children with cerebral palsy (CP) have an increased risk of cognitive impairments. This narrative review of the literature discusses assessment of cognition in children with CP, presents the most salient characteristics of cognitive functioning pertaining to each subtype, and discusses the relationships between brain injury, functioning, and intervention from a developmental perspective. A search for original studies of cognitive functioning in children with different subtypes of CP was performed. The search resulted in 81 unique hits. There were few studies with a representative sample of children with CP where all participants were individually assessed. Cognitive functioning in children with the most severe motor impairments were often assumed and not assessed. Furthermore, there was a confounding of IQ below 70 and intellectual disability, possibly leading to an overestimation of the prevalence of intellectual disability. Longitudinal neuropsychological studies, including also very young children and those with the most severe speech and motor impairments, as well as intervention studies, are called for. WHAT THIS PAPER ADDS: Few studies have assessed cognition in a representative sample of children with cerebral palsy. Cognition in children with severe motor impairment is often assumed, not assessed. Lack of assessment may lead to overestimating the prevalence of intellectual disability. Lowered cognitive functioning in older children highlights the need for longitudinal studies.


Assuntos
Paralisia Cerebral/psicologia , Cognição/fisiologia , Disfunção Cognitiva/psicologia , Paralisia Cerebral/complicações , Criança , Disfunção Cognitiva/complicações , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/psicologia , Testes Neuropsicológicos
13.
Arch Phys Med Rehabil ; 101(6): 1041-1052, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32059945

RESUMO

OBJECTIVE: To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). DATA SOURCES: Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes ("cerebral palsy," "adult," and "outcome assessment") in literature published between January 2000 and December 2018. STUDY SELECTION: Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. DATA EXTRACTION: Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. DATA SYNTHESIS: Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P<.01, respectively). The Fatigue Severity Scale score was 4.1 (95% CI, 3.8-4.4). Epilepsy (28.8% [95% CI, 20.1-38.4]) and asthma (28.3% [95% CI, 18.7-38.9]) were especially prevalent comorbidities. CONCLUSIONS: The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On average, adults with CP are fatigued, and a majority experience pain, are ambulant, and have little or no difficulty with manual ability. On average, 40% are employed and 30% live independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.


Assuntos
Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Adulto , Humanos
14.
Acta Orthop ; 91(2): 203-208, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31928285

RESUMO

Background and purpose - Children and young adults with cerebral palsy (CP) have an increased risk of developing scoliosis, with a prevalence ranging from 11% to 29%. Information on risk factors for the emergence and progression of scoliosis is inconclusive. This study aimed to develop a risk score based on 5-year-old children with CP to predict the risk of scoliosis before the age of 16.Patients and methods - This prospective registry study included 654 children with CP in Sweden born in 2000 to 2003 and registered with the Swedish CP follow-up program (CPUP) at the age of 5 years, including all Gross Motor Function Classification System (GMFCS) levels. 92 children developed a scoliosis before the age of 16 years. Univariable and multivariable logistic regressions were used to analyze 8 potential predictors for scoliosis: GMFCS, sex, spastic subtype, epilepsy, hip surgery, migration percentage, and limited hip or knee extension.Results - 4 predictors for scoliosis remained significant after analyses: female sex, GMFCS levels IV and V, epilepsy, and limited knee extension, and a risk score was constructed based on these factors. The predictive ability of the risk score was high, with an area under the receiver operating characteristics curve of 0.87 (95% CI 0.84-0.91).Interpretation - The risk score shows high discriminatory ability for differentiating between individuals at high and low risk for development of scoliosis before the age of 16. It may be useful when considering interventions to prevent or predict severe scoliosis in young children with CP.


Assuntos
Paralisia Cerebral/complicações , Escoliose/etiologia , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/fisiopatologia , Pré-Escolar , Epilepsia/complicações , Epilepsia/epidemiologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Amplitude de Movimento Articular , Sistema de Registros , Medição de Risco/métodos , Fatores de Risco , Escoliose/epidemiologia , Escoliose/fisiopatologia , Sensibilidade e Especificidade , Fatores Sexuais , Suécia/epidemiologia
15.
BMC Neurol ; 20(1): 15, 2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31926546

RESUMO

BACKGROUND: Pain is a common problem for individuals with cerebral palsy (CP). In Sweden, 95% of children and adolescents with CP are followed in a national follow-up programme (CPUP), which includes data on pain. The purpose of this study was to investigate the prevalence of pain based on age, sex, gross motor function and source of report (self or proxy). Pain intensity, pain site, and how much pain disturbed sleep and daily activities were also studied. METHODS: This was a cross-sectional register study based on all participants in CPUP, 4-18-years of age, with data reported in 2017-2018. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS). Logistic regression was used to analyse prevalence of pain and how much pain had disturbed sleep and daily activities in the last four weeks. RESULTS: In total, 3545 participants (2065 boys) were included. The overall prevalence of pain was 44%. Older age and female sex were associated with higher risk of pain with odds ratios of 1.07 (95% confidence interval (CI) 1.06-1.09) and 1.28 (CI 1.12-1.47), respectively. Pain was most common in the lower extremities. There was no statistically significant difference in prevalence of pain related to source of report. Pain intensity was higher at older ages and higher GMFCS-levels. Hip/thigh pain and abdominal pain were associated with the most intense pain. Of those who reported pain, pain disturbed sleep for 36% and daily activities for 61%. CONCLUSIONS: Both pain frequency and pain intensity were higher at higher age. Pain intensity increased with increasing GMFCS-level. Two-thirds of all children and adolescents with CP reported that their pain disturbed their daily activities, and one-third reported that pain disturbed their sleep.


Assuntos
Paralisia Cerebral/complicações , Dor/epidemiologia , Dor/etiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Sistema de Registros , Suécia/epidemiologia
16.
Spine Deform ; 8(1): 115-121, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31981152

RESUMO

STUDY DESIGN: Retrospective comparative study. OBJECTIVES: In patients with cerebral palsy (CP), we determine the impact of intrathecal baclofen pumps (ITBPs) on scoliosis curve progression before posterior spine fusion (PSF) and its effects on surgical outcome. BACKGROUND: Children with CP can have rapid scoliosis progression, and high rates of surgical complications can be encountered. It is unknown whether the presence of pre-existing ITBP results in more difficult surgery and higher complication rates in similarly affected children. METHODS: This is a single-center retrospective study of CP patients undergoing PSF over a 15-year period. Demographics, comorbidities, curve magnitudes, and surgical methods were compared between patients with ITBP and those without. Postoperative complications, length of intensive care unit/hospital stay, drain use and output volume, and need for further surgery were also compared. Curve progression analysis after ITBP placement was performed on a subgroup of patients with high-quality consistent radiographs. RESULTS: Nineteen patients with ITBP and 49 patients without ITBP met inclusion criteria. Age, comorbidities, number of levels fused, and fixation techniques during PSF were not significantly different between cohorts. ITBP patients were more likely to have PSF with osteotomy (p = 0.022). Increased intraoperative neurosurgical consultations were found for patients with ITBP (42.1% vs. 4.0%; p < 0.001). Median surgical time was 1.2 h greater in patients with ITBP (6.7 vs. 5.5 h, p = 0.039). There was no difference in hospital course and complications in patients with ITBP and those without ITBP. Thirty-one patients without ITB were compared with 15 ITBP patients for curve progression before PSF, demonstrating a mean rate of scoliosis progression of 9.6° ± 6.7°/year and 14.8° ± 9.1°/year (p = 0.0346), respectively. CONCLUSION: The presence of an ITBP appears to be associated with the increase in scoliosis progression; and these patients will likely have a more challenging spine fusion. Fortunately, the final outcome is not affected by ITBP. LEVEL OF EVIDENCE: Level III.


Assuntos
Baclofeno/administração & dosagem , Paralisia Cerebral/complicações , Paralisia Cerebral/tratamento farmacológico , Bombas de Infusão Implantáveis/efeitos adversos , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Adulto , Criança , Progressão da Doença , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
17.
Dev Med Child Neurol ; 62(5): 609-614, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31898321

RESUMO

AIM: To compare: (1) self- and proxy-reported quality of life (QoL) in adolescents with epilepsy, cerebral palsy (CP), both epilepsy and CP, and a representative general population sample; and (2) parental stress between parents of adolescents with epilepsy, CP, or both epilepsy and CP. METHOD: This was a cross-sectional observational study with 496 adolescents with epilepsy, 699 with CP, 192 with both CP and epilepsy, and 15 396 from the general population, assessed with the KIDSCREEN-52 and Parenting Stress Index (PSI). RESULTS: All KIDSCREEN-52 domains showed statistically significant differences across groups. The epilepsy population showed clinically better scores for 'school environment' than the general population (Cohen's d=0.62). Parents scored adolescents with CP lower than adolescents with epilepsy or general populations on 'physical health' (d=0.57, d=0.55) and 'social-support and peers' (d=0.82, d=0.91). Parents of adolescents with CP scored them lower than parents of the epilepsy group on 'autonomy' (d=0.62). Parents of adolescents with epilepsy scored them lower on 'mood and emotions' (d=0.52) and 'social acceptance' (d=0.66) than the general population. PSI scores were better for parents of adolescents with CP than for parents of adolescents with epilepsy (d=2.12, d=2.70, d=3.35, d=1.67). INTERPRETATION: Adolescents with epilepsy or CP self-report equal or better QoL than the general adolescent population, which should comfort families and allow clinicians to address parental concerns. WHAT THIS PAPER ADDS: Adolescents with epilepsy, with or without cerebral palsy (CP), self-reported better school environment than adolescents in the general population. Proxy quality of life (QoL) results showed clinically important differences across groups in 6 out of 10 domains of the KIDSCREEN-52. Proxy-reported results showed poorer QoL scores for adolescents with epilepsy or CP than the general population. Parental stress level was lower in parents of children with CP or both CP and epilepsy, than in those with only epilepsy.


Assuntos
Paralisia Cerebral/psicologia , Epilepsia/psicologia , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Estudos Transversais , Epilepsia/complicações , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , Qualidade de Vida , Apoio Social , Estresse Psicológico
18.
Spine (Phila Pa 1976) ; 45(11): 727-734, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31977680

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVE: The aim of this study was to investigate the clinical outcomes >10 years following laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy (CP). SUMMARY OF BACKGROUND DATA: Surgery for cervical myelopathy associated with CP remains a challenge because of perioperative instrumentation failure and adjacent segment problems due to patients' repetitive involuntary neck movements with deformity of the cervical spine. METHODS: A single-center series of 14 patients were reviewed. The patients comprised seven women and seven men with a mean age of 52 years at the time of surgery. The mean follow-up period was 12.5 years. The Barthel index (BI), which shows independence in activities of daily life, and Japanese Orthopaedic Association (JOA) score were assessed. Radiographic evaluation included changes of the C2-C7 angle in the sagittal plane, fusion rate, adjacent segment degeneration, and instrument failure. RESULTS: The 10-year BI and JOA score significantly improved at 36% and 31%, respectively. The preoperative Cobb angle of the sagittal plane from C2-C7 measured 11.9° of kyphosis, which improved to 0.8° of lordosis. In the radiographic analysis, 35% (proximal) and 21% (distal) of the adjacent segment showed progression in degeneration of more than one grade after 10 years. More than 90% of the patients who underwent magnetic resonance imaging showed progressive disc degeneration on either side after 10 years. Autofusion inside the disc or anterior vertebral bony bridging was observed in 86% of intervertebral levels without anterior procedures. CONCLUSION: The procedure showed favorable initial stability and maintained favorable clinical outcomes in patients with CP. More than 90% of the patients showed disc degeneration on either side. The rate of proximal adjacent segment degeneration was higher than that of distal segments with or without symptoms at the >10-year follow-up. LEVEL OF EVIDENCE: 4.


Assuntos
Paralisia Cerebral/cirurgia , Vértebras Cervicais/cirurgia , Laminoplastia/tendências , Parafusos Pediculares/tendências , Doenças da Medula Espinal/cirurgia , Adulto , Idoso , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/tendências , Fatores de Tempo , Resultado do Tratamento
19.
Dev Med Child Neurol ; 62(3): 372-378, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31777955

RESUMO

AIM: To describe health-related quality of life (HRQoL), pain, fatigue, and other health variables in young adults with cerebral palsy (CP), and to explore associations with the Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER) and physical activity. METHOD: This was a cross-sectional study of 61 young adults at a mean age of 21 years 2 months (standard deviation 8mo, range 20-22y) with CP, from a geographically defined area. Data collection included: Short Form 36 version 2 for HRQoL, Brief Pain Inventory - Short Form, Fatigue Severity Scale, level of physical activity, medical history, and physical examination. RESULTS: Overall HRQoL equalled that of population norms; however self-reported physical health was lower in GMFCS-ER levels III to V compared to GMFCS-ER levels I to II. Self-reported mental health was, inversely, lower in GMFCS-ER levels I to II compared to GMFCS-ER levels III to V. Pain prevalence was 49%, and pain was present across all GMFCS-ER levels. Fatigue, as well as sleep problems, had 41% prevalence, with fatigue severity decreasing with increasing level of physical activity. INTERPRETATION: General HRQoL in young adults with CP was comparable to population norms. Pain and fatigue are important to address in high motor-functioning individuals also. Physical activity could be a possible protective factor against fatigue. WHAT THIS PAPER ADDS: Health-related quality of life in young adults with cerebral palsy (CP) was comparable to population norms. Pain, fatigue, and sleep problems occurred at all Gross Motor Function Classification System levels. There is a possible protective effect of physical activity on fatigue.


Assuntos
Paralisia Cerebral/complicações , Fadiga/complicações , Dor/complicações , Qualidade de Vida , Paralisia Cerebral/fisiopatologia , Estudos Transversais , Fadiga/diagnóstico , Fadiga/fisiopatologia , Feminino , Nível de Saúde , Humanos , Masculino , Dor/diagnóstico , Dor/fisiopatologia , Medição da Dor , Índice de Gravidade de Doença , Adulto Jovem
20.
Dev Med Child Neurol ; 62(3): 379-385, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31602643

RESUMO

AIM: To evaluate whether spasticity measures are related to pain in adults with cerebral palsy (CP). METHOD: This cross-sectional study recruited individuals aged 16 to 89 years with a diagnosis of CP. Participants completed the Penn Spasm Frequency Scale (PSFS), Brief Pain Inventory (BPI), and PROMIS Pain Interference measures. The Modified Ashworth Scale (MAS) and Tardieu spasticity angles of six joints were rated and summed to composite MAS and Tardieu scores for each participant. Associations between spasticity and pain measures were evaluated. RESULTS: Forty-seven participants (27 females, 20 males) with a mean age of 35 years 7 months (range 18-77y) spanning all Gross Motor Function Classification System (GMFCS) levels were included. Twenty-six participants reported their average pain level on BPI as greater than 0 over the past week (median pain level 4.0). Median PSFS was 1.0 (range 0.0-1.0) and this correlated with average BPI and Pain Interference T scores (median 40.7; ρ=0.33 and ρ=0.31 respectively [both p=0.01]). When adjusted for pain medication use and age, MAS correlated with BPI (ρ=0.30; p=0.04). Other pain and spasticity measures, or GMFCS level, were not significantly related with pain interference or BPI rating. Age was weakly associated with BPI (slope=0.10; p<0.01). INTERPRETATION: PROMIS Pain Interference was lower than population-based norms. Patient-rated spasm frequency demonstrated better association with pain levels and interference than physician-rated MAS and Tardieu. WHAT THIS PAPER ADDS: Pain was not associated with Gross Motor Function Classification System level. Pain increased with age, as anticipated. Self-reported spasm scores were associated with increased pain in contrast to clinical examination scales. Adjusted, summed spasticity on the Modified Ashworth Scale was associated with pain scores on the Brief Pain Inventory. Although pain is experienced by adults with cerebral palsy, pain did not interfere with activities.


Assuntos
Paralisia Cerebral/complicações , Espasticidade Muscular/complicações , Dor/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Paralisia Cerebral/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Dor/fisiopatologia , Medição da Dor , Adulto Jovem
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