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1.
J Clin Pediatr Dent ; 45(4): 239-246, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34534305

RESUMO

OBJECTIVE: Regarding the 2011 census in Hungary, the number of children with movement deficiences can be around 7,000. These children with special health care needs are considered to be a vulnerable group even from a dental point of view. In our dental program, we gain comprehensive information about patients' oral health, health behavior, and monitor dental care. STUDY DESIGN: A total of 199 children went through a full pediatric dental examination, children with cerebral palsy were categorized into five different levels (GMFCS) and children without motor disfunction into two groups. We analyzed the df-t and DMF-T values. Oral hygiene routine, dental care, gingivitis, demographic characteristics, nutritional habits odds ratio to df-t and DMF-T were surveyed. RESULTS: The mean df-t and DMF-T was 1.87 and 1.15 out of a total of 199, and the group that scored worse was the GMFCS II. The mean RI (restorative index) was 18.12% and 27% for decidous and permanent teeth, respectively. The prevalence of gingivitis was 66.7%. CONCLUSION: The results of our research point to the fact that children with cerebral palsy have difficulties in developing and maintaining proper oral health due to their disadvantages and therefore require special care and attention.


Assuntos
Paralisia Cerebral , Cárie Dentária , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Índice CPO , Assistência Odontológica , Cárie Dentária/epidemiologia , Hábitos , Humanos , Saúde Bucal , Prevalência
2.
Res Dev Disabil ; 118: 104084, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34543811

RESUMO

BACKGROUND: In European and North American countries, stunting and malnutrition are common in children with cerebral palsy (CP), especially those with multiple disabilities. The extent of this problem in children with CP in North African countries is still unknown. AIMS: To evaluate feeding problems and growth in a sample of North African multidisabled children with CP and to determine the factors associated with malnutrition in this population. METHOD: We conducted a cross-sectional study including multidisabled children with severe CP. Anthropometric measurements (body weight, height, mid-upper arm circumference and triceps skinfold thickness) were performed. In addition, a thorough nutritional survey was conducted including feeding time and the presence of signs in favor of gastrointestinal problems. RESULTS: We included 40 children, mainly boys (60 %) with a mean age of 6.4 ± 3.7 (range 2-16 years). The nutritional survey had revealed the presence of dysphagia, constipation and gastroesophageal reflux in 55 %, 67.5 % and 70 % of cases, respectively. Sixty-five percent of children had a mealtime over 30 min. Based on World Health Organization (WHO) growth charts, 67.5 % of children were underweight. Forty percent of the children had their weight below the 20th percentile, 5 % and 7.5 % had their height and BMI below the 5th percentile according to CP specific growth charts. Triceps skinfold thickness and mid-upper arm circumference were below the 5th percentile in 50 % and 55 % of cases, respectively. Age (p = 0.047) and constipation (p = 0.003) were identified as predictors of malnutrition. CONCLUSIONS: Growth parameters and nutritional status are significantly altered in in our sample of North African multidisabled children with CP with a high prevalence of feeding problems represented especially by dysphagia, constipation and GER. Among the studied factors age and constipation may predict the existence of undernutrition.


Assuntos
Paralisia Cerebral , Desnutrição , Adolescente , Fatores Etários , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Humanos , Masculino , Desnutrição/epidemiologia , Estado Nutricional
3.
Croat Med J ; 62(4): 367-375, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34472740

RESUMO

AIM: To investigate the association of cerebral palsy motor disorders, perinatal factors, and related disabilities with brain magnetic resonance imaging classification score (MRICS)-based groups in a population-based sample. METHODS: The study enrolled children with cerebral palsy born from 2003 to 2015 treated at Split University Hospital who underwent brain MRI scanning. Perinatal data (plurality, birth weight, gestational age, and Apgar score) were collected from hospital records. Motor disorders of cerebral palsy (gross and fine motor function) and the related disabilities (intellectual status, speech and eating ability, epilepsy, vision and hearing status) were evaluated with neurological status assessment. Neuroimaging findings were presented as MRICS-based groups. RESULTS: Of 115 enrolled children, an abnormal finding on brain MRI was confirmed in 95%, including white matter injury (66%), maldevelopments (13.9%), gray matter injury (9.6%), and miscellaneous findings (6.1%). Gross and fine motor function were not significantly associated with MRICS-based group. All related disabilities and perinatal factors, except Apgar score, were significantly associated with MRICS-based group. CONCLUSION: Brain MRICS-based groups were associated with perinatal risk factors and related disabilities of cerebral palsy, but not with common motor disorders. MRI classification score is a reliable diagnostic tool, which strongly correlates with perinatal factors and related disabilities of cerebral palsy.


Assuntos
Paralisia Cerebral , Epilepsia , Encéfalo , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Criança , Feminino , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética , Gravidez
4.
J Pediatr Nurs ; 60: 293-296, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34450414

RESUMO

Children with cerebral palsy (CP) often experience distressing symptoms. It is estimated that 3 in 4 have chronic pain and 1 in 5 have a sleep disorder, with the highest frequency and severity occurring in children with the greatest impairment. Sleep impairment and pain can adversely impact activities, participation and quality of life; however, prevalence of these symptoms in children at risk for CP < 2 years of age remain unknown. The objective of this project was to develop a baseline understanding of the presence of sleep and pain symptoms among children <2 years at high risk for CP to establish a baseline estimate for future quality improvement initiatives. A retrospective chart review was performed on a convenience sample of 50 children <2 years of age that were determined to be high risk for CP. This was determined through a standardized Hammersmith Infant Neurological Evaluation (HINE) global score of less than 56 performed as part of routine care. Descriptive statistics were used to explore the sample. A nonparametric test was used to evaluate the differences between groups. Pain and sleep problems were frequently reported in our sample (38% sleep problems and 32% pain). There were also significant differences between reported symptoms and the HINE. Reported symptoms were associated with lower HINE scores. Sleep and pain are frequent symptoms in children at risk for cerebral palsy. Early identification of these symptoms can lead to clinic-level intervention which may include pharmacological and non-pharmacological management strategies that improve outcomes for children at high risk for CP.


Assuntos
Paralisia Cerebral , Dor Crônica , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Criança , Humanos , Lactente , Medição da Dor , Melhoria de Qualidade , Qualidade de Vida , Estudos Retrospectivos , Sono
5.
Nutrients ; 13(8)2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34444708

RESUMO

Neurodevelopmental morbidities developed more commonly in low-birth-weight premature infants. We sought to determine the effects of different lipid emulsions on the neurodevelopmental outcomes of children born prematurely. This retrospective cross-sectional study had two intervention legs, Lipofundin® MCT/LCT (LIPO) versus Smoflipid® (SMOF), which are mainly differentiated by fish oil. Data of premature neonates born between 2001 and 2015 from the research database of Chang Gung Memorial Hospital with corresponding individual medical records up to July 2020 were analyzed. Long-term neurodevelopmental outcomes were defined by the international classification of disease codes -9 or -10. The prevalence of diseases was compared between LIPO and SMOF groups at five and five years old and further analyzed by stratification of 1500 g birth weight. The LIPO and SMOF groups each included 1120 neonates. Epilepsy, cerebral palsy, developmental disorder and attention-deficit hyperactivity disorder (ADHD) were significantly decreased at age two years in the SMOF group, and epilepsy, language delay (LD), ADHD and autism spectrum disorder (ASD) were significantly decreased in the SMOF group at age five years. In children with birth weight < 1500 g, ADHD was decreased in the SMOF group at ages two and five years, and ASD was decreased in the SMOF group at age five years. In children with birth weight ≥ 1500 g, epilepsy, LD and ADHD were decreased in the SMOF group at age two years. LD was decreased in the SMOF group at age five years. We conclude that lipid emulsions with fish oil improve the neurodevelopmental outcomes of children born prematurely.


Assuntos
Emulsões Gordurosas Intravenosas/administração & dosagem , Óleos de Peixe/administração & dosagem , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/epidemiologia , Azeite de Oliva/administração & dosagem , Fosfolipídeos/administração & dosagem , Sorbitol/administração & dosagem , Óleo de Soja/administração & dosagem , Triglicerídeos/administração & dosagem , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/prevenção & controle , Estudos Transversais , Combinação de Medicamentos , Epilepsia/epidemiologia , Epilepsia/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/prevenção & controle , Estudos Retrospectivos
6.
BMC Musculoskelet Disord ; 22(1): 684, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384415

RESUMO

BACKGROUND: Gait deviation and associated torsional problems are common in patients with cerebral palsy (CP). Although femoral anteversion in CP has been extensively reviewed in previous studies, only a few studies have focused on tibial torsion. Therefore, this study aimed to evaluate tibial torsion in patients with CP and investigate the affecting factors. METHODS: Consecutive patients with cerebral palsy who underwent 3-dimensional computed tomography for the assessment of rotational profiles were reviewed. Femoral anteversion and tibial torsion were measured, and the demographic characteristics of the patients were recorded. A linear mixed model was implemented to overcome the retrospective nature of the study. RESULTS: After the implementation of inclusion and exclusion criteria, 472 patients were enrolled for this study. With age, external tibial torsion increased, while femoral anteversion decreased. The factors affecting external tibial torsion were increased femoral anteversion (p = 0.0057), increased age (p < 0.0001), higher Gross Motor Function Classification System (GMFCS) level (p < 0.0001), and involved/uninvolved limbs of hemiplegia (p = 0.0471/p = 0.0047). CONCLUSIONS: Older age, GMFCS level IV/V, hemiplegia, and increased femoral anteversion were the independent risk factors of increased external tibial torsion; therefore, performing an imaging study is recommended for assessing the extent of tibial torsion in patients with such characteristics.


Assuntos
Paralisia Cerebral , Idoso , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Fêmur/diagnóstico por imagem , Marcha , Humanos , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/epidemiologia , Anormalidade Torcional/etiologia
7.
J Indian Soc Pedod Prev Dent ; 39(2): 214-220, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34341244

RESUMO

Background: Cerebral palsy (CP) is a childhood debilitating condition which impairs the physical and mental ability of an individual to maintain oral health. Aim: The objective of the present study was assessment of dental neglect and burden of treatment needs of children affected with CP as compared to normal children in a tertiary care hospital in Delhi. Settings and Design: A sample size of 104 children of age group of 6-14 years was selected, in which 52 children of CP (case group) and 52 normal school children (control group) were recruited. Materials and Methods: Children from both groups were examined, and calculation of drug master files (DMFS), defs, oral hygiene index (OHI), and gingival index was done. The presence of trauma and malocclusion was assessed. Present caries activity was assessed by the level of Streptococcus mutans present in saliva in both groups. Treatment needs were then assessed based on intraoral findings. Statistical Analysis: Data were analyzed by SPSS 20.0 software. Student's t-test and nonparametric statistical tests such as Chi-square test and Mann-Whitney test were used as per the nature of variables studied for statistical analysis with the level of significance denoted at P < 0.05. Results: The mean DMFS, gingival index, OHI, and treatment needs were observed to be higher in the CP group. Increased S. mutans levels were observed in saliva of CP patients. Defs score, trauma, and malocclusion were not statistically significantly higher in CP group as compared to the control group. Conclusion: Cerebral palsy group had a poor oral and gingival health, a higher DMFT and burden of treatment needs and an increased risk of further caries progression due to high caries activity indicated by increased level of salivary Streptococcus mutans than the control group.


Assuntos
Paralisia Cerebral , Cárie Dentária , Adolescente , Paralisia Cerebral/epidemiologia , Criança , Índice CPO , Cárie Dentária/epidemiologia , Humanos , Índia/epidemiologia , Saúde Bucal , Saliva , Streptococcus mutans , Centros de Atenção Terciária
8.
Medicine (Baltimore) ; 100(29): e26269, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398001

RESUMO

ABSTRACT: Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.


Assuntos
Paralisia Cerebral/classificação , Teste de Esforço/normas , Paralisia Cerebral/epidemiologia , Distribuição de Qui-Quadrado , Criança , Eletrocardiografia/métodos , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Segurança do Paciente , República da Coreia/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34360167

RESUMO

BACKGROUND: In international cooperation projects that are carried out in less developed and developing countries, a large number of children with disabilities present cerebral palsy (CP). Orthopaedic disorders are frequent complications associated with this disorder. Their prevention and early intervention are essential to achieve an appropriate therapeutic approach for children with PC and to improve their quality of life. OBJECTIVE: To describe the treatment approach that is currently used in international cooperation projects for the rehabilitation management of the orthopaedic disorders in children with cerebral palsy. METHODS: This is an observational, descriptive, cross-sectional study, carried out by means of an online questionnaire to professionals in the field of Physiotherapy and Rehabilitation working in international cooperation projects. The inclusion criteria were professionals working in the rehabilitation field in development aid, humanitarian action or emergency projects that provided rehabilitation services, working with children with cerebral palsy from 0 to 18 years old. RESULTS: Ninety-eight questionnaires were analysed. The average age of the participants was 33.2 years, they were mainly working in development cooperation projects (83.33%) that were implemented in rehabilitation centres and through community-based rehabilitation services (60%). The projects were located in countries all over the world but mainly on the Asian continent (71.4%). Physiotherapists and orthopaedic technicians (72.22%) were the main professionals working in these projects, followed by occupational therapists and social workers (55.56%). The results indicated that the orthopaedic disorders were very frequent in the sample (66.67%), with hip subluxation (50%), scoliosis (77.78%), kyphosis (61.1%), clubfoot (88.7%) and varus foot (61.11%) standing out. The most commonly used treatment approaches were positioning (88.89%) and the Bobath concept (83.33%). The technical aids that were used by the professionals were ankle foot orthosis (AFO) (94.44%), bracing (66.67%), standing frames (83.33%), moulded seats (100%), corner seats (93.75%) and adapted seats (92.85%). CONCLUSIONS: In international cooperation projects, the rehabilitation treatment of children with cerebral palsy is based on a holistic approach. This is reflected in the interventions that are carried out to treat their orthopaedic disorders and in locally produced devices, awareness raising and community education. However, the professionals surveyed considered that the aids or orthoses used are insufficient in the treatment and prevention of orthopaedic disorders in cerebral palsy.


Assuntos
Paralisia Cerebral , Órtoses do Pé , Doenças Musculoesqueléticas , Adolescente , Adulto , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Doenças Musculoesqueléticas/epidemiologia , Qualidade de Vida
10.
Nutrients ; 13(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34371923

RESUMO

BACKGROUND: Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. METHODS: A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). RESULTS: A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. CONCLUSION: MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.


Assuntos
Paralisia Cerebral/diagnóstico , Transtornos de Deglutição/diagnóstico , Deglutição , Crianças com Deficiência , Desnutrição/diagnóstico , Estado Nutricional , Higiene Bucal , Estado de Hidratação do Organismo , Adolescente , Desenvolvimento do Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Fatores Etários , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Criança , Desenvolvimento Infantil , Estudos Transversais , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/terapia , Comportamento Alimentar , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Desnutrição/terapia , Destreza Motora , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Espanha/epidemiologia
11.
Disabil Rehabil ; 43(15): 2123-2130, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34275406

RESUMO

PURPOSE: Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver's mental health. METHODS: Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed. RESULTS: Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05). CONCLUSIONS: Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development.Implications for rehabilitationCaregivers of adolescents with cerebral palsy in rural Bangladesh are at significantly higher risk of depression and stress than caregivers of adolescents without disability.We recommend interventions to improve caregiver mental health give specific consideration to older caregivers, those whose adolescent report mental health problems, families living in crowded households, and/or whose child has hearing impairment.We recommend interventions include poverty reduction measures to improve social and economic capital and target both caregivers and adolescents with CP to enhance long term outcomes.


Assuntos
Cuidadores , Paralisia Cerebral , Adolescente , Ansiedade/epidemiologia , Bangladesh/epidemiologia , Paralisia Cerebral/epidemiologia , Criança , Depressão/epidemiologia , Humanos , Qualidade de Vida
13.
BMC Neurol ; 21(1): 254, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193065

RESUMO

BACKGROUND: Effective inclusion in society for young people with disabilities is increasingly seen as generating opportunities for self-development, and improving well-being. However, significant barriers remain in the vast majority of activities meaningful for young adults. Research argues that various personal (disabilities, health) and environmental (access to the resources needed, accessible environment, discrimination, lack of personal economic independence) factors contribute to limited participation. However, previous studies conducted in young people with cerebral palsy (CP) mainly investigated the transition period to adulthood, and did not fully consider the whole range of impairment severity profiles or environmental barriers. In this study, we will use the follow-up of the SPARCLE cohort and a comparison group from the general population (1) to investigate the impact of the environment on participation and quality of life of young adults with CP, (2) to determine predictors of a successful young adulthood in educational, professional, health and social fields, (3) to compare quality of life and frequency of participation in social, work and recreational activities with the general population, (4) to document on participation and quality of life in those with severe disabilities. METHODS: The SPARCLE3 study has a combined longitudinal and cross-sectional design. Young adults with CP aged 22 to 27 years in 6 European regions previously enrolled in the SPARCLE cohort or newly recruited will be invited to self-complete a comprehensive set of questionnaires exploring participation (daily life and discretionary activities), health-related quality of life, body function, personal factors (health, personal resources), and contextual factors (availability of needed environmental items, family environment, services provision) during home visits supervised by trained researchers. Proxy-reports or adapted questionnaires will be used for those with the most severe impairments. The recruitment of a large group from the general population (online survey) will enable to identify life areas where the discrepancies between young people with CP and their able-bodied peers are the most significant. DISCUSSION: This study will help identify to what extent disabilities and barriers in environment negatively affect participation and quality of life, and how previous valued experiences during childhood or adolescence might modulate these effects.


Assuntos
Paralisia Cerebral/epidemiologia , Qualidade de Vida , Adulto , Estudos Transversais , Atividades Humanas/estatística & dados numéricos , Humanos , Estudos Longitudinais , Adulto Jovem
14.
BMC Neurol ; 21(1): 276, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253183

RESUMO

BACKGROUND: Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries. METHODS: This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland. RESULTS: A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017-2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries. CONCLUSION: There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.


Assuntos
Baclofeno/administração & dosagem , Toxinas Botulínicas Tipo A/administração & dosagem , Paralisia Cerebral/terapia , Espasticidade Muscular/terapia , Sistema de Registros , Rizotomia/métodos , Adolescente , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Europa (Continente)/epidemiologia , Humanos , Injeções Espinhais/métodos , Masculino , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/epidemiologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/patologia
15.
BMJ ; 374: n1592, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261639

RESUMO

OBJECTIVE: To assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children. DESIGN: Population based cohort study on behalf of NHS England using the OpenSAFELY platform. SETTING: Patient level data were obtained for more than 17 million people registered with a general practice in England that uses TPP software. Electronic health records were linked with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service. PARTICIPANTS: Adults (aged 16-105 years) and children (<16 years) from two cohorts: wave 1 (registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The main exposure group consisted of people on a general practice learning disability register; a subgroup was defined as those having profound or severe learning disability. People with Down's syndrome and cerebral palsy were identified (whether or not they were on the learning disability register). MAIN OUTCOME MEASURE: Covid-19 related hospital admission and covid-19 related death. Non-covid-19 deaths were also explored. RESULTS: For wave 1, 14 312 023 adults aged ≥16 years were included, and 90 307 (0.63%) were on the learning disability register. Among adults on the register, 538 (0.6%) had a covid-19 related hospital admission; there were 222 (0.25%) covid-19 related deaths and 602 (0.7%) non-covid deaths. Among adults not on the register, 29 781 (0.2%) had a covid-19 related hospital admission; there were 13 737 (0.1%) covid-19 related deaths and 69 837 (0.5%) non-covid deaths. Wave 1 hazard ratios for adults on the learning disability register (adjusted for age, sex, ethnicity, and geographical location) were 5.3 (95% confidence interval 4.9 to 5.8) for covid-19 related hospital admission and 8.2 (7.2 to 9.4) for covid-19 related death. Wave 2 produced similar estimates. Associations were stronger among those classified as having severe to profound learning disability, and among those in residential care. For both waves, Down's syndrome and cerebral palsy were associated with increased hazards for both events; Down's syndrome to a greater extent. Hazard ratios for non-covid deaths followed similar patterns with weaker associations. Similar patterns of increased relative risk were seen for children, but covid-19 related deaths and hospital admissions were rare, reflecting low event rates among children. CONCLUSIONS: People with learning disability have markedly increased risks of hospital admission and death from covid-19, over and above the risks observed for non-covid causes of death. Prompt access to covid-19 testing and healthcare is warranted for this vulnerable group, and prioritisation for covid-19 vaccination and other targeted preventive measures should be considered.


Assuntos
COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Deficiências da Aprendizagem/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Paralisia Cerebral/epidemiologia , Estudos de Coortes , Pessoas com Deficiência , Síndrome de Down/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Mymensingh Med J ; 30(3): 678-683, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34226455

RESUMO

Cerebral palsy (CP) is the commonest movement disorder in childhood. Clinical spectrum of CP is variable and CT scan of brain is an important mode of diagnosis and prognosis in recourse limited set up. This study was done to categorize the CT scan findings and correlate them with the type of motor disturbances of CP patients. This was a cross sectional study done in 100 children diagnosed as CP carried out in Pediatric Neurology unit, BSMMU from July 2009 to July 2010. The patients were randomly selected and CT scan was done in all the patients. Detailed history and clinical examination was done to find out the baseline characteristics, risk factors and topographic type of CP patients. Among 100 patients 92% had abnormal CT scan finding. Most common abnormality was cerebral atrophy. Maximum number of abnormal CT scan was found in quadriplegic CP (92%). Highest number of children was in 13-24 months (29%) and a slight male predominance was found. Commonest risk factor was perinatal asphyxia (75%). The brain lesions are often associated with a clinical phenotype where specific needs may be anticipated and addressed. This is important for the planning of intervention in the child with CP.


Assuntos
Asfixia Neonatal , Paralisia Cerebral , Encéfalo , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Tomografia Computadorizada por Raios X
18.
Nutrients ; 13(6)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34073813

RESUMO

A study of the literature shows the lack of data on a comprehensive analysis of eating disorders in children with neurodysfunction, which constitute a clinical subgroup with an increased risk of abnormalities in this area. Therefore, the aim of this study was to determine the relationship between the coexistence of nutritional disorders and diseases or syndromes associated with neurodysfunction based on data collected during hospitalization at a rehabilitation center for children and adolescents. A retrospective analysis was carried out in a group of 327 children and adolescents aged 4-18 years. The study group covered various types of diseases or syndromes involving damage to the central nervous system. A retrospective analysis of baseline data (age, sex, main and additional diagnosis and Body Mass Index-BMI) was performed. Two assessment criteria of nutritional status were taken into account (z-score BMI and other previously published normative values). In the study group, malnutrition was found more frequently (18.0% of the respondents) than obesity (11.3% of the subjects). Hypothyroidism coexisting with malnutrition was identified in the study group (N% = 43.8%, p = 0.011) and malnutrition with tetraplegia in the subgroup of spastic cerebral palsy (N% = 34.2 %, p = 0.029).


Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Transtornos Nutricionais/epidemiologia , Adolescente , Índice de Massa Corporal , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Desnutrição/epidemiologia , Transtornos Motores/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Quadriplegia/epidemiologia , Centros de Reabilitação , Estudos Retrospectivos , Síndrome
19.
J Pediatr Orthop ; 41(8): e659-e663, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34101699

RESUMO

BACKGROUND: The aim of this study was to evaluate whether the femoral head-shaft angle (HSA) is a predictor of hip displacement in children with cerebral palsy (CP). METHODS: The patients were recruited from a population-based hip surveillance program. Inclusion criteria were age under 5 years, bilateral CP, Gross Motor Function Classification System (GMFCS) levels III-V, and migration percentage (MP) of both hips <40% at the primary radiograph. With these criteria, 101 children (61 boys) were included. GMFCS was level III in 26 patients, level IV in 23, and level V in 52. An anteroposterior radiograph of the pelvis was taken at diagnosis and at the last follow-up. Only the worst hip of each patient (the hip with the largest MP) was used for the analyses. RESULTS: The mean age at the primary radiograph was 2.4 years (range, 0.8 to 4.9 y). The mean primary HSA was 171.0 degrees (range, 152 to 190 degrees). The mean follow-up time was 4.3 years (range, 0.9 to 11.8 y). The mean MP at the primary radiograph was 17.5% (range, 0% to 39%) and at the last follow-up 41.9% (range, 0% to 100%). At that point, MP was <40% in 54 hips and ≥40% in 47 hips. There was no significant difference in primary HSA between patients with final MP<40% and those with final MP≥40% (170.8 and 171.3 degrees, respectively; P=0.761). At the last follow-up, the mean HSA was significantly larger in hips with final MP≥40% than in hips with final MP<40% (171.1 vs. 167.4 degrees; P=0.029). CONCLUSIONS: There was a markedly increased valgus position of the proximal femur in nonambulatory children with CP. However, the primary HSA in children below 5 years of age was not a predictor of later hip displacement, defined as MP≥40%. CLINICAL RELEVANCE: Measurement of HSA is not necessary in routine hip surveillance in children below 5 years. LEVEL OF EVIDENCE: Level I-investigating a diagnostic test.


Assuntos
Paralisia Cerebral , Luxação do Quadril , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Fêmur , Cabeça do Fêmur/diagnóstico por imagem , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/epidemiologia , Luxação do Quadril/etiologia , Humanos , Masculino , Radiografia
20.
Medicina (Kaunas) ; 57(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071238

RESUMO

Background and Objectives: This is the first study assessing risk factors for cerebral palsy (CP) among children born in Moldova. The aim of this study was to identify and describe risk factors for cerebral palsy (CP) among children born in Moldova, which is one of the low-middle income countries in Europe. Materials and Methods: We identified 351 children with CP born during 2009 and 2010 in Moldova. Detailed information on 417 children without CP served as a reference group. Logistic regression analyses were applied to the calculate crude and adjusted odds ratios (OR) for CP with 95% confidence intervals (CI) in addition to attributable fraction (AF). Results: Among children with CP (40.5% girls), 26% had spastic unilateral, 54% bilateral, 13% dyskinetic, 5% ataxic and 2% unclassified CP. Significant risk factors for CP included maternal alcohol consumption during pregnancy (OR 1.7, p = 0.002), maternal hypertension (OR 2.0, p < 0.001), children born to mothers from the rural areas (OR 1.6, p < 0.001), maternal age ≥35 years (OR 0.6, p = 0.018), maternal epilepsy (OR 4.3, p < 0.001), breech delivery (OR 3.1, p = 0.001), home births (OR 6.3, p = 0.001), umbilical cord around neck (OR 2.2, p < 0.001), AVD (OR 3.1, p < 0.001), male gender (OR 1.3, p < 0.001), SGA (OR 1.3, p = 0.027), multiple gestations (OR 1.7, p < 0.001) and hyperbilirubinemia (OR 4.5, p < 0.001). Multivariable analyses showed that the AF of CP was 64% for rural residence (OR 2.8, p = 0.002), 87% for home birth (7.6, p = 0.005), 79% for pre-labor rupture of membrane (OR 4.9, p = 0.001), 66% for breech delivery (OR 2.9, p = 0.002) and 81% for hyperbilirubinemia (OR 5.4, p < 0.001). Conclusions: A combination of factors related to the mother, the delivery and the child were risk factors for CP in Moldova, many of them possibly avoidable. Improved pregnancy and maternity care would potentially reduce the risk of CP. A national CP registry in Moldova is suggested as an opportunity to follow up on these findings.


Assuntos
Paralisia Cerebral , Serviços de Saúde Materna , Adulto , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/etiologia , Criança , Europa (Continente) , Feminino , Humanos , Masculino , Moldávia/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco
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