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1.
Medicine (Baltimore) ; 100(4): e23907, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530188

RESUMO

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 ETHICS AND DISSEMINATION: Private information from individuals will not be published.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


Assuntos
Terapia por Acupuntura , Paralisia Cerebral/reabilitação , Metanálise como Assunto , Moxibustão , Revisões Sistemáticas como Assunto , Terapia por Acupuntura/efeitos adversos , Paralisia Cerebral/fisiopatologia , Criança , Protocolos Clínicos , Humanos , Destreza Motora , Moxibustão/efeitos adversos , Projetos de Pesquisa
2.
Curr Sports Med Rep ; 20(1): 19-25, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395127

RESUMO

ABSTRACT: Cerebral palsy (CP) is a group of debilitating motor disorders that carries a wide array of clinical presentations ranging from isolated physical or cognitive impairment to global loss of function. Despite the prevalence of CP, recommendations and benefits of physical activity/exercise have historically not been clearly defined. The research on the subject has several limitations, including small sample size, power, standardized measures/outcomes, and poor classification regarding severity of the disease. Nonetheless, the general consensus and new research shows that individuals with CP who participate in sports and exercise regimens, even at reduced frequency and intensity, exhibit improvements in health care benefits, including cardiorespiratory endurance, gross motor function, gait stability, and reduction in pain. These regimens can be prescribed safely and individualized by health care providers to improve morbidity and mortality in patients suffering from CP.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Exercício Físico , Esportes , Humanos
3.
Dev Neurorehabil ; 24(2): 118-129, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33356732

RESUMO

Purpose: To explore the relationship of intelligibility, receptive language, executive functioning, and motor skills to nonverbal cognitive skills among children with cerebral palsy (CP) in different speech-language profile groups. Method: Twenty-seven children with CP aged 10-12 years old participated in the study. They completed a battery of standard clinical assessments. The relationship of various skillsets with nonverbal cognitive ability was explored using correlational procedures. Additionally, we examined pairwise differences in nonverbal cognitive skills among profile groups. Cohen's Kappa and Chi-square tests were used to study the consistency of receptive language and nonverbal cognitive performance. Results: Children who showed better nonverbal cognitive abilities demonstrated better motor, receptive language, and intelligibility skills. Nonverbal cognition was generally consistent with receptive language. Conclusion: Nonverbal cognitive impairment often co-occurs with language and speech motor impairment among children with CP. Speech-language profile groups are a useful framework for describing both communication and cognitive abilities.


Assuntos
Paralisia Cerebral/fisiopatologia , Cognição , Desenvolvimento da Linguagem , Destreza Motora , Inteligibilidade da Fala , Criança , Pré-Escolar , Função Executiva , Feminino , Humanos , Masculino
4.
Turk J Med Sci ; 51(2): 385-392, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33350298

RESUMO

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Paralisia Cerebral/reabilitação , Espasticidade Muscular/tratamento farmacológico , Paralisia Cerebral/fisiopatologia , Criança , Controle de Doenças Transmissíveis , Técnica Delfos , Humanos , Controle de Infecções , Injeções Intramusculares/métodos , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Guias de Prática Clínica como Assunto
5.
BMC Neurol ; 20(1): 388, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33096988

RESUMO

BACKGROUND: Cerebral Palsy (CP) is a group of disorders that affect the development of movement and posture. CP results from injuries to the immature brain during the prenatal, perinatal, or postnatal stage of development. Neuroimaging research in CP has focused on the structural changes of the brain during early development, but little is known about brain's structural and functional changes during late adolescence and early adulthood, a period in time when individuals experience major changes as they transition into adulthood. The work reported here served as a feasibility study within a larger program of research (MyStory Study). We aimed to determine whether it would be feasible to scan and obtain good quality data without the use of sedation during a resting state condition for functional connectivity (FC) analyses in young adults with CP. Second, we aimed to identify the FC pattern(s) that are associated with depressive mood ratings, indices of pain and fatigue, and quality of life in this group. METHODS: Resting state functional images were collected from 9 young people with CP (18-29 years). We applied a stringent head motion correction and quality control methods following preprocessing. RESULTS: We were able to scan and obtain good quality data without the use of sedation from this group of young individuals with CP who demonstrated a range of gross motor ability. The functional connectivity networks of interest were identified in the data using standard seed regions. Our analyses further revealed that higher well-being scores were associated with higher levels of FC between the Medial Pre-Frontal Cortex and the right Lateral Parietal regions, which are implicated in prosocial and emotion regulations skills. The implications of this association are discussed. CONCLUSION: The findings of the present study demonstrate that it is feasible to conduct resting state functional connectivity in young adults with CP with different gross motor abilities without the use of sedation. Our results also highlight a neural circuitry that is associated with the self-report of quality of life and emotion regulation. These findings identify these regions/circuitries as important seeds for further investigations into mental health and wellbeing in CP.


Assuntos
Encéfalo/diagnóstico por imagem , Paralisia Cerebral/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Neuroimagem/métodos , Adolescente , Adulto , Encéfalo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Rede Nervosa/fisiopatologia , Qualidade de Vida , Adulto Jovem
6.
Medicine (Baltimore) ; 99(30): e21082, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791681

RESUMO

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


Assuntos
Acupuntura , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/reabilitação , Criança , Desenvolvimento Infantil , Eletroencefalografia , Humanos , Rim , Imagem por Ressonância Magnética , Destreza Motora , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
S Afr Med J ; 110(4): 308-312, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657743

RESUMO

BACKGROUND: Neonatal hypoxic ischaemic encephalopathy (NHIE) is an important cause of long-term handicap in survivors. There is limited information on the burden of handicap from NHIE in sub-Saharan Africa. OBJECTIVES: To determine the developmental outcomes in survivors of NHIE in South Africa (SA). METHODS: In this prospective observational study, the developmental outcomes in 84 infants who had survived hypoxic ischaemic encephalopathy (the NHIE group) were compared with those in 64 unaffected infants (the control group). The Bayley Scales of Infant Development version III were used for assessment of developmental outcomes. RESULTS: Significant differences were found between the developmental outcomes of the two groups, with a significantly lower composite language score and higher proportions with language, motor and cognitive developmental delays in the NHIE group than in the control group. Cerebral palsy (CP) was present in 13 of the infants with NHIE (15.5%) and none in the control group (p<0.001). CP was associated with developmental delay, and also with the severity of NHIE. Therapeutic hypothermia (TH) was administered in 58.3% of the study group, but although it was associated with lower rates of CP and developmental delay than in the group without TH, the only significant difference was for delay on the language subscale. CONCLUSIONS: Survivors of NHIE in SA are at risk of poor developmental outcomes.


Assuntos
Paralisia Cerebral/epidemiologia , Desenvolvimento Infantil , Deficiências do Desenvolvimento/epidemiologia , Hipóxia-Isquemia Encefálica/epidemiologia , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Estudos de Casos e Controles , Paralisia Cerebral/fisiopatologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Doenças do Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/fisiopatologia , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , África do Sul/epidemiologia
8.
PLoS One ; 15(6): e0234654, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544177

RESUMO

Children with Cerebral Palsy (CP) show the postural constraints while standing, and gait disorders, resulting from both primary and secondary impairments of brain injury. In our previous studies, several characteristic postural and gait patterns in children with unilateral as well as with bilateral CP were defined, and the relationship between these patterns was demonstrated. The purpose of present study was to identify which features of body posture deviation during standing were strongly related to gait deviations in independently ambulatory children with CP. For this aim we explored the cross-relationship between features of body posture while standing examined by surface topography and the selected gait parameters from three-dimensional instrumented gait analysis in one hundred twenty children with cerebral palsy, aged between 7 and 13 years, who were able to walk independently. First, our study documented that that sagittal misalignment of the spine curvature was significantly related to kinematic deviations such as deviations of pelvic tilt, inadequate swing phase and knee flexion, and peak dorsiflexion in stance. Second, the study shows that the static asymmetry of pelvis and trunk was significantly associated with kinematic deviations during gait cycle such as pelvic rotation, hip abduction in swing, ROM of knee flexion, peak dorsiflexion in stance. Based on obtained results and referring to our previous findings it can be assumed that the first model of the relationship between postural deviation and gait disturbances, called 'postural and gait complex of disorders in sagittal plane', is related to children with bilateral CP, whereas the second model 'postural and gait complex of disorders in coronal plane' to children with unilateral CP. The clinical applications of this study relate to the early recognition of particular features of postural deviation using surface topography, instead of more difficult and demanding expensive tools 3-D gait analysis.


Assuntos
Paralisia Cerebral/fisiopatologia , Marcha , Postura , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Análise da Marcha , Humanos , Masculino , Curvaturas da Coluna Vertebral/fisiopatologia
9.
Acta Orthop Traumatol Turc ; 54(3): 262-268, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32544062

RESUMO

OBJECTIVE: The aim of this study was to analyze the results of the split anterior tibialis tendon transfer (SPLATT) to peroneus tertius (PT) for equinovarus foot deformity in children with cerebral palsy (CP). METHODS: The medical records of 25 ambulatory CP patients (mean age: 8.7±3.2 years, range: 4-16 years) with equinovarus foot (33 feet), who underwent SPLATT to PT surgery between 2014 and 2016, were retrospectively reviewed. A senior surgeon performed all the surgical procedures. SPLATT was performed as part of a single-event multilevel surgery for the lower limb, and the concomitant procedures on the same extremity were recorded. The patients who required any additional foot or ankle surgery that could affect the clinical outcome (except heel cord lengthening) were excluded from the study. The Kling's College Criteria were used to evaluate the procedural outcome of the foot position and gait, and the associated complications were recorded. RESULTS: The mean follow-up time was 28.8±5 months (range: 24-42 months). The postoperative Kling scores were excellent for 27 feet of the patients who had a plantigrade foot, without fixed or postural deformity, in a regular shoe, having no calluses; good for 5 cases for those who walked with less than 5° varus, valgus, or equinus posture of the hind foot, wearing regular shoes, having no callosities; and fair for 1 case for those who had recurrence of the deformity. There was only one wound detachment, which was treated with wound care and dressing. None of the patients had overcorrection, infection, or bone fracture. CONCLUSION: The dynamic SPLATT to PT surgery for the management of the equinovarus foot deformities in the CP patients is a safe and less complicated surgical alternative with a good functional outcome. It is a safe and effective treatment method for the management of equinovarus foot deformities in CP. LEVEL OF EVIDENCE: Level IV, Therapeutic study.


Assuntos
Paralisia Cerebral/complicações , Pé Torto Equinovaro , Espasticidade Muscular , Transferência Tendinosa , Tendões , Paralisia Cerebral/fisiopatologia , Pré-Escolar , Pé Torto Equinovaro/etiologia , Pé Torto Equinovaro/fisiopatologia , Pé Torto Equinovaro/cirurgia , Feminino , Pé/fisiopatologia , Pé/cirurgia , Humanos , Masculino , Espasticidade Muscular/complicações , Espasticidade Muscular/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transferência Tendinosa/efeitos adversos , Transferência Tendinosa/métodos , Tendões/fisiopatologia , Tendões/cirurgia
10.
J Pediatr Orthop ; 40(6): e498-e503, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32501922

RESUMO

BACKGROUND: Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment. Evaluation and treatment include observation, tone management multilevel orthopaedic surgery to address muscle contractures and bony deformities, and the use of gait analysis for preoperative and postoperative assessment. METHODS: A PubMed search of the orthopaedic literature for studies published between January 2016 and February 2019 was performed. Eligible abstracts included the use of 3-dimensional instrumented gait analysis in the evaluation and treatment of the lower extremities in ambulatory children with CP. Seven hundred twenty abstracts were reviewed, with 84 papers identified as eligible, of which 45 full manuscripts were included for detailed review. RESULTS: The review summarized recent advances regarding the treatment of torsional alignment, knee deformities and clinical gait evaluation with visual assessment tools compared with instrumented gait analysis. CONCLUSIONS: Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance. LEVEL OF EVIDENCE: Level IV-literature review.


Assuntos
Paralisia Cerebral/fisiopatologia , Análise da Marcha/tendências , Transtornos Neurológicos da Marcha/reabilitação , Adolescente , Instituições de Assistência Ambulatorial , Criança , Feminino , Marcha/fisiologia , Humanos , Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Procedimentos Ortopédicos , Ortopedia , Avaliação de Resultados em Cuidados de Saúde , Modalidades de Fisioterapia
11.
J Neuroeng Rehabil ; 17(1): 59, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349752

RESUMO

BACKGROUND: Cerebral Palsy (CP) is characterised by variable difficulties in muscular action, resulting in inability of the individual to perform functional movement. An option to provide functionality to the individual with CP is the use of computer innovation. The aim of this paper was to verify if there was any performance improvement in a task performed in a virtual environment and if there was transfer to the task performed in the real environment and vice versa in this population. METHODS: A computer program was developed comprising a motor task, but with two possibilities of user interaction: a) concrete interface (with physical contact): in which the individual touches the computer screen to finish the task and b) abstract interface (no physical contact): in which the individual performs a hand movement in front of the Kinect device. Participants were split into two groups. The experimental group consisted of 28 individuals with CP within the ages of 6 and 15 years old. The control group included 28 typically developing individuals mirroring the age and sex of the experimental group. RESULTS: Individuals from both groups were able to improve task performance and retain acquired information. The CP group presented worse performance than the control group in all phases of the study. Further findings showed that the CP group presented better performance in the abstract interface than in the concrete interface, whereas, in the control group, the opposite occurred: their best performance was in the concrete. CONCLUSIONS: Motor tasks performed by individuals with CP through an interface with a more virtual environment feature (abstract interface: Kinect) provided better performance when compared to an interface with a more real characteristic (concrete interface: Touchscreen). TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03352440; Date of registration - November 17, 2017.


Assuntos
Paralisia Cerebral/reabilitação , Destreza Motora/fisiologia , Interface Usuário-Computador , Realidade Virtual , Adolescente , Paralisia Cerebral/fisiopatologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Jogos de Vídeo
12.
N Z Med J ; 133(1514): 63-70, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379740

RESUMO

BACKGROUND: Preterm infants have a high risk of neurodevelopmental disability, including cerebral palsy (CP). Often, CP is not diagnosed until after 12 months, leading to delay in targeted interventions. The General Movements assessment (GM) evaluates the spontaneous movements of high-risk infants from birth to 20 weeks corrected postnatal age (CPA), and accurately predicts the risk of CP. This allows for earlier diagnosis and intervention, potentially changing the trajectory of disability, yet routine use of GM is not well established in New Zealand. AIM: To describe the process of setting up GM in a tertiary neonatal unit. METHODS: We reviewed the process and progress made to date setting up GM in our service. RESULTS: Challenges and potential solutions for the implementation of GM were identified. Key areas of development included staff training and support, IT services, resources, medical documentation, inter-departmental communication and establishing clinical pathways. CONCLUSION: GM has become successfully integrated into the assessment of high-risk infants in our neonatal unit, with the aim to provide valuable information to health professionals and families to optimise intervention and improve outcomes. Efforts will continue to ensure there is robust and sustainable system for using GM in our service.


Assuntos
Paralisia Cerebral/diagnóstico , Movimento , Avaliação de Sintomas/métodos , Paralisia Cerebral/fisiopatologia , Procedimentos Clínicos , Diagnóstico Precoce , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Nova Zelândia , Seleção de Pacientes , Desenvolvimento de Programas , Fatores de Risco , Centros de Atenção Terciária , Gravação de Videoteipe
13.
Eur J Paediatr Neurol ; 27: 49-59, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417186

RESUMO

Cerebral Palsy (CP) is a complex neurological disorder, characterized by congenital motor disability associated with behaviour, perception and cognition disorders. The sensorimotor impairments represent the main hallmark of the disease, significantly impacting the quality of life. So far, few studies have investigated motor learning abilities in CP and their association with the plastic reorganization of the motor system remains largely unknown. The present proof-of-principle study explored explicit motor sequence learning in children with unilateral CP and different patterns of motor system reorganization (bilateral, ipsilateral, contralateral). Children with unilateral CP, and a group of age-matched typically developing (TD) children, underwent a sequential finger tapping task, performed with the affected hand by children with CP and with the non-dominant hand by TD children. The pattern of corticospinal tract projections in hemiparetic patients was assessed by single-pulse Transcranial Magnetic Stimulation (TMS). Results showed the presence of finger dexterity impairments in children with unilateral CP presenting with a bilateral or an ipsilateral control of the affected (trained) hand, as compared to TD children. Conversely, motor sequence learning was impaired in unilateral CP with ipsilateral or contralateral corticospinal reorganization, but not in the case of a bilateral control of the paretic hand. These preliminary findings, although referred to small clinical samples, suggest that unilateral control of the paretic upper-limb, from the ipsilateral or the contralateral motor cortex, may not be sufficient to develop typical motor learning with the affected hand, which seems to require a bilateral representation in the motor cortex. This evidence has potential implications for fine motor skills rehabilitation in CP.


Assuntos
Paralisia Cerebral/fisiopatologia , Aprendizagem/fisiologia , Destreza Motora/fisiologia , Tratos Piramidais/fisiopatologia , Adolescente , Paralisia Cerebral/complicações , Criança , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Plasticidade Neuronal/fisiologia , Projetos Piloto , Estimulação Magnética Transcraniana
14.
BMC Neurol ; 20(1): 172, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375677

RESUMO

BACKGROUND: The prognosis of gross motor function is a major concern for therapy and intervention in children with cerebral palsy (CP). The classification system for gross motor function, the Gross Motor Function Classification System (GMFCS), is actively studied because it could be useful in the communication between professionals and families. This study aimed to verify the stability of GMFCS over 2 years in children with CP aged 2-12 years. METHODS: The GMFCS level of 100 children with CP who underwent rehabilitation therapy in hospitals or who attended special elementary schools in South Korea were collected in the study. The agreements across three measurement points were analyzed in these children. RESULTS: The weighted kappa coefficients were statistically significant (p < .05). The coefficients ranged from 0.690 to 0.789 in children with CP aged 2-12 years. The lowest coefficient of 0.557 was observed in children with CP aged 2-4 years between the first and third measurements points. CONCLUSIONS: The results provided evidence of GMFCS stability for the first year and change of the GMFCS during the two-year study period in children aged 2-4 years. Moreover, the findings indicate that the stability of GMFCS varies with time, duration, and age. It is recommended that GMFCS assessments be performed periodically, which are even more necessary for children with CP aged 2-4 years.


Assuntos
Paralisia Cerebral/fisiopatologia , Destreza Motora , Índice de Gravidade de Doença , Criança , Pré-Escolar , Feminino , Humanos , Masculino , República da Coreia
15.
Percept Mot Skills ; 127(4): 684-697, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32321360

RESUMO

Manual dexterity has strongly predicted functional independence for daily life activities among children with cerebral palsy (CP). The Jebsen-Taylor Hand Function Test (JTHFT) is the most widely used assessment tool for exploring manual dexterity in the CP population, though no research has yet examined its psychometric properties for this use. This cross-sectional study explored the validity and internal consistency of the JTHFT in an Italian sample of inpatient and outpatient children with CP aged between 6-18 years (35 girls and 49 boys). We calculated internal consistency with Cronbach's alpha and tested validity against the Manual Ability Classification System (MACS) using Pearson's correlation coefficient. To better understand how the JTHFT compares with different levels of the MACS, we performed dominant hand timing variability for each test item. Results showed excellent internal consistency with a Cronbach's alpha of .944 and .911, respectively, for nondominant and dominant hands. There was also a statistically significant positive linear Pearson's correlation coefficient between the JTHFT and the MACS (p < .01). We observed high variability in writing performance (Item 1 of the JTHFT) within this sample for each level of the MACS. This study confirms that the JTHFT is a valid assessment tool when used in children with CP aged 6-18 years.


Assuntos
Paralisia Cerebral/fisiopatologia , Mãos/fisiopatologia , Adolescente , Criança , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Itália , Masculino , Psicometria , Reprodutibilidade dos Testes
16.
PLoS One ; 15(4): e0232064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32330162

RESUMO

Clinical gait analysis is widely used in clinical routine to assess the function of patients with motor disorders. The proper assessment of the patient's function relies greatly on the repeatability between the measurements. Marker misplacement has been reported as the largest source of variability between measurements and its impact on kinematics is not fully understood. Thus, the purpose of this study was: 1) to evaluate the impact of the misplacement of the lateral femoral epicondyle marker on lower limb kinematics, and 2) evaluate if such impact can be predicted. The kinematic data of 10 children with cerebral palsy and 10 aged-match typical developing children were included. The lateral femoral epicondyle marker was virtually misplaced around its measured position at different magnitudes and directions. The outcome to represent the impact of each marker misplacement on the lower limb was the root mean square deviations between the resultant kinematics from each simulated misplacement and the originally calculated kinematics. Correlation and regression equations were estimated between the root mean square deviation and the magnitude of the misplacement expressed in percentage of leg length. Results indicated that the lower-limb kinematics is highly sensitive to the lateral femoral epicondyle marker misplacement in the anterior-posterior direction. The joint angles most impacted by the anterior-posterior misplacement were the hip internal-external rotation (5.3° per 10 mm), the ankle internal-external rotation (4.4° per 10 mm) and the knee flexion-extension (4.2° per 10 mm). Finally, it was observed that the lower the leg length, the higher the impact of misplacement on kinematics. This impact was predicted by regression equations using the magnitude of misplacement expressed in percentage of leg length. An error below 5° on all joints requires a marker placement repeatability under 1.2% of the leg length. In conclusion, the placement of the lateral femoral epicondyle marker in the antero-posterior direction plays a crucial role on the reliability of gait measurements with the Conventional Gait Model.


Assuntos
Fenômenos Biomecânicos/fisiologia , Análise da Marcha/métodos , Joelho/fisiopatologia , Adolescente , Algoritmos , Articulação do Tornozelo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Criança , Feminino , Fêmur/fisiopatologia , Marcha/fisiologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes
17.
BMC Neurol ; 20(1): 133, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32290815

RESUMO

BACKGROUND: Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters. METHODS: This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures. DISCUSSION: We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impact the whole developmental curve of each child, improving functional ability, activity and participation in the short-, mid- and long-term. Name of the registry: Changes Induced by Early HABIT-ILE in Pre-school Children With Uni- and Bilateral Cerebral Palsy (EarlyHABIT-ILE). TRIAL REGISTRATION: Trial registration number: NCT04020354-Registration date on the International Clinical Trials Registry Platform (ICTRP): November 20th, 2018; Registration date on NIH Clinical Trials Registry: July 16th, 2019.


Assuntos
Paralisia Cerebral/terapia , Modalidades de Fisioterapia , Paralisia Cerebral/fisiopatologia , Pré-Escolar , Avaliação da Deficiência , Mãos/fisiopatologia , Humanos , Lactente , Extremidade Inferior/fisiopatologia , Destreza Motora/fisiologia , Plasticidade Neuronal , Prevenção Secundária , Inquéritos e Questionários , Extremidade Superior/fisiopatologia
18.
Neurol Clin ; 38(2): 397-416, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279717

RESUMO

Cerebral palsy is the most common cause of childhood motor disability, affecting 2 to 3/1000 children worldwide. Clinical abnormalities in tone, posture, and movement are the result of brain dysgenesis or injury early in life, and impairment varies in type, distribution, and in severity. The underlying brain disorder may also lead to other associated neurologic and systemic impairments. Variability in functional impairments, which can change during development, necessitates an individualized treatment plan. Treatment options are primarily symptomatic and directed toward optimizing independence, function, and/or ease of care-while limiting side effects. New promising disease-preventing and modifying treatments are emerging.


Assuntos
Paralisia Cerebral/terapia , Paralisia Cerebral/fisiopatologia , Criança , Humanos
19.
Dev Med Child Neurol ; 62(6): 693-699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32237147

RESUMO

AIM: To examine the psychometric evidence for high-level motor skills assessment tools for ambulant, school-aged children with cerebral palsy (CP). METHOD: We searched five databases for population (children with CP aged 5-18y in Gross Motor Function Classification System levels I and II), assessment focus (high-level motor skills), and psychometric evidence. We evaluated evidence strength using the number of studies, quality, and conduct according to COnsensus-based Standards for the selection of health status Measurement INstruments checklists. RESULTS: Eleven assessments (39 studies) met the criteria. Seven high-level motor skills assessment items (Muscle Power Sprint Test, 10m Shuttle Run Test, 10×5m Sprint Test, vertical jump, standing broad jump, seated throw, and Timed Up and Down Stairs) had strong validity and responsiveness evidence. Jumping items and seated throw lacked reliability data. Four high-level motor skills assessment batteries (Functional Strength Measure in CP, Gross Motor Function Measure-Challenge, Peabody Developmental Motor Scale, and Test of Gross Motor Development, Second Edition) had moderate-to-strong validity and/or reliability evidence. Responsiveness data were only available for the Gross Motor Function Measure-Challenge battery. The decision tree was developed with five levels: clinical feasibility, relevance, tool design, clinical utility, and psychometric properties. INTERPRETATION: High-level motor skills assessment tools have strong psychometric evidence for ambulant, school-aged children with CP. The decision tree can assist clinicians and researchers in identifying appropriate tools to measure high-level motor skills. WHAT THIS PAPER ADDS: An evidence-based decision tree guides the selection of appropriate high-level motor skills assessment tools. Seven high-level motor skills assessment items have strong psychometric evidence and clinical utility for ambulant children with cerebral palsy. Four high-level motor skills assessment batteries with recreation and mobility items have emerging psychometric evidence in this population.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Árvores de Decisões , Destreza Motora/fisiologia , Caminhada , Criança , Humanos , Psicometria
20.
Pediatr Phys Ther ; 32(2): 151-160, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32150030

RESUMO

PURPOSE: To investigate intrarater and interrater reliability, agreement, and concurrent validity of a smartphone photography-based application compared with a universal goniometer in children with cerebral palsy. METHODS: Range of motion of hip abduction, popliteal angle, and ankle dorsiflexion was measured with a universal goniometer and a photography-based application in children with cerebral palsy, Gross Motor Function Classification System levels I to V.A 2-way random-effects intraclass correlation coefficients and Bland-Altman plots, standard error of measurement, and smallest detectable change were used for analyses. RESULTS: The application had good to excellent reliability and concurrent validity compared with a universal goniometer, while the large measurement error of both methods suggests that changes of 10° to 23° are needed to be certain that changes over time are not results of measurement error. CONCLUSIONS: A photography-based goniometer can be a reliable and valid tool when measuring range of motion in children with cerebral palsy.


Assuntos
Artrometria Articular/normas , Paralisia Cerebral/fisiopatologia , Guias como Assunto , Quadril/fisiopatologia , Fotografação/normas , Amplitude de Movimento Articular , Smartphone/normas , Avaliação de Sintomas/normas , Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
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