Ataxic-hypotonic cerebral palsy in a cerebral palsy registry

ObjectiveTo specifically report on ataxic-hypotonic cerebral palsy (CP) using registry data and to directly compare its features with other CP subtypes.MethodsData on prenatal, perinatal, and neonatal characteristics and gross motor function (Gross Motor Function Classification System [GMFCS]) and comorbidities in 35 children with ataxic-hypotonic CP were extracted from the Canadian Cerebral Palsy Registry and compared with 1,804 patients with other subtypes of CP.ResultsPerinatal adversity was detected significantly more frequently in other subtypes of CP (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.5–11.7). The gestational age at birth was higher in ataxic-hypotonic CP (median 39.0 weeks vs 37.0 weeks, p = 0.027). Children with ataxic-hypotonic CP displayed more intrauterine growth restriction (OR 2.6, 95% CI 1.0–6.8) and congenital malformation (OR 2.4, 95% CI 1.2–4.8). MRI was more likely to be either normal (OR 3.8, 95% CI 1.4–10.5) or to show a cerebral malformation (OR 4.2, 95% CI 1.5–11.9) in ataxic-hypotonic CP. There was no significant difference in terms of GMFCS or the presence of comorbidities, except for more frequent communication impairment in ataxic-hypotonic CP (OR 4.2, 95% CI 1.5–11.6).ConclusionsOur results suggest a predominantly genetic or prenatal etiology for ataxic-hypotonic CP and imply that a diagnosis of ataxic-hypotonic CP does not impart a worse prognosis with respect to comorbidities or functional impairment. This study contributes toward a better understanding of ataxic-hypotonic CP as a distinct nosologic entity within the spectrum of CP with its own pathogenesis, risk factors, clinical profile, and prognosis compared with other CP subtypes.

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The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: a pilot randomized study

Clinical Rehabilitation ◽

10.1177/0269215518821714 ◽

2019 ◽

Vol 33 (4) ◽

pp. 704-710 ◽

Cited By ~ 4

Author(s):

Tamis W Pin ◽

Penelope B Butler

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Intervention Group ◽

Controlled Study ◽

Control Group ◽

Gross Motor ◽

Gross Motor Function ◽

Gross Motor Function Measure ◽

Significant Difference ◽

Function Measure

Objectives: To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy. Design: A pilot single-blinded matched randomized controlled study. Setting: Community. Participants: In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group. Intervention: The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme. Measurements: All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure–66-Item Set and 2-Minute Walk Test. Results: All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure–66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35). Conclusion: The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.

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Correlation of Gross Motor Function with Topographical Diagnosis in Children with Cerebral Palsy

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-23-1-10 ◽

2012 ◽

Vol 23 (1) ◽

pp. 10-14

Author(s):

Nonica Laisram ◽

Tufail Muzaffar ◽

S Y Kothari

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Care Hospital ◽

Weak Correlation ◽

Chi Square ◽

Gross Motor ◽

Gross Motor Function ◽

Topographical Distribution ◽

Significant Difference ◽

Gmfcs Level

Abstract There is a need for appropriate classification to describe gross motor function status in a child with cerebral palsy (CP). It was hypothesised that: greater the number of limbs involved, higher would be the Gross Motor Function Classification System (GMFCS) level; and, there would be spectrum of GMFCS level for each of the topographical types of the cerebral palsy. A cross-sectional study of 182 children of both sexes in the age group of 7 months to 30 years having spastic CP who attended CP clinic from 2008 to 2009 in tertiary care hospital were assessed for topographical diagnosis and GMFCS levels. Topographical distribution showed diplegia (42%), quadriplegia (30%), hemiplegia (23%), triplegia (4%) and monoplegia (1%). GMFCS levels were almost evenly distributed, level II (26%) was most common followed by level V (23%). Statistical analysis was done using Cramer's ratio and Pearson's Chi-square test. Cramer's ratio of 0.277 showed fairly weak correlation between GMFCS levels and topographical CP types. Pearson's Chi-square (12) =41.7, p=0.000 indicates that there is significant difference between expected and observed values of number of limbs involved in GMFCS levels, further substantiating the weak correlation. These results mean that GMFCS in different topographical groups have different distributions. It was also observed that GMFCS had weak correlation with the number of limbs involved, thus reflecting that the GMFCS is a better indicator of gross motor function impairment than the traditional topographical categorisation of CP that specifies the number of limbs involved.

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Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial

Neurorehabilitation ◽

10.3233/nre-203102 ◽

2020 ◽

Vol 47 (4) ◽

pp. 495-508

Author(s):

Stanislava Klobucká ◽

Robert Klobucký ◽

Branislav Kollár

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Conventional Therapy ◽

Gait Training ◽

Adult Patients ◽

Robot Assisted ◽

Gross Motor ◽

Motor Functions ◽

Gross Motor Function ◽

Significant Difference

BACKGROUND: Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE: To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS: Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3–4 months later (V3). RESULTS: Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3–4 months after RAGT (p < 0.001). CONCLUSION: We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.

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Cerebral palsy in preterm infants

Vojnosanitetski pregled ◽

10.2298/vsp140321019d ◽

2016 ◽

Vol 73 (4) ◽

pp. 343-348 ◽

Cited By ~ 2

Author(s):

Cila Demesi-Drljan ◽

Aleksandra Mikov ◽

Karmela Filipovic ◽

Snezana Tomasevic-Todorovic ◽

Aleksandar Knezevic ◽

...

Keyword(s):

Cerebral Palsy ◽

Preterm Birth ◽

Motor Function ◽

Gestational Age ◽

Significant Risk ◽

Gross Motor ◽

Gross Motor Function ◽

Extremely Preterm ◽

Significant Difference ◽

Associated Conditions

Background/Aim. Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods. The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results. More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion. The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

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Profile of children with cerebral palsy spectrum disorder and a normal MRI study

Neurology ◽

10.1212/wnl.0000000000007726 ◽

2019 ◽

Vol 93 (1) ◽

pp. e88-e96 ◽

Cited By ~ 6

Author(s):

Arielle Springer ◽

Sasha Dyck Holzinger ◽

John Andersen ◽

David Buckley ◽

Darcy Fehlings ◽

...

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Classification System ◽

Spectrum Disorder ◽

Gross Motor ◽

Gross Motor Function ◽

Causal Pathways ◽

Significant Difference ◽

Children With Cerebral Palsy ◽

Mri Study

ObjectiveThis study looks at what profile can be expected in children with cerebral palsy spectrum disorder (CP) and a normal MRI.MethodsThe data were excerpted from the Canadian Cerebral Palsy Registry database. Only patients who had undergone MRI were included in the analysis. Neuroimaging classification was ascertained by university-based pediatric neuroradiologists and split into 2 categories: normal and abnormal MRIs. Six factors were then compared between those 2 groups: prematurity, perinatal adversity, presence of more than 1 comorbidity, CP subtype, bimanual dexterity (Manual Ability Classification System [MACS]), and gross motor function (Gross Motor Function Classification System [GMFCS]).ResultsParticipants with no perinatal adversity were 5.518 times more likely to have a normal MRI (p < 0.0001, 95% confidence interval [CI] 4.153–7.330). Furthermore, participants with dyskinetic, ataxic/hypotonic, and spastic diplegic forms of CP were 2.045 times more likely to have a normal MRI than those with hemiplegia, triplegia, and quadriplegia (p < 0.0001, 95% CI 1.506–2.778). No significant difference was found in prematurity, GMFCS levels, MACS levels, and the number of comorbidities.ConclusionsNormal MRIs were associated with lack of perinatal adversity as well as with the dyskinetic, ataxic/hypotonic, and spastic diplegic CP subtypes. As MRI normality is not strongly associated with the severity of CP, continuous follow-up in children with normal imaging appears warranted. Further advanced imaging modalities, as well as strong consideration for metabolic and genetic testing, may provide additional insights into causal pathways in this population.

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Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy

Global Pediatric Health ◽

10.1177/2333794x19857378 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1985737 ◽

Cited By ~ 3

Author(s):

Bolarinwa Isaac Akinola ◽

Caleb Ademola Gbiri ◽

Daniel Oluwafemi Odebiyi

Keyword(s):

Cerebral Palsy ◽

Exercise Training ◽

Training Program ◽

Motor Function ◽

Aquatic Exercise ◽

Spastic Cerebral Palsy ◽

Gross Motor ◽

Gross Motor Function ◽

Exercise Training Program ◽

Significant Difference

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement ( P < .05) in all dimensions of gross motor function except for walking, running, and jumping ( P = .112). Statistically significant difference ( P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

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Validity and Reliability of the Indonesian Version Gross Motor Function Measure to Measure Gross Motor Function in Cerebral Palsy Children

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v1i1.214 ◽

1970 ◽

Vol 1 (1) ◽

pp. 71-79

Author(s):

Selly C Anggoro ◽

Amendi Nasution ◽

Luh K Wahyuni ◽

Aria Kekalih

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Internal Consistency ◽

Criterion Validity ◽

Gross Motor ◽

Gross Motor Function ◽

Gross Motor Function Measure ◽

Significant Difference ◽

Good Internal Consistency ◽

Function Measure

Objectives: Cerebral palsy (CP) is the most physical disabling disease in children. Gross motor capacity in CP usually measured and evaluated by Gross Motor Function Measure (GMFM), a standardizedobservational instrument to evaluate gross motor function. Studies showed GMFM reliable, valid, and responsive to change of CP gross motor function. This research aims to examine validity and reliabilityof GMFM translated into Indonesian.Methods: Cross sectional study with consecutive sampling of CP children aged 2-15 years came to pediatric rehabilitation clinic at RSCM Medical Rehabilitation Department or YPAC Jakarta. Subjects classified by age, type, anatomical distribution, and severity.Gross motor function evaluated with 88 GMFM items translated into Indonesia. Inter-rater evaluated gross motor function through video records. Criterion validity tested by correlation coefficient, construct validity tested by comparing GMFM item with dimension total scores and GMFM total score with corrected Spearman correlation. Inter-rater reliability tested by unpaired T-test, internal consistency by alpha Cronbach.Results: Thirty one CP children with mean age 7 years 11 months, mean GMFM score 58.40 (SD=49.09).No significant difference of all GMFM dimensions; almost all GMFM items obtained from inter-rater evaluation. Good internal consistency (alpha Cronbach 0.884) and good criterion validity of all dimensions;; inter-item and total correlations good to strong (r=0.523-0.859).Conclusion: GMFM Indonesian has good to strong criterion validity. Construct validity of all dimensions was quite good. Internal consistency was good. No significant difference between inter-raters showed GMFM inter-rater reliability good enough.Keywords: Cerebral palsy, gross motor function, gross motor function measure, validity, reliability.

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Prevalence of Speech Problems and the Use of Augmentative and Alternative Communication in Children With Cerebral Palsy: A Registry-Based Study in Norway

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac19.1.12 ◽

2010 ◽

Vol 19 (1) ◽

pp. 12-20 ◽

Cited By ~ 29

Author(s):

Guro Andersen ◽

Tone R. Mjøen ◽

Torstein Vik

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Gestational Age ◽

Augmentative And Alternative Communication ◽

Alternative Communication ◽

Gross Motor ◽

Gross Motor Function ◽

Children With Cerebral Palsy ◽

Communicative Abilities ◽

Normal Speech

Abstract This study describes the prevalence of speech problems and the use of augmentative and alternative communication (AAC) in children with cerebral palsy (CP) in Norway. Information on the communicative abilities of 564 children with CP born 1996–2003, recorded in the Norwegian CP Registry, was collected. A total of 270 children (48%) had normal speech, 90 (16%) had slightly indistinct speech, 52 (9%) had indistinct speech, 35 (6%) had very indistinct speech, 110 children (19%) had no speech, and 7 (1%) were unknown. Speech problems were most common in children with dyskinetic CP (92 %), in children with the most severe gross motor function impairments and among children being totally dependent on assistance in feeding or tube-fed children. A higher proportion of children born at term had speech problems when compared with children born before 32 weeks of gestational age 32 (p > 0.001). Among the 197 children with speech problems only, 106 (54%) used AAC in some form. Approximately 20% of children had no verbal speech, whereas ~15% had significant speech problems. Among children with either significant speech problems or no speech, only 54% used AAC in any form.

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Ankle contractures are frequent among children with cerebral palsy and associated with lower gross motor function and degree of spasticity

Acta Paediatrica ◽

10.1111/apa.15804 ◽

2021 ◽

Author(s):

Lærke Hartvig Krarup ◽

Pia Kjær Kristensen ◽

Louise Strand ◽

Sofie Langbo Bredtoft ◽

Inger Mechlenburg ◽

...

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Gross Motor ◽

Gross Motor Function ◽

Children With Cerebral Palsy

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Motor learning-based activities may improve functional ability in adults with severe cerebral palsy: A controlled pilot study

Neurorehabilitation ◽

10.3233/nre-201581 ◽

2021 ◽

pp. 1-11

Author(s):

Helle Hüche Larsen ◽

Rasmus Feld Frisk ◽

Maria Willerslev-Olsen ◽

Jens Bo Nielsen

Keyword(s):

Cerebral Palsy ◽

Motor Learning ◽

Motor Function ◽

Functional Ability ◽

Active Group ◽

Control Group ◽

Gross Motor ◽

Gross Motor Function ◽

Learning Principles

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental disturbance characterized by impaired control of movement. Function often decreases and 15% of adults are classified as severely affected (Gross Motor Function Classification Scale III-V). Little is known about interventions that aim to improve functional abilities in this population. OBJECTIVE: To evaluate a 12-week intervention based on motor learning principles on functional ability in adults with severe CP. METHODS: 16 adults (36±10 years, GMFCS III-V) were enrolled and divided into an intervention group (Active group) and a standard care group (Control group). Primary outcome measure was Gross Motor Function Measure (GMFM-88). Secondary measures were neurological status. The Active group were measured at baseline, after the intervention and at one-month follow-up. The Control group were measured at baseline and after one month. RESULTS: Analysis showed statistically significant improvement in GMFM-88 for the Active group from baseline to post assessment compared with the Control group (group difference: 5 points, SE 14.5, p = 0.008, CI: 1.2 to 8.7). Improvements were maintained at follow-up. Results from the neurological screening showed no clear tendencies. CONCLUSIONS: The study provides support that activities based on motor learning principles may improve gross motor function in adults with severe CP.

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