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BACKGROUND: Up to one-third of children with cerebral palsy (CP) develop migration of the hip, and the risk increases with a higher Gross Motor Function Classification System (GMFCS). In progressive hip migration in young children, adductor tenotomy is an accepted treatment option to delay or prevent progressive hip migration. However, there is quite a large variability in reported results. This systematic review aims to determine the effectiveness of a soft-tissue release in the prevention of progressive hip migration in children with CP. METHODS: This systematic review was performed in accordance with the guidelines of the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statements. Our inclusion criteria were studies describing pediatric, skeletally immature patients with CP and a "hip at risk" of progressive hip migration. Exclusion criteria were simultaneous bony reconstructions, case reports, technical notes, published abstracts, or studies with a follow-up under 1 year postoperatively. The primary outcomes were defined as failure rate (progressive hip migration and/or need for bony surgery, as defined by each paper) and change in migration percentage (MP) at final follow-up. As secondary analyses, we evaluated the outcome after specific subtypes of surgeries and assessed whether performing lengthening of iliopsoas, neurectomy of the anterior branch of the obturator nerve, age at the time of surgery, GMFCS level, and postoperative management impact the outcome. RESULTS: Our literature search identified 380 titles. Eighty-four articles underwent full-text review, of which 27 met our inclusion/exclusion criteria and were subsequently selected for quantitative analysis. A prevalence meta-analysis was performed including 17 studies (2,213 hips). Mean follow-up ranged from 12 to 148.8 months. The mean preoperative MP was 33.4% (2,740 hips) and 29.9% at follow-up. The overall reported failure rate was 39% (95% confidence interval, 26%-52%). Performing a release of only adductor longus had a failure rate of 87%, whereas more extensive soft-tissue releases showed significantly better results with failure rates ranging from 0 to 44% (p < 0.001). Lengthening of the iliopsoas had no significant impact on failure rate (p = 0.48), nor did performing an obturator neurectomy (p = 0.92). CONCLUSION: The failure rate of adductor tenotomies to prevent progressive hip migration appears to be as high as 39% in studies with a varying follow-up. The failure rates are significantly higher when isolated release of the adductor longus is performed. This systematic review supports clinical decision making in children with CP and early hip migration. LEVEL OF EVIDENCE: Level IIA. See Instructions for Authors for a complete description of levels of evidence.
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Parálisis Cerebral , Tenotomía , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Niño , Tenotomía/métodos , Luxación de la Cadera/cirugía , Luxación de la Cadera/prevención & control , Luxación de la Cadera/etiología , PreescolarRESUMEN
INTRODUCTION: Sepsis is associated with neurocognitive impairment among preterm neonates but less is known about term neonates with sepsis. This systematic review and meta-analysis aims to provide an update of neurocognitive outcomes including cognitive delay, visual impairment, auditory impairment, and cerebral palsy, among neonates with sepsis. METHODS: We performed a systematic review of PubMed, Embase, CENTRAL and Web of Science for eligible studies published between January 2011 and March 2023. We included case-control, cohort studies and cross-sectional studies. Case reports and articles not in English language were excluded. Using the adjusted estimates, we performed random effects model meta-analysis to evaluate the risk of developing neurocognitive impairment among neonates with sepsis. RESULTS: Of 7,909 studies, 24 studies (n = 121,645) were included. Majority of studies were conducted in the United States (n = 7, 29.2%), and all studies were performed among neonates. 17 (70.8%) studies provided follow-up till 30 months. Sepsis was associated with increased risk of cognitive delay [adjusted odds ratio, aOR 1.14 (95% CI: 1.01-1.28)], visual impairment [aOR 2.57 (95%CI: 1.14- 5.82)], hearing impairment [aOR 1.70 (95% CI: 1.02-2.81)] and cerebral palsy [aOR 2.48 (95% CI: 1.03-5.99)]. CONCLUSION: Neonates surviving sepsis are at a higher risk of poorer neurodevelopment. Current evidence is limited by significant heterogeneity across studies, lack of data related to long-term neurodevelopmental outcomes and term infants.
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Sepsis Neonatal , Humanos , Recién Nacido , Sepsis Neonatal/complicaciones , Parálisis Cerebral/complicaciones , Trastornos de la Visión/etiologíaRESUMEN
INTRODUCTION: Selective posterior rhizotomy (SPR) is a preferred procedure for relieving spastic children with cerebral palsy, but it is associated with severe pain and significant emergence agitation (EA). The thoracolumbar interfascial plane (TLIP) block provides an effective blockade to the dorsal branch of the spinal nerve. We hypothesise that the TLIP block may be an effective tool to alleviate EA and postoperative pain scores in children with cerebral palsy undergoing SPR. METHODS AND ANALYSIS: This study is a single-centre, randomised, parallel-controlled trial being conducted in Beijing, China. A total of 50 paediatric patients with cerebral palsy scheduled for SPR are randomised in a 1:1 ratio to receive bilateral TLIP block with 0.2% ropivacaine 0.5 mL/kg or control. Patients in the TLIP group receive general anaesthesia combined with TLIP block, while patients in the control group receive only general anaesthesia, without a TLIP block. The primary outcome is the Paediatric Anaesthesia Emergence Delirium Score. The secondary outcomes are the incidence of EA, the Wong-Baker Faces Pain-rating Scale, the perioperative haemodynamics, the intraoperative remifentanil and propofol dosage, the extubation time and recovery time, and adverse reactions. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine on 21 September 2023 (2023DZMEC-379-02). Written informed consent is obtained from the legal guardian of each patient. The results of this study will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: ChiCTR2300076397.
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Anestesia General , Parálisis Cerebral , Delirio del Despertar , Bloqueo Nervioso , Dolor Postoperatorio , Rizotomía , Ultrasonografía Intervencional , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Anestesia General/métodos , Bloqueo Nervioso/métodos , Niño , Rizotomía/métodos , Ultrasonografía Intervencional/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Masculino , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Femenino , Preescolar , Ensayos Clínicos Controlados Aleatorios como Asunto , Anestésicos Locales/administración & dosificación , China , AdolescenteRESUMEN
Patients with cerebral palsy (CP) are particularly vulnerable to respiratory infections, yet comparative outcomes between COVID-19 and influenza in this population remain underexplored. Using the National Inpatient Sample from 2020-2021, we performed a retrospective analysis of hospital data for adults with CP diagnosed with either COVID-19 or influenza. The study aimed to compare the outcomes of these infections to provide insights into their impact on this vulnerable population. We assessed in-hospital mortality, complications, length of stay (LOS), hospitalization costs, and discharge dispositions. Multivariable logistic regression and propensity score matching were used to adjust for confounders, enhancing the analytical rigor of our study. The study cohort comprised 12,025 patients-10,560 with COVID-19 and 1465 with influenza. COVID-19 patients with CP had a higher in-hospital mortality rate (10.8% vs. 3.1%, p = 0.001), with an adjusted odds ratio of 3.2 (95% CI: 1.6-6.4). They also experienced an extended LOS by an average of 2.7 days. COVID-19 substantially increases the health burden for hospitalized CP patients compared to influenza, as evidenced by higher mortality rates, longer hospital stays, and increased costs. These findings highlight the urgent need for tailored strategies to effectively manage and reduce the impact of COVID-19 on this high-risk group.
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COVID-19 , Parálisis Cerebral , Mortalidad Hospitalaria , Hospitalización , Gripe Humana , Tiempo de Internación , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/complicaciones , Gripe Humana/mortalidad , Gripe Humana/epidemiología , Gripe Humana/complicaciones , Masculino , Femenino , Estados Unidos/epidemiología , Persona de Mediana Edad , Parálisis Cerebral/complicaciones , Parálisis Cerebral/epidemiología , Adulto , Estudios Retrospectivos , Anciano , Bases de Datos Factuales , Adulto JovenRESUMEN
CASE: A 13-year-old adolescent boy with spastic diplegic cerebral palsy (CP) presented with crouch gait and bilateral knee flexion contractures (KFCs). After failure of conservative treatments, the patient was referred to orthopaedics for surgical intervention. Anterior distal femoral hemiepiphysiodesis (ADFH), using a retrograde approach, and Strayer gastrocnemius recession were performed bilaterally. No complications were reported during surgery/follow-up. Full-active knee extension and improved gait were achieved. CONCLUSION: KFC is prevalent in ambulatory patients with CP, reducing gait function. Retrograde ADFH is an effective surgical intervention to reduce KFC and improve gait, and offers simpler insertion/removal than the traditional antegrade technique.
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Parálisis Cerebral , Humanos , Masculino , Adolescente , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Fémur/cirugía , Epífisis/cirugía , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagenRESUMEN
This study aimed to investigate how electromyography (EMG) cluster analysis of the rectus femoris (RF) could help to better interpret gait analysis in patients with cerebral palsy (CP). The retrospective gait data of CP patients were categorized into two groups: initial examination (E1, 881 patients) and subsequent examination (E2, 377 patients). Envelope-formatted EMG data of RF were collected. Using PCA and a combined PSO-K-means algorithm, main clusters were identified. Patients were further classified into crouch, jump, recurvatum, stiff and mild gait for detailed analysis. The clusters (labels) were characterized by a significant peak EMG activity during mid-swing (L1), prolonged EMG activity during stance (L2), and a peak EMG activity during loading response (L3). Notably, L2 contained 76% and 92% of all crouch patients at E1 and E2, respectively. Comparing patients with a crouch gait pattern in L2-E1 and L2-E2, two subgroups emerged: patients with persistent crouch (G1) and patients showing improvement at E2 (G2). The minimum activity of RF during 20-45% of the gait was significantly higher (p = 0.025) in G1 than in G2. A greater chance of improvement from crouch gait might be associated with lower RF activity during the stance phase. Using our findings, we could potentially establish an approach to improve clinical decision-making regarding treatment of patients with CP.
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Parálisis Cerebral , Electromiografía , Músculo Cuádriceps , Humanos , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/complicaciones , Electromiografía/métodos , Masculino , Femenino , Niño , Músculo Cuádriceps/fisiopatología , Análisis por Conglomerados , Estudios Retrospectivos , Marcha/fisiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/etiología , Adolescente , Preescolar , Adulto , Análisis de la Marcha/métodos , Adulto JovenRESUMEN
BACKGROUND: Children with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study's aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP. METHODS: Nineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks. RESULTS: The majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (rs = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories). CONCLUSIONS: Adults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.
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Parálisis Cerebral , Robótica , Extremidad Superior , Humanos , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/complicaciones , Masculino , Femenino , Adulto , Extremidad Superior/fisiopatología , Robótica/instrumentación , Persona de Mediana Edad , Adulto Joven , Desempeño Psicomotor/fisiología , Dispositivo Exoesqueleto , Lateralidad Funcional/fisiologíaRESUMEN
BACKGROUND: Hinged ankle foot orthoses (HAFO) are commonly prescribed for children with cerebral palsy (CP) to improve their ambulatory function. OBJECTIVES: The aim of this study was to compare the effect of vibration-HAFO with that of the same orthosis without vibration on gait, function, and spasticity in hemiplegic CP children. STUDY DESIGN: Randomized Control Trial Design (a pilot study). METHODS: Twenty-three children with hemiplegic CP participated in this study. The control group (n = 12) used HAFO, and the intervention group (n = 11) used vibration-HAFO for four weeks. Pre-post three-dimensional gait analysis was done. Calf muscle spasticity and function were also measured. RESULTS: Results showed significant differences between the two groups in the one-minute walking test (p = 0.023) and spasticity (after intervention [p = 0.022], after follow-up [p = 0.020]). Also, significant differences were detected between the two groups in the step width (p = 0.042), maximum hip abduction (p = 0.008), stance maximum dorsiflexion (p = 0.036) and mean pelvic tilt (p = 0.004) in the barefoot condition. Gait cycle time (p = 0.005), maximum hip abduction (p = 0.042), and cadence (p = 0.001) were different between groups in the braced condition. We couldn't find any significant within and between groups differences in knee kinematic parameters. The mean time of using vibration was 16.83 minutes per day. CONCLUSIONS: The vibration-hinged AFO is feasible, safe, and acceptable for children with hemiplegic CP to be integrated into practice. Temporospatial and clinical parameters, especially spasticity, were improved. There were slight trends toward improvement in pelvic and knee kinematics. Vibration-HAFO is of benefit to ambulatory CP children with mild and moderate spasticity. It improved the walking capacity of the children.
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Parálisis Cerebral , Ortesis del Pié , Espasticidad Muscular , Vibración , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/rehabilitación , Parálisis Cerebral/fisiopatología , Niño , Masculino , Espasticidad Muscular/etiología , Espasticidad Muscular/rehabilitación , Espasticidad Muscular/terapia , Espasticidad Muscular/fisiopatología , Femenino , Vibración/uso terapéutico , Proyectos Piloto , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Marcha/fisiología , Diseño de Equipo , Hemiplejía/rehabilitación , Hemiplejía/etiología , Hemiplejía/fisiopatología , Resultado del Tratamiento , Adolescente , Articulación del Tobillo/fisiopatología , Fenómenos BiomecánicosRESUMEN
INTRODUCTION: This study purpose of determining the short-term effects of kinesio taping on drooling in children with cerebral palsy (CP). METHODS: CP were randomly divided into 3 groups as the kinesio tape (n = 16), sham tape (n = 16), and control (n = 16) groups. The drooling severity and frequency were assessed with the Drooling Severity and Frequency Scale, and the amount of saliva was measured by the 5-minute drooling quotient. All outcome measurements were repeated for all children at the baseline, after 45 minutes, and after 2 days of application. RESULTS: There was a significant decrease found in drooling severity, frequency, and amount in the kinesio taping group (p < .05). There was no significant difference in the sham taping and control groups (p > .05). CONCLUSION: The use of kinesio tape in drooling reduced drooling severity, frequency, and amount.
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Cinta Atlética , Parálisis Cerebral , Sialorrea , Humanos , Sialorrea/etiología , Sialorrea/rehabilitación , Parálisis Cerebral/complicaciones , Parálisis Cerebral/rehabilitación , Masculino , Niño , Femenino , Resultado del Tratamiento , Índice de Severidad de la Enfermedad , PreescolarRESUMEN
Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers.
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Parálisis Cerebral , Comorbilidad , Humanos , Parálisis Cerebral/complicaciones , Niño , Trastornos Respiratorios/etiología , Trastornos Respiratorios/epidemiología , Calidad de VidaRESUMEN
BACKGROUND: Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting. METHODS: The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg-1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume. RESULTS: Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4-0.7) mL.kg-1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities. CONCLUSION: Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.
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Parálisis Cerebral , Ayuno , Cuidados Preoperatorios , Estómago , Ultrasonografía , Humanos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/diagnóstico por imagen , Estudios Prospectivos , Femenino , Masculino , Ultrasonografía/métodos , Niño , Estómago/diagnóstico por imagen , Preescolar , Cuidados Preoperatorios/métodos , Procedimientos Ortopédicos/métodos , AdolescenteRESUMEN
BACKGROUND: Severity of dyskinesia in children with cerebral palsy is often assessed using observation-based clinical tools. Instrumented methods to objectively measure dyskinesia have been proposed to improve assessment accuracy and reliability. Here, we investigated the technique and movement features that were most suitable to objectively measure the severity of dystonia in children with cerebral palsy. METHODS: A prospective observational study was conducted with 12 participants with cerebral palsy with a predominant motor type of dyskinesia, spasticity, or mixed dyskinesia/spasticity who had upper limb involvement (mean age: 12.6 years, range: 6.7-18.2 years). Kinematic and electromyography data were collected bilaterally during three upper limb tasks. Spearman rank correlations of kinematic or electromyography features were calculated against dystonia severity, quantified by the Dyskinesia Impairment Scale. FINDINGS: Kinematic features were more influential compared to electromyography features at grading the severity of dystonia in children with cerebral palsy. Kinematic measures quantifying jerkiness of volitional movement during an upper limb task with a reaching component performed best (|rs| = 0.78-0.9, p < 0.001). INTERPRETATION: This study provides guidance on the types of data, features of movement, and activity protocols that instrumented methods should focus on when objectively measuring the severity of dystonia in children with cerebral palsy.
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Parálisis Cerebral , Distonía , Electromiografía , Índice de Severidad de la Enfermedad , Extremidad Superior , Humanos , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/complicaciones , Niño , Electromiografía/métodos , Extremidad Superior/fisiopatología , Masculino , Femenino , Adolescente , Distonía/fisiopatología , Distonía/diagnóstico , Fenómenos Biomecánicos , Estudios Prospectivos , Movimiento , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations. METHODS: A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness. RESULTS: From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity. CONCLUSION: The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately.
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Parálisis Cerebral , Espasticidad Muscular , Humanos , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/etiología , Espasticidad Muscular/diagnóstico , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Niño , Reproducibilidad de los Resultados , Rango del Movimiento Articular , Diagnóstico por Imagen de Elasticidad/métodosAsunto(s)
Catatonia , Parálisis Cerebral , Terapia Electroconvulsiva , Epilepsia , Humanos , Catatonia/terapia , Catatonia/etiología , Epilepsia/terapia , Epilepsia/complicaciones , Femenino , Parálisis Cerebral/complicaciones , Parálisis Cerebral/terapia , Vasculitis por Lupus del Sistema Nervioso Central/terapia , Vasculitis por Lupus del Sistema Nervioso Central/complicaciones , AdultoRESUMEN
PURPOSE: Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in patients who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia. METHODS: Retrospective data analysis was performed for patients that underwent non-selective cervicothoracic VDR between 2022 and 2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected. RESULTS: Six patients (three female) were included. Four patients underwent a bilateral C6-T1 VDR, one patient underwent a left C7-T1 VDR, and another underwent a left C6-T1 VDR. Three patients had quadriplegic mixed hypertonia, one patient had quadriplegic spasticity, one patient had triplegic mixed hypertonia, and one patient had mixed hemiplegic hypertonia. The mean difference of proximal upper extremity modified Ashworth scale (mAS) was - 1.4 ± 0.55 (p = 0.002), and - 2.2 ± 0.45 (p < 0.001) for the distal upper extremity. Both patients with independence noted quality of life improvements as well as increased ease with dressing and orthotics fits. Caregivers for the remaining four patients noted improvements in caregiving provision, mainly in dressing, orthotics fit, and ease when transferring. CONCLUSION: Cervicothoracic VDR is safe and provides tone control and quality of life improvements in short-term follow-up. It can be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.
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Parálisis Cerebral , Hipertonía Muscular , Rizotomía , Humanos , Femenino , Rizotomía/métodos , Masculino , Hipertonía Muscular/cirugía , Estudios Retrospectivos , Parálisis Cerebral/complicaciones , Parálisis Cerebral/cirugía , Niño , Adolescente , Vértebras Torácicas/cirugía , Vértebras Cervicales/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: The aims of this study were to 1) assess and quantify white matter (WM) microstructural characteristics derived from diffusion tensor imaging (DTI) in children with cerebral palsy (CP) prior to selective dorsal rhizotomy (SDR), and 2) investigate potential associations between WM diffusion properties and gross motor function and spasticity in children with spastic CP who underwent SDR. METHODS: This study is a multisite study based on DT images acquired prior to SDR as well as postoperative outcome data. DTI data collected from two sites were harmonized using the ComBat approach to minimize intersite scanner difference. The DTI abnormalities between children with spastic CP and controls were analyzed and correlated with the severity of impaired mobility based on the Gross Motor Function Classification System (GMFCS). The improvement in gross motor function and spasticity after SDR surgery was assessed utilizing the Gross Motor Function Measure-66 (GMFM-66), the Modified Tardieu Scale (MTS), and the modified Ashworth scale (MAS). Alterations in these outcome measures were quantified in association with DTI abnormalities. RESULTS: Significant DTI alterations, including lower fractional anisotropy (FA) in the genu of the corpus callosum (gCC) and higher mean diffusivity (MD) in the gCC and posterior limb of the internal capsule (PLIC), were found in children in the SDR group when compared with the age-matched control group (all p < 0.05). Greater DTI alterations (FA in gCC and MD in gCC and PLIC) were associated with lower mobility levels as determined based on GMFCS level (p < 0.05). The pre- to post-SDR improvement in motor function based on GMFM-66 was statistically significant (p = 0.006 and 0.002 at 6-month and 12-month follow-ups, respectively). The SDR efficacy was also identified as improving spasticity in lower-extremity muscle groups assessed with the MTS and MAS. Partial correlation analysis presented a significant association between pre- to post-SDR MTS alteration and DTI abnormalities. CONCLUSIONS: The findings in the present study provided initial quantitative evidence to establish the WM microstructural characteristics in children with spastic CP prior to SDR surgery. The study generated data for the association between baseline DTI characteristics and mobility in children with CP prior to SDR surgery. The study also demonstrated SDR efficacy in improving motor function and spasticity based on the GMFM-66, MTS, and MAS, respectively, in association with DTI data.
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Parálisis Cerebral , Imagen de Difusión Tensora , Rizotomía , Sustancia Blanca , Humanos , Parálisis Cerebral/cirugía , Parálisis Cerebral/diagnóstico por imagen , Parálisis Cerebral/complicaciones , Imagen de Difusión Tensora/métodos , Rizotomía/métodos , Niño , Masculino , Femenino , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/cirugía , Sustancia Blanca/patología , Preescolar , Espasticidad Muscular/cirugía , Espasticidad Muscular/diagnóstico por imagen , Espasticidad Muscular/etiología , Adolescente , Resultado del Tratamiento , Anisotropía , Cuerpo Calloso/diagnóstico por imagen , Cuerpo Calloso/cirugíaRESUMEN
BACKGROUND: Children with neuromuscular disorders, such as cerebral palsy, frequently develop foot deformities, such as equinopronovalgus and equinosupovarus, leading to walking difficulties and discomfort. Traditional assessment methods, including clinical measures and radiographs, often fail to capture the dynamic nature of these deformities, resulting in suboptimal treatment. 3D gait analysis using multisegment foot models offers a more detailed understanding of these deformities. RESEARCH QUESTION: To determine whether the combination of multisegment foot models, multivariate functional principal component analysis, and k-means cluster analyses could identify distinct, clinically relevant foot types in a large pediatric cohort with cerebral palsy. METHODS: This was a retrospective analysis of 3D gait data from 197 patients with cerebral palsy collected using a multisegment foot model. Multivariate functional principal component analysis was used to reduce these data prior to using k-means clustering to identify foot posture clusters. Further analyses, including ANOVA and Fisher's Exact tests, were used to evaluate demographic, radiographic, and gait characteristics to explain the clinical relevance of each cluster. RESULTS: Analysis of kinematic data from 371 feet revealed six clinically significant clusters, with a low misclassification rate of 2â¯%. One-factor ANOVAs demonstrated significant differences across clusters for all MPCs, whereas no significant differences were noted in basic anthropometric variables. Significant variations were observed in radiographic and gait function variables, and a strong association between GMFCS levels and cluster categorization was identified. SIGNIFICANCE: The novel approach of integrating multivariate functional principal component analysis and k-means clustering identified a spectrum of foot deformities in children with CP, ranging from equinosupovarus to marked equinopronovalgus. This methodology provides an objective classification based on kinematic data and can facilitate improved diagnosis and treatment of cerebral palsy-related foot deformities.
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Parálisis Cerebral , Análisis de Componente Principal , Humanos , Parálisis Cerebral/fisiopatología , Parálisis Cerebral/complicaciones , Femenino , Masculino , Niño , Estudios Retrospectivos , Fenómenos Biomecánicos , Análisis por Conglomerados , Preescolar , Pie/fisiopatología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/etiología , Análisis Multivariante , Marcha/fisiología , Análisis de la Marcha/métodos , AdolescenteRESUMEN
OBJECTIVES: Poor sleep is frequently reported in children with neuromuscular diseases (NMD) and cerebral palsy (CP) however breathing disorders during sleep are often the clinical focus. Periodic limb movements (PLMs) have an increased prevalence in adults with NMD and may contribute to sleep disturbance in this population. We assessed the prevalence of PLMs in children with NMD or CP. METHODS: Retrospective review of polysomnography (PSG) with leg electromyography in children age 1-18 years with NMD (including Duchenne muscular dystrophy, myotonic dystrophy, spinal muscular atrophy) or CP performed at a paediatric sleep centre 2004-2022. RESULTS: Leg electromyography was available in at least 1 PSG in 239 children (125 NMD, 114 CP), and in 2 PSGs in 105 children (73 NMD, 32 CP). At initial PSG, 72 (30 %) were female with a median age 9y and respiratory disturbance index 3.5/h (interquartile range 1.3-9.9/h). Elevated PLM index (PLMI; >5/h) occurred in 9.6 % of each of the CP and NMD groups, quantified by initial PSG. Overall, PLMI increased from baseline (median 0, maximum 33/h) to follow-up (median 0, maximum 55.8/h; p < 0.05). In those with an elevated PLMI, arousal percentage attributable to PLMs was up to 25 % (median 7.5 %). CONCLUSIONS: Elevated PLMI occurred at a higher prevalence in children with NMD and CP than reported in other clinic-referred paediatric populations. It is important that PLMs are not overlooked as identification and treatment may help improve sleep outcomes. Further research is required to understand the pathophysiology and consequences of PLMs specifically in this population.