The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.
Biomechanics ; Cerebral Palsy/rehabilitation* ; Cerebral Palsy/physiopathology* ; Cerebral Palsy/complications ; Child ; Comparative Study ; Energy Metabolism* ; Equipment Design ; Female ; Gait* ; Human ; Male ; Paraplegia/rehabilitation* ; Paraplegia/physiopathology* ; Paraplegia/complications ; Walkers/standards*

Brain computed tomography (CT) is a useful tool for evaluating the pathologic findings in the brains of children with neurologic abnormalities. Brain CT investigation and the Munchner Funtionelle Entwicklungs Diagnostik (MFED) developmental assessment was performed in 88 patients with spastic cerebral palsy. The incidence of abnormal brain CT findings in patients with spastic cerebral palsy was 69.3%. The group with pathologic CT findings had a greater possibility of having developmental delay than the group with normal CT findings (p < 0.05). However, there was no significant relationship between the specific MFED categories and the types of brain CT abnormalities. Pathological CT findings could offer important prognostic information indicating a higher risk concerning the grade of developmental delay.
Adolescence ; Adult ; Atrophy ; Brain/radiography* ; Cerebral Palsy/radiography* ; Cerebral Palsy/physiopathology* ; Cerebral Palsy/complications ; Child ; Child Development/physiology* ; Developmental Disabilities/etiology ; Female ; Human ; Male ; Middle Age ; Muscle Spasticity/radiography ; Muscle Spasticity/physiopathology ; Time Factors ; Tomography, X-Ray Computed*

OBJECTIVESponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals.

METHODSAll premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development.

RESULTSOne hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography.

CONCLUSIONSThe data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.

Cerebral Hemorrhage ; complications ; physiopathology ; Cerebral Palsy ; etiology ; Echoencephalography ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Premature ; Intelligence ; Leukomalacia, Periventricular ; complications ; physiopathology

BACKGROUND: The aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy. METHODS: This prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation. RESULTS: Seventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) < or = 3, 9 patients showed 3 < VAS < or = 7, and one patient showed a VAS > 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98). CONCLUSIONS: Approximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting.
Adolescent ; Age Factors ; Arthralgia/*etiology/physiopathology ; Cerebral Palsy/*complications/physiopathology ; Child ; Female ; Humans ; *Knee Joint/physiopathology ; Male ; Prospective Studies ; Range of Motion, Articular ; Risk Factors ; Walking ; Young Adult

Acupuncture Points ; Acupuncture Therapy ; Aged ; Bulbar Palsy, Progressive ; etiology ; physiopathology ; therapy ; Cerebral Infarction ; complications ; Female ; Humans ; Male ; Middle Aged ; Pharynx ; physiopathology ; Treatment Outcome

OBJECTIVEThis study was undertaken to investigate the clinical features of oral motor dysfunction and feeding problems as well as the nutritional status of children with cerebral palsy (CP).

METHODSFifty-nine CP children, 39 boys and 20 girls, mean age 31 months (20 to 72 months), were recruited. Their parents were interviewed for high risk factors and feeding history. Each case was assessed for oral motor and feeding problems based on oral motor and feeding skill score; for nutritional status by measurement of weight, height; neurologically for type of cerebral palsy and for developmental age by Gesell's developmental scale. Equal number of age and sex matched controls were included for comparison of nutritional status, oral motor and feeding skill score.

RESULTSAmong 59 patients, 51 cases had oral motor dysfunction and 55 cases had feeding problems including all athtosis, spastic tetraplegia, and 16 had spastic diplegia. The scores of both the mean oral motor function and feeding skill of CP children were significantly lower than those of the controls (P < 0.001). Main food of children with cerebral palsy consisted of liquid and semisolid diet. Body weight and height below the 25th percentile were found in 13 cases and 19 cases, respectively.

CONCLUSIONSThe majority of the children with cerebral palsy had oral motor dysfunction and feeding problems which appeared in early age and disturbed the growth and nutritional status. Thorough assessment for oral motor function, feeding problems and nutritional status of CP children is indicated in order to start timely rehabilitation and nutritional interventions which can significantly improve their nutritional status and quality of life.

Cerebral Palsy ; complications ; physiopathology ; Child ; Child, Preschool ; Feeding and Eating Disorders of Childhood ; etiology ; physiopathology ; Female ; Humans ; Infant ; Male ; Mouth ; physiopathology ; Mouth Diseases ; etiology ; physiopathology ; Muscular Diseases ; etiology ; physiopathology ; Nutritional Status

PURPOSE: The aim of this study was to investigate the effect of incentive spirometer exercise (ISE) on pulmonary function and maximal phonation time (MPT) in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: Fifty children with CP were randomly assigned to two groups: the experimental group and the control group. Both groups underwent comprehensive rehabilitation therapy. The experimental group underwent additional ISE. The forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and MPT were assessed as outcome measures before and after 4 weeks of training. RESULTS: There were significant improvements in FVC, FEV1, PEF, and MPT in the experimental group, but not in the control group. In addition, the improvements in FVC, FEV1, and MPT were significantly greater in the experimental group than in the control group. CONCLUSION: The results of this randomized controlled study support the use of ISE for enhancing pulmonary function and breath control for speech production in children with CP.
Adolescent ; Body Fluids ; Breathing Exercises/*methods ; Cerebral Palsy/complications/*physiopathology ; Child ; *Exercise ; Female ; Forced Expiratory Volume ; Humans ; Lung ; Male ; Motivation ; *Spirometry ; Treatment Outcome

OBJECTIVETo investigate major risk factors for childhood cerebral palsy (CP) during pregnancy and to provide evidence for the prevention of CP.

METHODSUsing the search terms of "cerebral palsy", "pregnancy", "risk factor", and "case-control", a search was performed to collect case-control studies on the risk factors for childhood CP from 1998 to 2011. The obtained data were subjected to metaanalysis using fixed effects model and DersimonionLaird random effects model to quantitatively evaluate risk factors for childhood CP during pregnancy.

RESULTSEighteen studies involving 11050 cases and 15941 controls were collected. The results of the multivariate analysis for risk factors of childhood CP during pregnancy were as follows: maternal age (≥35 years) (OR = 4.172, 95%CI = 1.670-10.426, P < 0.05), multiple pregnancy (OR = 8.402, 95% CI = 2.386-29.584, P < 0.05), medicine use in early pregnancy (OR = 3.974, 95% CI = 2.217-7.123, P < 0.05), harmful environment (OR = 3.299, 95% CI = 1.058-10.289, P < 0.05), recurrent vaginal bleeding during pregnancy (OR = 4.736, 95% CI = 1.792-12.517, P < 0.05), pregnancy infectious diseases (OR = 1.238, 95%CI: 0.284-5.395, P > 0.05), pregnancy induced hypertension (OR = 4.096, 95%CI: 2.246-7.469, P < 0.05), meat intake (OR = 1.436, 95%CI:0.382-5.393, P > 0.05), father smoking (OR = 2.376, 95%CI: 0.801-7.049, P > 0.05).

CONCLUSIONSThe major risk factors for childhood CP during pregnancy include advanced maternal age (≥35 years), multiple pregnancy, medicine use in early pregnancy, harmful environment, recurrent vaginal bleeding during pregnancy and pregnancy-induced hypertension.

Adult ; Case-Control Studies ; Cerebral Palsy ; etiology ; prevention & control ; Child ; Female ; Fetus ; drug effects ; Humans ; Hypertension, Pregnancy-Induced ; physiopathology ; Maternal Age ; Pregnancy ; Risk Factors ; Uterine Hemorrhage ; complications

OBJECTIVETo explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy.

METHODSFrom March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment.

RESULTSAll patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P < 0.01).

CONCLUSIONSelective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy was used to treat spastic cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.

Adolescent ; Arm ; physiopathology ; Cerebral Palsy ; complications ; Cervical Vertebrae ; surgery ; Exercise Therapy ; Female ; Humans ; Male ; Muscle Spasticity ; etiology ; physiopathology ; surgery ; therapy ; Paralysis ; etiology ; physiopathology ; surgery ; therapy ; Spinal Nerve Roots ; surgery ; Young Adult

PURPOSE: To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. MATERIALS AND METHODS: Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. RESULTS: Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. CONCLUSION: Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.
Adolescent ; Ankle Joint ; Botulinum Toxins, Type A/administration & dosage/*pharmacology ; Cerebral Palsy/*complications/drug therapy ; Child ; Child, Preschool ; Clubfoot/*drug therapy/*etiology/physiopathology ; Female ; Foot ; Gait/*drug effects/physiology ; Humans ; Injections, Intramuscular ; Male ; Muscle Spasticity/drug therapy ; Muscle, Skeletal/diagnostic imaging ; Neuromuscular Agents/administration & dosage/*pharmacology ; Pressure ; Prospective Studies ; Treatment Outcome ; Weight-Bearing