PURPOSE: The Upper Limb Physician's Rating Scale (ULPRS) is a tool that assesses movement quality of the upper limbs. It is used as an outcome measure after botulinum toxin type A injection in children with cerebral palsy (CP). This study aimed to investigate the reliability and validity of the ULPRS in children with spastic CP. MATERIALS AND METHODS: Thirty children with spastic CP (M:F=17:13) aged 5 to 13 years old were recruited. The ULPRS was scored based on recorded videotapes by four physicians on two separate occasions. The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) was scored by an occupational therapist. Intraclass correlation coefficients (ICCs), 95% confidence intervals and weighted kappa statistics were calculated for the scores of ULPRS to obtain interrater and intrarater reliability. The relationship between ULPRS and MUUL was assessed using Pearson correlation coefficients. RESULTS: The ICCs for the total ULPRS scores were 0.94 between raters and 0.99 to 1.00 within raters. The weighted kappa statistics for subitem scores for the ULPRS ranged from 0.67 to 1.00 within raters and from 0.46 to 0.86 between raters. The relationship between ULPRS and MUUL was strong (Pearson correlation coefficient=0.751; p<0.05). CONCLUSION: The results demonstrated the high reliability of the total ULPRS score within and between raters. A significant concurrent validity between ULPRS and MUUL also supports the clinical utility of the ULPRS as an outcome measure of spastic upper limb in children with CP.
Adolescent ; Arm/*physiopathology ; Cerebral Palsy/*physiopathology ; Child ; Child, Preschool ; Female ; Humans ; Male ; *Physicians ; Reproducibility of Results

The purpose of this study was to investigate the function of the autonomic nervous system in children with spastic cerebral palsy (CP) through an analysis of heart rate variability (HRV) occurring with orthostatic stress. Twelve children with spastic CP and twelve normal children participated in this study. The echocardiogram (ECG) signals were recorded for 3 minutes in both the supine and 70 degrees C head-up tilt positions, and then the HRV signals underwent power spectrum analysis at each position. Two components were measured; a low- frequency (LF) component (0.05 - 0.15Hz) primarily reflecting sympathetic activity during orthostatic stress and a high-frequency (HF) component (0.15 - 0.4Hz) reflecting parasympathetic activity. In the supine position, there was no significant difference between any of the HRV components of the two groups. In the head-up tilt position, absolute and normalized LF were significantly increased and absolute HF was significantly decreased in the normal children (p < 0.05), but not in the children with spastic CP. The results of this study suggest that cardiac autonomic functions, such as vagal withdrawal and sympathetic activation which occur during head-up tilt position, are not sufficient to overcome the orthostatic stress arising in spastic CP children.
Autonomic Nervous System/*physiopathology ; Cerebral Palsy/*physiopathology ; Child ; Female ; *Heart Rate ; Human ; Male ; Posture ; Supine Position

OBJECTIVETo study the effect of suspension exercise training on motor and balance functions in children with spastic cerebral palsy.

METHODSA total of 97 children with spastic cerebral palsy were randomly divided into an observation group with 49 children and a control group with 48 children. Both groups were given routine rehabilitation training, and the children in the observation group were given suspension exercise training in addition. The scores of the D and E domains of the 88-item version of the Gross Motor Function Measure (GMFM-88) and Berg Balance Scale (BBS) were recorded before treatment and at 1, 3, and 6 months after treatment. Surface electromyography was performed to observe the changes in the root mean square (RMS) of surface electromyogram signals of the adductor muscle and the gastrocnemius muscle.

RESULTSOver the time of treatment, both groups had varying degrees of improvement in the scores of the D and E domains of GMFM-88 and BBS. Compared with the control group, the observation group had significantly greater improvements in D and E functional areas and balance function (P<0.05). Both groups had reductions in the RMS of the surface electromyogram signals of the adductor muscle and the gastrocnemius muscle over the time of treatment, and the observation group had significantly greater reductions than the control group (P<0.05).

CONCLUSIONSSuspension exercise training can effectively improve the motor and balance functions of children with spastic cerebral palsy.

Cerebral Palsy ; physiopathology ; therapy ; Child ; Child, Preschool ; Exercise ; Female ; Humans ; Male ; Motor Activity ; Muscles ; physiopathology

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*

PURPOSE: The objective of this study was to describe hand function in relation with gross motor function and subtype of spastic cerebral palsy and to investigate the relationships among gross motor function, bimanual performance, unimanual capacity and upper limb functional measures in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: We collected upper extremity data of 140 children with spastic CP. The Gross Motor Functional Classification System (GMFCS) was used to assess gross motor function, Manual Ability Classification System (MACS) for bimanual performance, and Modified House Functional Classification (MHC) for the best capacity of each hand. Upper limb functions were evaluated by using the Upper Limb Physician's Rating Scale and Upper Extremity Rating Scale. RESULTS: There was a good correlation between GMFCS and MACS in children with bilateral CP, but the correlation was not strong in children with unilateral CP. No significant difference between GMFCS and MACS was found in children with bilateral CP, but children with unilateral CP scored higher on GMFCS than on MACS. A strong correlation was observed between MACS and MHC in children with bilateral CP, but not in children with unilateral CP. The upper limb functional measures in each hand were highly related with MACS and MHC in bilateral CP, but not in unilateral CP. CONCLUSION: Gross motor function, bimanual performance and the best capacity of each hand are closely related with each other in children with bilateral CP, but not in children with unilateral CP.
Cerebral Palsy/classification/*physiopathology ; Child ; Child, Preschool ; Disability Evaluation ; Hand/*physiopathology ; Humans ; *Motor Skills ; Upper Extremity/physiopathology

OBJECTIVETo observe the therapeutic effect of massage with manipulation of supplementing marrow and kneading tendon (SMKT) on spastic cerebral palsy (CP).

METHODSA total of 60 children with CP were randomly assigned to the treatment group and the control group equally. All were treated with rehabilitation training, but massage with SMKT was carried out additionally for those in the treatment group, five times every week and 3 months as a therapeutic course. Clinical efficacy was assessed adopting the gross motor function measurement (GMFM-66) and the revised Ashworth scale (MAS) before and after treatment.

RESULTSAll children showed significant improvements in GMFM-66 after treatment. Compared with baseline, the improvement was statistically significant (P <0.01). Significant difference was also found between the 2 groups in MAS and in GMFM scores after treatment (P <0.05).

CONCLUSIONMassage with SMKT manipulation shows a better effect than rehabilitation training therapy alone in treating spastic CP.

Cerebral Palsy ; physiopathology ; therapy ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Massage ; Muscle, Skeletal ; physiopathology ; Tendons ; physiopathology

OBJECTIVETo study the therapeutic effects of infra-low-frequency transcranial magnetic stimulation in children with spastic cerebral palsy.

METHODSSeventy-five children with spastic cerebral palsy were randomly divided into two groups: control (n=33) and treatment groups (n=42). The treatment group accepted infra-low-frequency transcranial magnetic stimulation besides conventional comprehensive rehabilitation therapy. The control group only accepted conventional comprehensive rehabilitation therapy. Motor functions were assessed by gross motor function measure (GMFM) and fine motor function measure (FMFM) at one and three months after treatment.

RESULTSImprovement in the ability to sit in the treatment was better than in the control group at one month after treatment (P<0.05). Improvement in the ability to sit, crawl and kneel, total score of GMFM, and improvement of joint active ability of limbs, grasping ability and operating ability in the treatment group were better than the control group at three months after treatment (P<0.05).

CONCLUSIONSInfra-low-frequency transcranial magnetic stimulation can effectively improve motor function in children with spastic cerebral palsy.

Cerebral Palsy ; physiopathology ; therapy ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Motor Activity ; Transcranial Magnetic Stimulation

OBJECTIVETo examine the reliability and validity of the 66-item version on the gross motor function measure (GMFM-66) to assess the gross motor functions of children below 3 years oldwith cerebral palsy.

METHODS298 valid samples were obtained from 171 children with cerebral palsy (male 126, female 45 with mean age 19 months, age range 3-36 months) measured with GMFM-88. Then a 73-item version of GMFM (GMFM-73) special for these children was obtained by Rasch analysis. Both GMFM-66 and GMFM-73 scores of to each sample were obtained. The reliability and validity of GMFM-66 were evaluated through analyzing the correlation between the scores and between the changed scores of these two GMFM versions. The relative precision of GMFM-73 versus GMFM-66 was also analyzed.

RESULTSSignificant correlations were found between the scores and between the changed scores of these two versions of GMFM. A 14% less gain in relative precision was achieved when using GMFM-73 versus GMFM-66.

CONCLUSIONResults indicated that the GMFM-66 had good reliability and validity in assessing the gross motor functions of children below 3 years old with cerebral palsy.

Cerebral Palsy ; physiopathology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Motor Skills ; classification ; Reproducibility of Results ; Surveys and Questionnaires

OBJECTIVETo measure gray matter volume of whole brain with voxel-based morphometry (VBM) method and to study brain structures associated with gross motor function.

METHODForty children with cerebral palsy were recruited in the authors' hospital from Oct. 2012 to Dec. 2013 (26 male, 14 female cases, average age (3.6 ± 2.0) years ). Gross motor function classification system (GMFCS) for children was used to obtain their motor function. The whole-brain three dimensional magnetic resonance imaging (MRI) was performed on a 3.0 T MRI scanner. The data were segmented by VBM 5, and the whole brain volumes of gray matter, white matter and cerebospinal fluid were produced. Correlation analysis was used to analyze the correlation of GMFCS with whole brain volumes using SPM 5 in Matalab 7.1.

RESULTThe volume in left meditemporal gyrus (Z=3.57) and inferior temporal gyrus (Z=3.40), right thalamus and pallidum (Z=3.36), left thalamus and pallidum (Z=2.76), left supramarginal gyrus (Z=3.14), left precuneus gyrus (Z=3.00), right dorsolateral superior frontal gyrus (Z=3.08), right superior and medial occipital gyrus (Z=2.84) significantly increased as aggravation of gross motor dysfunction. The volume of the left medial orbitofrontal lobe and anterior cingulate (Z=3.28,3.02), left medial superior frontal gyrus (Z=3.19), left caudate (Z=3.04, 2.94, 2.92), left cerebellum (Z=2.94), right cerebellum (Z=2.97), left parahippocampal (Z=3.94), right parahippocampal (Z=3.43, 3.00), left insula (Z=3.50), right insula (Z=3.41, 3.80), left lingual (Z=3.37), right lingual (Z=3.30), left post cingulum (Z=2.73), left midioccipital gyrus (Z=2.92) and right miditemporal gyrus (Z=3.05) significantly reduced as the aggravation of gross motor dysfunction (P all<0.005).

CONCLUSIONGMFCS in children with cerebral palsy is related to abnormalities of brain gray matter structure for motor, emotion, memory and default model network when examined with VBM method.

Cerebral Palsy ; physiopathology ; Child, Preschool ; Female ; Gray Matter ; pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male