Cerebral Palsy Medical and Health News Headlines

Cerebral palsy and restricted growth status at birth: population-based case-control study.

BJOG. 2008 Sep;115(10):1250-5

Authors: Jacobsson B, Ahlin K, Francis A, Hagberg G, Hagberg H, Gardosi J

OBJECTIVE: To evaluate the association between growth status at birth and subsequent development of cerebral palsy in preterm and term infants. DESIGN: Population-based case-controlled study. SETTING: Cerebral palsy register in Western Sweden. Subjects Cohort of 334 singletons born between 1983 and 1990, with cerebral palsy diagnosed from age 4, and 668 singletons matched for gestation, gender and delivery unit. METHOD: Growth status at birth was determined using small for gestational age (SGA) categories, with customised birthweight percentiles (SGAcust) based on the Swedish population. MAIN OUTCOME MEASURES: Proportion of babies that were SGAcust, comparing cases and controls in three gestational age categories: early preterm (24-33 weeks), late preterm (34-36 weeks) and term (37+ weeks). RESULTS: Of the 334 children with cerebral palsy, 87 (26.6%) were born early preterm, 27 (8.1%) late preterm and 218 (66%) at term. Children who had been born at term were more likely to have been SGA <1st customised percentile (SGAcust1) than their matched controls (OR 6.6, 95% CI 2.3-18.6). In contrast, children with cerebral palsy born preterm were not more likely to have been SGAcust1 (OR 0.9, 95% CI 0.4-1.9), and this applied to early preterm as well as late preterm births. For less severely small babies (SGA between 1st and 5th customised percentiles), the association with cerebral palsy remained significant for term births (OR 5.2, 95% CI 2.7-10.1) but was again not significant for preterm births. CONCLUSIONS: Term singletons with severely SGA birthweights had a five- to seven-fold risk of developing cerebral palsy compared with gestational age-matched infants with birthweights within normal limits. For children born preterm, SGA was not more likely to be present in cases than in controls. These findings support the concept of cerebral palsy as a multifactorial condition and highlight the importance of antenatal surveillance of fetal growth.

PMID: 18715410 [PubMed - in process]

Related Articles

Interventions and outcomes for children with dysphagia.

Dev Disabil Res Rev. 2008;14(2):165-73

Authors: Gisel E

Feeding problems are common even in typically developing infants and children. However, they are more frequent and persistent in children with developmental disabilities. This article will provide an overview of current literature and a rationale underlying the interventions used for children with cerebral palsy (CP) who have eating impairments (dysphagia). The review is not intended to be exhaustive, but papers were selected that highlight some of the issues and challenges of the field. Normal oral-motor development is briefly discussed to show how it may inform clinical practice in the understanding of feeding problems. Description of the risk factors and the nature and extent of eating impairments will show how interventions need to be specific to the severity of eating impairments. Examination of sensorimotor therapies, using oral stimulation exercises or an intra-oral appliance, will highlight the range of their effectiveness, as well as their limitations. Similarly, an examination of tube feeding, used for nutritional rehabilitation of the most severely affected children, will address the benefits, controversies as well as moral issues encountered by caregivers and professionals. Multi-center studies will be needed to obtain more homogeneous samples, large enough to address questions of early interventions and their subsequent effect on later development.

PMID: 18646023 [PubMed - in process]

Related Articles

Growth and nutrition disorders in children with cerebral palsy.

Dev Disabil Res Rev. 2008;14(2):137-46

Authors: Kuperminc MN, Stevenson RD

Growth and nutrition disorders are common secondary health conditions in children with cerebral palsy (CP). Poor growth and malnutrition in CP merit study because of their impact on health, including psychological and physiological function, healthcare utilization, societal participation, motor function, and survival. Understanding the etiology of poor growth has led to a variety of interventions to improve growth. One of the major causes of poor growth, malnutrition, is the best-studied contributor to poor growth; scientific evidence regarding malnutrition has contributed to improvements in clinical management and, in turn, survival over the last 20 years. Increased recognition and understanding of neurological, endocrinological, and environmental factors have begun to shape care for children with CP, as well. The investigation of these factors relies on advances made in the assessment methods available to address the challenges inherent in measuring growth in children with CP. Descriptive growth charts and norms of body composition provide information that may help clinicians to interpret growth and intervene to improve growth and nutrition in children with CP. Linking growth to measures of health will be necessary to develop growth standards for children with CP in order to optimize health and well-being.

PMID: 18646022 [PubMed - in process]

Related Articles

Gastrointestinal disorders in children with neurodevelopmental disabilities.

Dev Disabil Res Rev. 2008;14(2):128-36

Authors: Sullivan PB

Children with neurodevelopmental disabilities such as cerebral palsy (CP), spina bifida, or inborn errors of metabolism frequently have associated gastrointestinal problems. These include oral motor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise. Gastrostomy tube feeding is increasingly being used in these children to circumvent oral motor dysfunction and prevent malnutrition. Foregut dysmotility causes several problems such as dysphagia from oesophageal dysmotility, gastro-oesophageal reflux disease, and delayed gastric emptying. Gastro-oesophageal reflux disease is common in these children but often fails to respond to medical management and may require surgical treatment. Finally, constipation is often a problem that may be overlooked in this population. This article focuses on these associated gastrointestinal manifestations and discusses the current diagnostic and therapeutic options available.

PMID: 18646021 [PubMed - in process]

The signal transduction mediated by erythropoietin and proinflammatory cytokines in the JAK/STAT pathway in the children with cerebral palsy.

Brain Dev. 2008 Aug 18;

Authors: Tao W, Wen F, Zhang H, Liu G

It is well established that erythropoietin (EPO) is a pleiotropic cytokine, which has a brain-derived neuroprotective effect in the central nervous system (CNS). Immune abnormality has a close relationship with cerebral palsy (CP), and may be even involved in the development of CP. There is evidence that the amount of EPO in CP children is lower than in normal children, but the levels of proinflammatory cytokines, such as interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha, are higher in the CP children. The signal transduction mediated by EPO that has a neuroprotective effect and mediated by proinflammatory cytokines that lead to brain damage shares the common JAK/STAT pathway. Under acute stress, the JAK/STAT pathway is occupied by massive proinflammatory cytokines, and the negative feedback inhibition factors like suppressor of cytokine signaling (SOCS) proteins are simultaneously activated, which exist in reciprocal inhibition to EPO in the JAK/STAT pathway. As a result, the signal transduction mediated by EPO is prevented or reduced, and the neuroprotective effect of EPO is eventually weakened. In this review, a novel approach to CP treatment through neurodevelopmental treatment (NDT) is put forward by analysis of the interrelationship of signal transduction mediated by EPO and proinflammatory cytokines in the JAK/STAT pathway and their roles in the development of CP, and some reasonable ideas for CP treatment are provided.

PMID: 18715729 [PubMed - as supplied by publisher]

[Mothers' experience with their developmentally disordered children: specificity of internal representations]

Medicina (Kaunas). 2008;44(7):553-63

Authors: Pukinskaite R, Praninskiene R

The purpose of the present study was to examine mothers' internal representations of experience with their developmentally disordered children. Maternal perceptions of children have been considered important in clinical work with developmentally disordered children and their families. Using developmental disability sample of 17-34-month-old children, we compared mothers' representations of their children in clinically referred and not referred groups, using the Working Model of the Child Interview. Twenty mothers of children with developmental disorders and twenty matched controls participated. Six (30%) children of experiment group had a diagnosis of cerebral palsy; 5 (25%) were diagnosed with Down's syndrome, while the remaining 9 (45%) had a diagnosis of mixed specific developmental disorder. Many children with disability also were diagnosed with heart disease, epilepsy, and hydrocephalus. Maternal representations' measures were compared to their self-perceived impact of child disability on family, their sensitivity to child, and some demographic and family characteristics. Compared to controls, mothers of children with developmental disability had representations of their children that were significantly more likely to be classified distorted or disengaged (chi(2)=7.24; df=2; P<0.05). More severe disability status was significantly associated with mothers' disengaged representations, fear for safety of children, and intensity of involvement in care giving (P<0.05). The study did not confirm relationships between maternal representation classifications and their self-perceived impact of child disability on family. No differences were found concerning mothers' emotional empathy index in clinical and control groups. The differences in mean emotional empathy scores were related to many aspects of maternal internal representations and to some areas of self-perceived stress. The results of Working Model of the Child Interview did not correlate with child age and gender, birth order, and parents' level of education.

PMID: 18695353 [PubMed - in process]

Use of a Low-Cost, Commercially Available Gaming Console (Wii) for Rehabilitation of an Adolescent With Cerebral Palsy.

Phys Ther. 2008 Aug 8;

Authors: Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P

BACKGROUND AND PURPOSE:/b> The purpose of this retrospective and prospective case report is to describe the feasibility and outcomes of using a low-cost, commercially available gaming system (Wii) to augment the rehabilitation of an adolescent with cerebral palsy. Patient and Setting The patient was an adolescent with spastic diplegic cerebral palsy classified as GMFCS level III who was treated during a summer session in a school-based setting. Intervention The patient participated in 11 training sessions, 2 of which included other players. Sessions were between 60 and 90 minutes in duration. Training was performed using the Wii sports games software, including boxing, tennis, bowling, and golf. He trained in both standing and sitting positions. OUTCOMES: /b> Three main outcome measures were used: (1) visual-perceptual processing, using a motor-free perceptual test (Test of Visual Perceptual Skills, third edition); (2) postural control, using weight distribution and sway measures; and (3) functional mobility, using gait distance. Improvements in visual-perceptual processing, postural control, and functional mobility were measured after training. DISCUSSION AND CONCLUSION::/b> The feasibility of using the system in the school-based setting during the summer session was supported. For this patient whose rehabilitation was augmented with the Wii, there were positive outcomes at the impairment and functional levels. Multiple hypotheses were proposed for the findings that may be the springboard for additional research. To the authors' knowledge, this is the first published report on using this particular low-cost, commercially available gaming technology for rehabilitation of a person with cerebral palsy.

PMID: 18689607 [PubMed - as supplied by publisher]

[Neuromuscular dysfunction of the lower urinary tract dysfunction beyond spinal cord injury and multiple sclerosis : A challenge for urologists.]

Urologe A. 2008 Aug 6;

Authors: Reitz A, Fisang C, Müller SC

Neurogenic bladder subsequent to paraplegia serves as a paradigm when classifying the type of disorder analogous to the level of paralysis. In cases of multiple sclerosis micturition symptoms already present a manifold picture that changes in the clinical course. Rarer neurological disorders, on the other hand, such as infantile cerebral palsy, Parkinson's disease, multisystem atrophy, Alzheimer's disease, cerebrovascular disorders, Guillain-Barré syndrome, AIDS, herpes zoster, systemic lupus erythematosus, and herniated lumbar disc, often cause uncertainty with regard to necessary diagnostic tests and treatment.This review considers the available knowledge about voiding disorders and urinary incontinence associated with specific neurologic and neuromuscular diseases and provides recommendations for diagnostic work-up and pragmatic therapy.

PMID: 18679645 [PubMed - as supplied by publisher]

Foot contact event detection using kinematic data in cerebral palsy children and normal adults gait.

Gait Posture. 2008 Aug 2;

Authors: Desailly E, Daniel Y, Sardain P, Lacouture P

Initial contact (IC) and toe off (TO) times are essential measurements in the analysis of temporal gait parameters, especially in cerebral palsy (CP) gait analysis. A new gait event detection algorithm, called the high pass algorithm (HPA) has been developed and is discussed in this paper. Kinematics of markers on the heel and metatarsal are used. Their forward components are high pass filtered, to amplify the contact discontinuities, thus the local extrema of the processed signal correspond to IC and TO. The accuracy and precision of HPA are compared with the gold standard of foot contact event detection, that is, force plate measurements. Furthermore HPA is compared with two other kinematics methods. This study has been conducted on 20 CP children and on eight normal adults. For normal subjects all the methods performed equally well. True errors in HPA (mean+/-standard deviation) were found to be 1+/-23ms for IC and 2+/-25ms for TO in CP children. These results were significantly (p<0.05) more accurate and precise than those obtained using the other algorithms. Moreover, in the case of pathological gaits, the other methods are not suitable for IC detection when IC is flatfoot or forefoot. In conclusion, the HPA is a simple and robust algorithm, which performs equally well for adults and actually performs better when applied to the gait of CP children. It is therefore recommended as the method of choice.

PMID: 18676147 [PubMed - as supplied by publisher]