Pretend Play of Children with Cerebral Palsy

ABSTRACT

Background and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the children's motor severity level and their elaborateness of play with conventional-imaginative and symbolic play materials and a number of object substitutions in symbolic play. This indicated that children with greater motor limitations had diminished play ability. In this sample, 35% of the children showed typical play styles, identified by good scores in elaborate pretend play actions, number of object substitutions, and ability to self-initiate play, whereas 65% showed delay in their play. Implications: The type of pretend play deficits that might be expected in children with cerebral palsy were described. Furthermore, suggested directions for therapeutic intervention to enhance pretend play performance in cerebral palsy children were proposed.     

Efficacy Studies in Children with Cerebral Palsy

No abstract available for this article.     

Muscle Strengthening in Children with Cerebral Palsy

Muscle strengthening as a therapeutic technique for cerebral palsy is controversial. Many therapists have been trained to avoid muscle strengthening in children with cerebral palsy because of the belief that overflow to the antagonist muscle might increase muscle tone or spasticity and therefore increase abnormal movement. Recently some clinicians have become interested in resisted exercise as a treatment for children with cerebral palsy. This review summarizes the few published studies relating to progressive resistive exercise in children and young adults with cerebral palsy. The results of these studies indicate that resistive exercise increased strength in individuals with mild cerebral palsy and none of the studies showed any deleterious effects on level of spasticity or range of motion. Some studies showing that strength measurement instruments can be reliable under certain conditions are also reviewed.     

Management of Spasticity in Children with Cerebral Palsy

Cerebral palsy is the most common cause of spasticity and physical disability in children and spasticity is one of the commonest problems in those with neurological disease. The management of spasticity in children with cerebral palsy requires a multidisciplinary effort and should be started as early as possible. There are a number of treatments available for the management of spasticity. This article reviews the variety of options available for the clinical management of spasticity.Key Words: Cerebral Palsy, Intrathecal Baclofen, Occupational Therapy, Physical Therapy, Rhizotomy, Spasticity     

Evaluation of a Child with Cerebral Palsy

Evaluation of a child with cerebral palsy (CP) requires a multidisciplinary approach with a team of professionals comprising of a pediatrician or pediatric neurologist, occupational therapist, a physiotherapist, child psychologist, and a social worker. The assessment is necessary to confirm the diagnosis, determine the cause, assess the motor function and associated problems. The diagnosis of CP is clinical but selected investigations may be required for ascertaining the cause. Evaluation includes assessment for common medical problems of childhood particularly nutritional disorders and assessment of family functioning. Additional disabilities are common. Routine assessment of vision and hearing is required in children with CP. Since CP is a changing disorder, some limitations may not be evident early in life but manifest in the school age or later. The evaluation of a child with CP is an ongoing process and should be a part of continuing care as the child grows from infancy to adolescence     

足底压力测量技术在足外翻脑性瘫痪患儿康复疗效评定中的应用

目的探讨足底压力测量技术在评估足外翻脑性瘫痪(脑瘫)患儿康复疗效中的应用价值。方法收集2010年3月-2011年3月在本院康复医学科就诊,并进行综合康复治疗的61例脑瘫患儿基本临床资料。患儿均在入院时采用粗大运动功能分级系统(GMFCS)评定患儿粗大运动功能级别,61例患儿122只外翻足采用JPD1600型足底压力测量仪对足底的5个区域进行数据采集,取得足底压力及着地时相等指标,经过6个月的综合康复治疗后,再次评估上述指标,将治疗前后进行统计分析,综合评定康复治疗的疗效。结果足底压力测量技术采集的数据显示治疗前后足前掌外侧及足弓外侧缘压力改变均有统计学意义(Pa<0.05),足前掌内侧、足弓内侧及足跟压力改变差异均有统计学意义(Pa<0.01);后足支撑期中整足接触时相、离地时相改变差异均有统计学意义(Pa<0.01)。运用GMFCS分级统计的结果示足外翻脑瘫患儿治疗前后的运动功能改变差异有统计学意义(P<0.01)。结论综合化康复治疗可有效改善脑瘫患儿足外翻;足底压力测量技术能够为脑瘫足外翻患儿康复疗效评定提供有效的、客观的功能评估。     

Reproducibility of Tactile Assessments for Children with Unilateral Cerebral Palsy

ABSTRACT

A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2–4 weeks apart. Test–retest percent agreements within one point for children with unilateral CP (and TDC) were Semmes-Weinstein monofilaments: 75% (90%); single-point localization: 69% (97%); static two-point discrimination: 93% (97%); and moving two-point discrimination: 87% (97%). Test–retest reliability for registration and unilateral spatial tactile perception tests was high in children with CP (intraclass correlation coefficient [ICC] = 0.79–0.96). Two tests demonstrated a learning effect for children with CP, double simultaneous and tactile texture perception. Stereognosis had a ceiling effect for TDC (ICC = 0) and variability for children with CP (% exact agreement = 47%–50%). The Semmes-Weinstein monofilaments, single-point localization, and both static and moving two-point discrimination are recommended for use in practice and research. Although recommended to provide a comprehensive assessment, the measures of double simultaneous, stereognosis, and tactile texture perception may not be responsive to change over time in children with unilateral CP.     

Self-Care Trajectories and Reference Percentiles for Children with Cerebral Palsy

Abstract

Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP).

Methods: Participants were 708 children with CP, 18?months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents’ completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles.

Results: The trajectories for children in levels I, II, and III are characterized by an average maximum score between 79.6 (level I) and 62.8 (level III) and an average attainment of 90% of the maximum score between 7 and 9?years of age. The trajectories for children in level IV and V show minimal change over time. Extreme variation in performance among children of the same age and GMFCS level complicate interpretation of percentile change of individual children.

Conclusion: The findings are useful for monitoring self-care of children with CP and evaluating change for children in GMFCS levels I–III.     

痉挛型偏瘫脑性瘫痪患儿表面肌电特征

目的 探讨痉挛型偏瘫脑性瘫痪(脑瘫)患儿肱二头肌、股四头肌在最大自主等长收缩( MIVC)过程中的表面肌电图(sEMG)的特征变化.方法 采用患、健侧自身对照试验方法设计.选择2008年9月-2010年7月在广州市康复训练中心进行康复的痉挛型偏瘫脑瘫患儿11例.其中男5例,女6例;年龄(10.09±2.47)岁.采用FexComp型表面肌电仪及Ag/Agcl表面电极,在康复训练前对受试者进行测试,采样时令所有受试者保持相同姿势.将EMG的表面电极固定于其双侧肱二头肌、股四头肌体表上,在进行肘关节屈肌、膝关节伸肌MIVC时,同步记录其健、患侧肱二头肌、股四头肌的表面肌电信号,并进行频域特征量化分析,包括中位频率(MF)及平均功率频率(MPF).结果采用SPSS 13.0软件进行统计学处理.结果 在MIVC状态下,痉挛型偏瘫脑瘫患儿健侧肱二头肌、股四头肌MPF值均明显大于患侧(P ＜0.01,0.05),健、患侧肱二头肌、股四头肌的MF值比较,差异均无统计学意义(Pa＞0.05).患儿健侧功率谱sEMG信号明显强于患侧.结论 痉挛型偏瘫脑瘫患儿肱二头肌、股四头肌存在sEMG信号异常,提示表面肌电仪对神经肌肉系统功能状态的评价具有实用价值.     

脑性瘫痪患儿150例血清TORCH抗体检测的意义

目的分析150例脑性瘫痪(脑瘫)患儿的TORCH抗体检测结果,为防治提供依据。方法对150例1个月~3岁脑瘫患儿采用间接酶联免疫吸附方法进行TORCH-IgG检测,1~6个月患儿同时检测TORCH-IgM。分析比较阳性与阴性患儿间的高危因素、脑瘫分型、并发症、头颅CT、脑干听觉诱发电位、眼底检查、脑电图等情况。结果共检测出TORCH-IgG阳性患儿58例(阳性率38.58%);阳性中以巨细胞病毒(CMV)为最常见,其次为弓形体(TOX);母子TORCH阳性符合率达85.71%。高危因素中阳性患儿以窒息、早产、黄疸、低体质量为多见,阴性患儿以窒息、早产、颅内出血为主。脑瘫分型在阳性患儿以痉挛型四肢瘫和偏瘫多见,而阴性患儿以痉挛性双瘫和偏瘫为多见。阳性患儿并发症较阴性患儿多,尤以智力低下为最明显。阳性患儿的头颅CT、脑干听觉诱发电位、眼底检查、脑电图异常率明显较阴性患儿高。结论TORCH感染是婴幼儿脑瘫的重要病因之一,对孕妇、新生儿及婴幼儿常规进行TORCH抗体检测是防治脑瘫发生的重要措施之一。     

伴随发作性症状的脑性瘫痪患儿视频脑电图分析

目的分析伴随各种发作性症状的脑性瘫痪（CP）患儿视频脑电图（VEEG）特征,鉴别癫痫与非癫痫事件。方法伴各种发作性症状的522例CP患儿分为临床确诊癫痫组（A组,215例）及可疑癫组（B组,307例）。分别对其进行24 h VEEG监测。结果A组检出样放电183例（85.12%）,监测到临床发作127例（59.07%）并明确了发作类型;B组检出样放电58例（18.90%）,监测到临床发作264例（86.0%）,其中210例（40.23%）同步VEEG无样放电而排除癫痫发作;292例VEEG非特异性异常（55.94%）,二组无显著差异（P〉0.05）。结论CP患儿VEEG非特异性异常及样放电率较高,但相当部分伴随的发作性症状为非癫痫事件。     

Reliability of the Functional Mobility Scale for Children with Cerebral Palsy

ABSTRACT

This study examined inter-rater reliability of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP) and the presence of rater bias. A consecutive sample of 118 children with CP, 2–18 years old (mean 10.3 years, SD 3.6), was recruited from a hospital setting. Children were classified using the gross motor function classification system (GMFCS) with 13 in Level I, 49 in Level II, 44 in Level III, and 12 in Level IV. Each child was independently scored on the FMS by two raters. Raters were randomly assigned from a sample of 44 orthopaedic surgeons, hospital-based physiotherapists, and community-based physiotherapists. Quadratic weighted kappa coefficients for mobility ratings varied from 0.86 to 0.92 for the three distances, indicating substantial chance corrected agreement. Levels of agreement were similar when administering the scale in person and by telephone, suggesting that the FMS can be administered by either method. There was a tendency for surgeons to rate mobility higher than physiotherapists, however, only one of the comparisons was statistically significant. The FMS is a reliable tool that can be used by clinicians to assess mobility in children with CP.     

痉挛型脑瘫患儿脑脊液兴奋性、抑制性氨基酸的研究

目的：探讨脑瘫肌痉挛形成的机制及选择性脊神经后根切断术（ＳＰＲ）后脊髓中枢的改变。方法：采用丹酰氯－聚酰胺薄膜层析法，测定了２４例痉挛型脑瘫、３１例非神经系统疾病儿童及１２例ＳＰＲ后脑瘫患儿脑脊液中兴奋性、抑制性氨基酸水平。结果：痉挛型脑瘫患儿脑脊液中γ－氨基丁酸低于对照组（Ｐ＜０．００１），谷氨酸、天冬氨酸高于对照组（Ｐ＜０．００１），谷氨酸与患儿增高的肌张力呈等级正相关；ＳＰＲ后，γ－氨基丁酸、丙氨酸、甘氨酸明显升高，且高于正常组（Ｐ＜０．０５），谷氨酸、天冬氨酸明显下降，且谷氨酸低于正常组（Ｐ＜０．０５）。结论：突触前抑制下降、脊神经后根传入纤维侧支出芽、突触再建在脑瘫肌痉挛形成中起了重要的作用；ＳＰＲ后，脑脊液中兴奋性氨基酸下降、抑制性氨基酸上升与肌痉挛的解除有关，抑制性氨基酸能神经元侧支出芽、突触再建可能参与了脊髓中枢新的抑制易化平衡     

Tactile Assessment in Children with Cerebral Palsy: A Clinimetric Review

ABSTRACT

This review evaluates the clinimetric properties of tactile assessments for children with cerebral palsy. Assessment of registration was reported using Semmes Weinstein Monofilaments (SWMs) or exteroception. Assessment of two-point discrimination was reported using the Disk-Criminator® or paperclip methods; Single point localization and double simultaneous were reported from the Neurosensory Motor Developmental Assessment (NSMDA); graphaesthesia was reported from the Sensory Integration and Praxis Test (SIPT); and stereognosis was assessed using Manual Form Perception from the SIPT and the Klingels method (Klingels, K. et al. (2010). Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably? Disability and Rehabilitation, 32(5), 409–416) and the Cooper method (Cooper, J., Majnemer, A., Rosenblatt, B., & Birnbaum, R. (1995). The determination of sensory deficits in children with hemiplegic cerebral palsy. Journal of Child Neurology, 10, 300–309). The SIPT and NSMDA demonstrated stronger content validity. Inter-rater reliability was excellent for SIPT (ICC = 0.99) and exteroception (k = 0.88). Test–retest reliability was excellent for exteroception (k = 0.89) and stereognosis (ICC = 0.86; 100%), moderate for SIPT (r = 0.69–0.74) and poor for SWM (k = 0.22). Together these assessments measure tactile registration and spatial perception. Temporal and textural tests are to be developed for comprehensive tactile examination.