Does early communication mediate the relationship between motor ability and social function in children with cerebral palsy?

BackgroundChildren diagnosed with neurodevelopmental conditions such as cerebral palsy (CP) are at risk of experiencing restrictions in social activities negatively impacting their subsequent social functioning. Research has identified motor and communication ability as being unique determinants of social function capabilities in children with CP, to date, no research has investigated whether communication is a mediator of the relationship between motor ability and social functioning.AimsTo investigate whether early communication ability at 24 months corrected age (ca.) mediates the relationship between early motor ability at 24 months ca. and later social development at 60 months ca. in a cohort of children diagnosed with cerebral palsy (CP).MethodA cohort of 71 children (43 male) diagnosed with CP (GMFCS I = 24, 33.8%, II = 9, 12.7%, III = 12, 16.9%, IV = 10, 14.1%, V = 16, 22.5%) were assessed at 24 and 60 months ca. Assessments included the Gross Motor Function Measure (GMFM), the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP) Infant-Toddler Checklist and the Paediatric Evaluation of Disability Inventory (PEDI). A mediation model was examined using bootstrapping.ResultsEarly communication skills mediated the relationship between early motor abilities and later social functioning, b = 0.24 (95% CI = 0.08–0.43 and the mediation model was significant, F (2, 68) = 32.77, p < 0.001, R² = 0.49.Conclusions and implicationEarly communication ability partially mediates the relationship between early motor ability and later social function in children with CP. This demonstrates the important role of early communication in ongoing social development. Early identification of communication delay and enriched language exposure is crucial in this population.     

Development of postural control in typically developing children and children with cerebral palsy: possibilities for intervention?

The basic level of postural control is functionally active from early infancy onwards: young infants possess a repertoire of direction-specific postural adjustments. Whether or not direction-specific adjustments are used depends on the child's age and the nature of the postural task. The second level of control emerges after 3 months: children start to develop the capacity to adapt postural activity to environmental constraints. But the adult form of postural adaptation first emerges after adolescence.

Children with cerebral palsy (CP) in general have the ability to generate direction-specific adjustments, but they show a delayed development in the capacity to recruit direction-specific adjustments in tasks with a mild postural challenge. Children with CP virtually always have difficulties in the adaptation of direction-specific activity.

The limited data available on the effect of intervention on postural development suggest that intervention involving active trial and error experience may accelerate postural development in typically developing infants and may improve postural control in children with or at high risk for a developmental motor disorder.     

Determinants of inclusive education of 8–12 year-old children with cerebral palsy in 9 European regions

The principle of inclusive education has been increasingly recognised over recent decades and most countries officially support schooling of children with disabilities in mainstream settings. The SPARCLE study offers the opportunity to report on the schooling practices for children with cerebral palsy according to the nature and severity of their impairments and the schooling policy in European regions. The aim of this paper is to describe the type of schooling of children with cerebral palsy in various European regions after controlling for relevant individual factors. Children aged 8–12 years with cerebral palsy from 9 European regions and their families were interviewed. Our findings support the hypothesis that between-region variations in the type of schooling are still significant after adjustment for individual factors; and that motor function and intellectual ability have different effects on inclusion in mainstream school, depending on the region.     

Predictors of dental anxiety in Brazilian 5–7 years old children

ObjectivesThe aim of this study was to analyze the predictors of dental anxiety in 5 to 7-year-old children in a two years follow-up.Materials and methodsThis is a longitudinal study conducted with 784 children with 5 to 7 years old. A face-to-face interview was conducted with the parents. The Dental Anxiety Question (DAQ) answers were categorized as presence or absence of dental anxiety. The possible predictor factors analyzed were: related to the children (age, sex, parentage, childbirth, physical activity, body satisfaction, psychological well-being, physical well-being, dentist visit); and related to the parents or guardians (excessive alcohol consumption, smoke, family income, number of children). Forward stepwise logistic binary regression was performed for the multivariate analysis. The analysis was controlled by gender.ResultsThe prevalence of dental anxiety was 17.4%. Children in lower family income had 2.3 (95% CI: 1.3–4.0) greater chance to report high dental anxiety in comparison to children in higher family income. Similarly, children's parents who reported lower psychological well-being had 1.5 (95% CI: 1.0–3.0) greater chance to report high dental anxiety in comparison to children's parents with higher psychological well-being.ConclusionsThe prevalence of dental anxiety was high, and the family income and psychological well-being were inversely associated to dental anxiety in children.Clinical relevanceKnowing the dental anxiety predictors could help the pediatric dentist to analyze and understand who is more susceptible to develop dental anxiety. An adequate approach, a trust relationship could be built, improving the oral health conditions and reducing the need of treatment in children.     

What areas of functioning are influenced by aquatic physiotherapy? Experiences of parents of children with cerebral palsy

Objectives: To explore the experiences regarding aquatic physiotherapy among parents of children with cerebral palsy and to identify a list of relevant intervention categories for aquatic physiotherapy treatments. Methods: We conducted semi-structured interviews and focus groups using the components of the International Classification of Functioning, Disability and Health (ICF) as a frame of reference to explore and code experiences regarding aquatic physiotherapy. A non-probabilistic purposive sampling strategy was used. Content analysis methods and ICF linking processes were used to analyze data. Results: From the parents’ perspective (n = 34), both the Body Functions and Activities and Participation components were mainly influenced by aquatic physiotherapy. Also, parents described Environmental Factors acting as barriers affecting progress during therapy. Conclusions: Parents identified a wide range of categories influenced by aquatic physiotherapy. Social and contextual aspects were highlighted, as well as a series of changes related to the illness as a result of treatment.     

Correlation of glucose metabolism in brain cells and brain morphological changes with clinical typing in children with cerebral palsy

INTRODUCTION Cerebral palsy of children is a non-processing brain injury which is caused by various factors before and 1 month after birth. The main symptoms are central motor disorder and postural abnormality, which are always combined with dysnoesia and…     

Does hip displacement influence health-related quality of life in children with cerebral palsy?

Objective: To evaluate the association of hip lateralisation with health-related quality of life (HRQL) in children with cerebral palsy (CP) using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD®) questionnaire. Methods: We assessed n?=?34 patients (mean age: 10.2 years, SD: 4.7 years; female: n?=?16) with bilateral CP and Gross Motor Function Classification System (GMFCS) Level III–V using the CPCHILD® questionnaire. Hip lateralisation was measured by Reimer`s migration percentage (MP). Results: There was an association between both, MP and GMFCS with CPCHILD® total score. Stratified analyses did not suggest interaction of the association between MP and CPCHILD® total score by GMFCS level. After adjustment for GMFCS level, we found a significant linear decrease of CPCHILD® total score of ?0.188 points by 1% increment in MP. Conclusions: There was an association between MP and HRQL, which could not be explained by the GMFCS level.     

Do the abilities of children with cerebral palsy explain their activities and participation?

The aim of this study was to use family-assessed instruments and details of children's impairments to explore factors affecting the activities and participation of children with cerebral palsy (CP). A postal survey was conducted with families of a geographically defined population of children with CP aged 6 to 12 years. Family-assessed indices of children's activities and participation were the Activities Scale for Kids (ASK) and Lifestyle Assessment Questionnaire (LAQ-CP). Families also assessed children's abilities using the Gross Motor Function and Manual Ability Classification Systems (GMFCS; MACS). Details of children's impairments were available from the 4Child epidemiological database and used with the GMFCS and MACS as explanatory variables in multiple regression analyses to identify their effect on children's activities and participation. Families of 175/314 (56%) children returned an assessment using the GMFCS and 129 (41%) children participated fully by returning all the questionnaires. Full participants (72 males, 57 females) did not differ from those who did not take part by their age, sex, CP characteristics, or associated impairments: GMFCS Level I-25, Level II-43, Level III-15, Level IV-14, Level V-23; MACS Level I-14, Level II-30, Level III-18, Level IV-13, Level V-13. Scores for the ASK and LAQ-CP Physical Independence and Mobility domains were predicted well by children's movement, manual, and intellectual disability, and also, to some extent, by the presence of seizures or speech problems. LAQ-CP domains for Economic and Clinical Burden and Social Integration were not well explained by children's abilities and impairments. Family assessment, therefore, offers a useful method for measuring children's activities and participation; however, currently available instruments do not fully represent all the domains in the International Classification of Functioning, Disability and Health. Children's abilities only partially explain their activities and participation.     

Prevalence and characteristics of significant social anxiety in children aged 8–13 years

Background  Social anxiety has been frequently studied in both population- and clinical-based adult and adolescent samples. Corresponding research in children is scarce and is dominated by clinical studies. The aim of the present population-based study was to examine the prevalence of significant social anxiety (SSA) in preadolescent children and compare their characteristics with those of children without SSA. The spectrum of social anxiety is explored by comparing children with different levels of social anxiety, as defined by 1–2 versus 3–5 social situations feared. Method  The sample consisted of 14,497 parents and their 3rd–7th grade children (8–13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A–D for social anxiety disorder (SAD). Socio-demographic data, social and school functioning, somatic complaints, parent–child relationships, and use of health services were added to a logistic regression model to explore characteristics associated with children with, and without SSA. Associated emotional and behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ) using parent and self-report. Results  Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The majority of children with SSA managed their everyday life well. However, compared with children without SSA, children with SSA struggled more often in different areas of life and showed a significantly higher prevalence of associated emotional and behavioural symptoms. Our findings also support the notion of social anxiety as a spectrum concept. Conclusions  Social anxiety problems start in childhood and can be impairing, even in non-clinical populations and in reasonably young age groups. Increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.     

Increase in physical activities in kindergarten children with cerebral palsy by employing MaKey–MaKey-based task systems

In this study, we employed Flash- and Scratch-based multimedia by using a MaKey–MaKey-based task system to increase the motivation level of children with cerebral palsy to perform physical activities. MaKey MaKey is a circuit board that converts physical touch to a digital signal, which is interpreted by a computer as a keyboard message. In this study, we used conductive materials to control this interaction. This study followed single-case design using ABAB models in which A indicated the baseline and B indicated the intervention. The experiment period comprised 1 month and a half. The experimental results demonstrated that in the case of two kindergarten children with cerebral palsy, their scores were considerably increased during the intervention phrases. The developmental applications of the results are also discussed.     

Neuronal quantity and ultrastructure in extracorticospinal tract of newborn rabbits with cerebral palsy

BACKGROUND: The liver enzyme system and blood brain barrier function of newborn rabbits are incomplete. High level of bilirubin can lead to cerebral palsy (CP) of newborn rabbits. The pathological and ultrastructural changes of brains of immature rabbits may differ from those of mature rabbits. OBJECTIVE: To observe the changes in dopaminergic neuron amount and ultrastructure in the extracorticospinal tract of animal models of CP induced by hyperbilirubinemia. DESIGN: A randomized controlled observation. SETTING: Rehabilitation Medical College of Jiamusi University; Laboratory for Pediatric Neurology Rehabilitation of Jiamusi University. MATERIALS: Thirty newborn 2- to 5- day inbred Japanese rabbits, weighing about 50 g, of either gender, were provided by Experimental Animal Center, Jilin University. Bilirubin and tyrosine hydroxylase (TH) antibody were purchased from Sigma Corporation, USA. METHODS: This experiment was carried out in the laboratory for children neuro-rehabilitation, Jiamusi University between September 2002 and December 2005. ①Thirty rabbits were randomly divided into 2 groups: control group (n =10) and model group (n =20). ②Bilirubin of 100 mg/kg was given to the rabbits of model group through intraperitoneal injection, once every other day, 3 times totally; The same amount of normal saline was given to the rabbits of control group. After injection, the newborn rabbits had been fed by maternal milk for 45 days. ③TH-positive neurons in substantia nigra and corpora striatum in each area of 0.15 mm×0.15 mm were counted. Ultrastructures of substantia nigra and corpora striatum were observed under the electron miscroscope. The concentration of bilirubin in brain tissue of CP rabbits of model group was measured with high performance liquid chromatogram. MAIN OUTCOME MEASURES: Quantitative analysis results and ultrastructure of TH-positive neurons in substantia nigra and corpora striatum in two groups. RESULTS: Thirty newborn rabbits were involved, 6 rabbits from model group died and 4 were failed in modeling, finally, 20 rabbits were involved in the result analysis. ① The concentration of bilirubin in brain tissue of newborn rabbits of model group was (59.9±17.04) mg/L, which was significantly higher than that of control group [(42.79±3.57) mg/L, P < 0.01]. ② TH positive neurons amount in the substantia nigra and corpora striatum of newborn rabbits in the model group was 30.30±9.58, 4.70±2.79, which was significantly less than that in the control group respectively (45.20±12.74, 11±2.45, P < 0.01). ③The concentration of bilirubin in brain tissue was significantly negatively correlated with TH-positive neurons in substantia nigra(r =-0.69, P < 0.01); The concentration of bilirubin in brain tissue was also significantly negatively correlated with TH-positive neurons in corpora striatum(r =-0.59, P < 0.01). TH-positive neurons in substantia nigra were positively correlated with those in corpora striatum (r =0.77, P < 0.01).④ Under the electron microscope, the nerve cells in substantia nigra and corpora striatum of newborn rabbits of model group were significantly changed in ultrastructure as compared with control group. CONCLUSION: Ultrastructure of extracorticospinal tract of newborn rabbits with CP is significantly changed, presenting the injury of dopaminergic neuron and decrease of neuronal amount.     

Predictors for changes in various developmental outcomes of children with cerebral palsy—A longitudinal study

We aimed to identify predictors for the changes of various developmental outcomes in preschool children with cerebral palsy (CP). Participants were 78 children (49 boys, 29 girls) with CP (mean age: 3 years, 8 months; SD: 1 year, 7 months; range: 1 year to 5 years, 6 months). We examined eight potential predictors: age, sex, CP subtype, Gross Motor Function Classification System (GMFCS) level, selective motor control, Modified Ashworth Scale, and the spinal alignment (SA) and range of motion subscales of the Spinal Alignment and Range of Motion Measure (SAROMM). Developmental outcomes for cognition, language, self-help, and social and motor functions were measured at baseline and a 6-month follow-up with the Comprehensive Developmental Inventory for Infants and Toddlers. Regression model showed GMFCS level was a negative predictor for change of language (adjusted r² = 0.30, p < .001), motor function (adjusted r² = 0.26, p < .001), social function (adjusted r² = 0.07, p = 0.014), and self-help (adjusted r² = 0.26, p < .001). Age was a negative predictor for change of cognition (adjusted r² = 0.21, p < .001) and language functions (adjusted r² = 0.26, p < .001). SAROMM-SA was a negative predictor for cognitive change (adjusted r² = 0.30, p < .001). The GMFCS levels and age are robust negative predictors for change of most developmental domains in these children.     

Magnetic resonance imaging of the brain in children and young people with cerebral palsy: who reports matters?

Retrospective case note audits were undertaken of children with clinically diagnosed cerebral palsy known to paediatricians and physiotherapists in Sunderland (UK). Evidence of brain magnetic resonance imaging (MRI) was recorded, including expert opinions requested, in order to quantify the perceived mismatch between local, general radiological and regional, specialist neuroradiological reporting, towards ensuring the best possible yield to inform clinical practice and accurate information-sharing with families. One hundred and ninety-seven out of 214 (92%) had documented neuroimaging; 111 out of 197 (56.3%) were dual reported. Only 34 out of 111 reports were concordant overall. Sixty per cent of brain MRI reported as normal locally, were found not to be normal on specialist review. Clinicians requesting brain MRI in children with disordered development must be mindful of the expertise of those reporting. Those based in district settings must network closely with specialists in expert centres, if disabled children and young people are to receive equitable care of the highest standard.     

Impact of clinical types and involved sites on the recovery of gross motor function after interventions in children with cerebral palsy

INTRODUCTION Cerebral palsy is a disorder caused by damages to the brain, espe- cially affecting the ability to control movement and posture before thebrain develops to mature in infants, and it is usually intellectual, lan- guage, emotional and behaviora…     

How do changes in body functions and structures,activity, and participation relate in children with cerebral palsy?

Rehabilitation increasingly addresses the International Classification of Functioning, Disability and Health's (ICF) concepts of activity and participation, but little is known about associations between changes in body functions and structures, activity, and participation. We conducted a before-and-after study of 35 ambulatory children with spastic diplegia or hemiplegic cerebral palsy, mean age 5 years 6 months (SD 2 y 2 mo). Children were in Gross Motor Function Classification System (GMFCS) Levels I (n=11), II (n=12), or III (n=12). We assessed body functions and structures, activity, and participation at baseline and at 2 months and 6 months post-botulinum toxin type A (BoNT-A) injection. Repeated-measures analysis of variance evaluated change, and linear regression assessed relationships. Baseline score relationships were moderate to strong but, despite similar directions of change at 2 months, change score relationships between measures of body functions and structures (spasticity and timed walk), activity (Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory), and participation (Pediatric Outcomes Data Collection Instrument) at 2 months and 6 months were poor to fair (r<0.40). Predictor combinations accounted for <69% of variation in activity and participation change scores. Predictors often pertained to baseline score, GMFCS level, or age. Relationships between changes at different ICF levels are complex, and activity and participation gains post-BoNT-A are likely to be influenced by the child and environment factors.