Upper limb function evaluation scales for individuals with cerebral palsy: a systematic review

[Purpose] The aim of the present study was to perform a systematic review of the literature on the scales and methods most often used for the evaluation of upper limb function in individuals with cerebral palsy. [Materials and Methods] Searches were conducted in the Medline, PEDro, Lilacs, Scielo, and PubMed databases. The following inclusion criteria were used for the selection of articles: randomized controlled study, evaluation of upper limb function in individuals with cerebral palsy, and publication between 2006 and 2014. The methodological quality of the articles was evaluated using the PEDro evidence scale. [Results] Five articles met the inclusion criteria and achieved 6 points or higher on the PEDro scale of methodological quality. [Conclusion] The studies analyzed used different evaluation scales, but no consensus has been reached thus far on which scale is the most appropriate. Thus, further studies are needed to establish an adequate method for the evaluation of upper limb function in individuals with cerebral palsy.Key words: Cerebral palsy, Scale function, Upper limbs     

Rehabilitation outcomes in children with cerebral palsy during a 2 year period

[Purpose] To observe motor and functional progress of children with cerebral palsy during 2 years. [Subjects and Methods] Pediatric cerebral palsy patients aged 3–15 years (n = 35/69) with 24-month follow-up at our outpatient cerebral palsy clinic were evaluated retrospectively. The distribution of cerebral palsy types was as follows: diplegia (n = 19), hemiplegia (n = 4), and quadriplegia (n = 12). Participants were divided into 3 groups according to their Gross Motor Functional Classification System scores (i.e., mild, moderate, and severe). All participants were evaluated initially and at the final assessment 2 years later. During this time, patients were treated 3 times/week. Changes in motor and functional abilities were assessed based on Gross Motor Function Measure-88 and Wee Functional Independence Measure. [Results] Significant improvements were observed in Gross Motor Function Measure-88 and Wee Functional Independence Measure results in all 35 patients at the end of 2 years. The Gross Motor Function Measure-88 scores correlated with Wee Functional Independence Measure Scores. Marked increases in motor and functional capabilities in mild and moderate cerebral palsy patients were observed in the subgroup assessments, but not in those with severe cerebral palsy. [Conclusion] Rehabilitation may greatly help mild and moderate cerebral palsy patients achieve their full potential.Key words: Cerebral palsy, Outcome, Physical therapy     

脑瘫儿童的康复与教育初探-附60例分析

目的 探讨脑瘫儿童康复治疗和教育的基本方法及其关系.方法 将60例脑瘫患儿分为康复组、教育组和康复＋教育组各20例，观察康复训练和教育效果.结果 2年后，WeeFIM量表评定康复组和教育组为有效，而康复＋教育组为基本恢复，且疗效优于康复组和教育组（ P＜0.05）.结论 对脑瘫患儿分阶段、有针对性地采取医疗康复与教育相结合的方法，可获得良好效果。     

Direct effect of percutaneous electric stimulation during gait in children with hemiplegic cerebral palsy: a report of 2 cases

The feasibility of using percutaneous intramuscular functional electric stimulation (FES) in children with cerebral palsy (CP) as a method to improve ankle kinematics and kinetics during gait was investigated. Two children with right hemiplegic CP had percutaneous intramuscular electrodes implanted into the gastrocnemius and tibialis anterior muscles of the involved limb. FES was provided during the gait cycle using force-sensing foot switches to detect gait phase transitions. The children ambulated using FES under 3 conditions (gastrocnemius on, tibialis anterior on, gastrocnemius and tibialis anterior on). For each condition, two 45-minute walking sessions were conducted per day for 1 week. Immediately after each week of practice, a gait analysis was performed at the subject's self-selected walking speed for that stimulation condition and without stimulation. Both children demonstrated improvements in ankle dorsiflexion angle at initial contact, peak dorsiflexion during swing, mean dorsiflexion during swing, and ankle work during early stance with tibialis anterior stimulation alone and combined gastrocnemius and tibialis anterior stimulation. Improvements in ankle work were found during late stance for both children with all stimulation conditions. These results suggest that percutaneous intramuscular FES was effective in improving aspects of ankle kinematics and kinetics of 2 children with hemiplegic CP.     

Effect of a single session of transcranial direct-current stimulation combined with virtual reality training on the balance of children with cerebral palsy: a randomized,controlled, double-blind trial

[Purpose] The aim of the present study was to investigate the effects of a single session of transcranial direct current stimulation combined with virtual reality training on the balance of children with cerebral palsy. [Subjetcs and Methods] Children with cerebral palsy between four and 12 years of age were randomly allocated to two groups: an experimental group which performed a single session of mobility training with virtual reality combined with active transcranial direct current stimulation; and a control group which performed a single session of mobility training with virtual reality combined with placebo transcranial direct current stimulation. The children were evaluated before and after the training protocols. Static balance (sway area, displacement, velocity and frequency of oscillations of the center of pressure on the anteroposterior and mediolateral axes) was evaluated using a force plate under four conditions (30-second measurements for each condition): feet on the force plate with the eyes open, and with the eyes closed; feet on a foam mat with the eyes open, and with the eyes closed. [Results] An increase in sway velocity was the only significant difference found. [Conclusion] A single session of anodal transcranial direct current stimulation combined with mobility training elicited to lead to an increase in the body sway velocity of children with cerebral palsy.Key words: Cerebral palsy, Electrical stimulation, Static balance     

Adult acetonemic vomiting complicated with low body weight in a subject with Mycobacterium avium complex pulmonary disease: a case report

Pulmonary diseases often cause significant health issues and nutritional disorders. Weight loss and malnutrition are related to the severity of obstructive disorders. Therefore, patients with such conditions often experience low nutritional energy. Acetonemic vomiting is caused by acetonemic syndrome. Previously, it was believe that acetonemic vomiting was observed only in childhood. However, it was recently suggested that acetonemic vomiting can also occur in adults. It is also considered that acetonemic vomiting can occur in subjects with low body weight because stored carbohydrate levels are reduced and fats are mainly used for energy. Consequently, large amounts of acetone are produced, ultimately resulting in nausea and vomiting. In this study, we report a case of adult acetonemic vomiting complicated by low body weight in a subject with Mycobacterium avium complex pulmonary disease.     

Physical strain of comfortable walking in children with mild cerebral palsy

Purpose.?To evaluate the physical strain of comfortable walking in children with mild cerebral palsy ((CP)) in comparison to typically developing ((TD)) children. Physical strain was defined as the oxygen uptake during walking ((VO_2walk)) expressed as a percentage of their maximal aerobic capacity ((VO_2peak)).

Method.?Eighteen children ((aged 8–16 years)) participated, including eight ambulant children ((four girls, four boys)) with mild spastic CP ((three hemiplegia, five diplegia, GMFCS I: n == 7 and II: n == 1)) and 10 TD children. VO_2walk was measured during 5?min of walking on an indoor track at comfortable walking speed. VO_2peak was measured in a shuttle run test.

Results.?VO_2walk was significantly higher in CP ((19.7 ((2.8)) ml//kg//min)) compared to TD ((16.8 ((3.6)) ml//kg//min, p == 0.033)), while walking speed did not differ significantly between groups. VO_2peak was significantly lower in CP ((37.2 ((2.2)) ml//kg//min)) compared to TD ((45.0 ((5.3)) ml//kg//min, p == 0.001)). Consequently, the physical strain during walking was significantly higher in CP ((52 ((7.7)) %%)) compared to TD ((36 ((8.4)) %%, p == 0.001)).

Conclusions.?The higher physical strain during comfortable walking of children with mild CP compared to TD children may be related to reported problems with fatigue in this population, and suggest a need for physical aerobic training programmes.     

Assistive technology for promoting adaptive skills of children with cerebral palsy: ten cases evaluation

Abstract

Objectives: To extend the use of assistive technology for promoting adaptive skills of children with cerebral palsy. To assess its effects on positive participation of ten participants involved. To carry out a social validation recruiting parents, physiotherapists and support teachers as external raters.

Method: A multiple probe design was implemented for Studies I and II. Study I involved five participants exposed to a combined program aimed at enhancing choice process of preferred items and locomotion fluency. Study II involved five further children for a combined intervention finalized at ensuring them with literacy access and ambulation responses. Study III recruited 60 external raters for a social validation assessment.

Results: All participants improved their performance, although differences among children occurred. Indices of positive participation increased as well. Social raters favorably scored the use of both technology and programs.

Conclusion: Assistive technology-based programs were effective for promoting independence of children with cerebral palsy.

• Implications for Rehabilitation

• A basic form of assistive technology such as a microswitch-based program may be useful and helpful for supporting adaptive skills of children with cerebral palsy and different levels of functioning.

• The same program may improve the participants' indices of positive participation and constructive engagement with beneficial effects on their quality of life.

• The positive social rating provided by external experts sensitive to the matter may recommend a favorable acceptance and implementation of the program in daily settings.

     

Physical function for children and youth with cerebral palsy: Item bank development for computer adaptive testing

The purposes of this paper are to: 1) present a conceptual framework that supports development of a computer adaptive test (CAT) outcome measure of physical functioning for children with cerebral palsy; 2) illustrate the development and refinement of an item bank for use in the CAT; and 3) describe the intended application of these newly developed items in a CAT platform. Improvement in physical functioning is one of the most important developmental and rehabilitative outcomes for children with cerebral palsy (CP). Computer adaptive testing technology provides means to improve outcome measures. We adopted a conceptual framework appropriate to support a CAT of physical functioning consisting of 4 sub-domains: lower extremity skills, upper extremity skills, physical activity, and global physical health. Review of existing tests and measures of physical function, expert clinician review, and cognitive testing were used to identify, develop and refine sets of items (item banks) that reflect the breadth of each sub-domain. These item banks will be used to develop contemporary parent-report instruments by application of Item Response Theory (IRT) analyses, leading to a CAT outcome measure. Such CAT approaches can efficiently assess broad areas of physical functioning across a wide age-range and levels of severity of children with CP.     

Improving care for children with cerebral palsy

A report about the health care of people with learning disability published by a UK charity concluded that this group was discriminated against and that healthcare professionals had a poor understanding of their needs. A case report of a young person with cerebral palsy is used here to demonstrate good practice in the care of children with learning disabilities. The careful development over time of individualised solutions makes a difference to the quality of life for children and families. Improved understanding through education as well as collaborative working and family participation will help ensure that children and young people receive the range of services they require.     

Effects of interactive games on motor performance in children with spastic cerebral palsy

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.Key words: Games, Motor, Pediatrics     

小儿脑性瘫痪242例临床分析

BACKGROUND：Childrencerebralpalsynotonlyaffectsthequalityoftheaffectedchildren＇slivesbutalsoburdensthefamilyandthesocietyheavily．Therefore，analysisofthediseaseanditscausesfromtheviewpointofclinicmighthelpfulintreatmentandpreventionofthedisease．OBJECTIVE：Clinicalstatusandcausesofthe２４２casesofcerebralpalsywereanalyzedinordertoprovidesomehelpinpre－ventionofthedevelopmentofchildrencerebralpalsy．UNIT：DepartmentofTraditionalChineseMedicine，ZhengzhouChildrenHospitalSUBJECTS…     

Pulmonary and extrapulmonary features in bronchopulmonary dysplasia: a comparison with healthy children

[Purpose] The aim of this study was to compare functional capacity and peripheral muscle strength in preterm children with bronchopulmonary dysplasia (BPD) with those of age-matched full-term healthy controls. [Subjects and Methods] Eighteen BPD subjects and 20 healthy subjects were enrolled in the study. Pulmonary function testing was performed. Body composition was determined using the skinfold method. An analysis of posture was scored. Muscle strength was evaluated using a dynamometer. Functional capacity was assessed using the six-minute walking test (6MWT). [Results] Pulmonary function testing parameters, 6MWT distance, and quadriceps strength of the children with BPD were significantly lower than those of healthy peers. The scores of posture analysis of the children with BPD were significantly higher than those of healthy subjects. Exercise heart rate was significantly higher in the children with BPD compared to healthy children. The 6MWT distance correlated with height, fat-free mass, exercise dyspnea perception, and hand grip strength in BPD children. [Conclusion] The study showed that preterm children with BPD had disturbed pulmonary and extrapulmonary characteristics. BPD had lower fat free mass, reduced lung function, worsen postural function, a shorter 6MWT distance, and lower quadriceps strength than healthy children. These features may provide insights into the choice of outcome measures for pulmonary rehabilitation for BPD.Key words: Bronhopulmonary dysplasia, Functional capacity, Lung function     

Relationship between activity limitations and participation restriction in school-aged children with cerebral palsy

[Purpose] This study investigated the relationship between activity limitation and participation restriction in school-aged children with cerebral palsy. [Subjects and Methods] Data were collected from 109 children with cerebral palsy aged 6–12 years. Activity limitations were assessed by using functional classification systems including the Korean-Gross Motor Function Classification System, the Korean-Manual Ability Classification System, and the Korean-Communication Function Classification System. Participation restriction was measured using the Korean-Frequency of Participation Questionnaire. Physical or occupational therapists and parents collected the data. [Results] All levels of the functional classification systems were significantly negatively correlated with Korean-Frequency of Participation Questionnaire ratings (r= −0.382 to −0.477). The Korean-Frequency of Participation Questionnaire ratings differed significantly with respect to the functional classification systems; in particular, the differences in the ratings of levels I and V were significant. The Korean-Communication Function Classification System and Korean-Gross Motor Function Classification System were significant predictors of participation, explaining 26.5% of the variance. [Conclusion] Intervention programs are required to promote communication skills and gross motor ability in order to improve the participation of children with cerebral palsy.Key words: Cerebral palsy, Functional classification system, Participation     

遗传性高氨血症误诊为小儿脑性瘫痪六例分析

遗传性高氨血症为小儿遗传性代谢疾病，国外资料表明其发病率1／3万，国内尚未见相关报道。1998～2004年我院收治6例，均误诊。本文总结临床资料并分析误诊原因。