The effects of weight gain over time on gait in children with cerebral palsy: Comparison to a matched healthy weight cerebral palsy control group

BackgroundChildren with cerebral palsy (CP) have demonstrated higher rates of overweight and obesity than their typically developed peers. Limited studies have assessed how being overweight or obese affect lower limb kinematics during gait in these children.Research questionHow are lower limb kinematics during gait affected in children with CP who progress from a healthy weight to being overweight or obese compared to a well-matched healthy weight CP control group?MethodsA retrospective analysis of the movement analysis laboratory database was conducted.Children with CP were included if they were aged between 4 and 17 years at baseline,had a follow-up assessment with a minimum of 12 months between assessments, and had no orthopaedic interventions between assessments. A matched control group of children with CP with the same inclusion criteria, except for a requirement of healthy BMI at follow-up, was included. Temporal-spatial and full 3-dimensional lower limb kinematic data were examined.ResultsNormalized speed and step length reduced from baseline to follow-up for both groups,with no difference in the amount of change between groups. Children with increased BMI demonstrated increased external hip rotation during stance at follow-up not evident in the control group.SignificanceResults demonstrated similar changes over time between groups. Increased external hip rotation in children with increased BMI was considered small and within the threshold of error associated with transverse plane kinematics. Our results suggest that being overweight or obese does not result in a meaningful change in lower limb kinematics in children with CP.     

The impact of being overweight on the mobility,temporal-spatial and kinematic aspects of gait in children with cerebral palsy

AimObesity causes altered gait patterns in typically developing children, but its effect on gait in children with physical disabilities is largely unknown. This study explores associations between body mass index (BMI), functional mobility and gait in children with cerebral palsy (CP).MethodAn observational cross-sectional study was conducted using three-dimensional gait analysis data from 197 children with CP, Gross Motor Functional Classification System (GMFCS) levels I to III. BMI values were categorised using the Centres for Disease Control and Prevention (2000) BMI percentiles, which are specific to age and gender. Regression analyses, with GMFCS level as a covariate, explored associations between BMI category and temporal-spatial, kinematic and functional mobility variables. Analyses included children categorised as healthy weight and overweight/obese only (n = 174), with underweight children excluded (n = 23).Results131 children (mean age 10.5 years, SD 3) were categorised as healthy weight and 43 children (mean age 9.6 years, SD 2.5) as overweight or obese. BMI was not associated with most gait variables. Increased double support time, reduced hip extension and increased ankle dorsiflexion were observed in children that were overweight, but most differences were small and of uncertain clinical significance. A lower proportion of overweight children walked independently over 500 m.ConclusionWe found little evidence that BMI has a substantial influence on gait patterns in children with CP but some to suggest it may affect long-distance mobility. Different research strategies are required to improve understanding of relationships between adiposity, strength and function, for effective targeting of interventions to improve mobility.     

脑性瘫痪的危险因素研究进展（综述）

脑性瘫痪目前发病率有上升趋势,病因相当复杂,其危险因素按脑损伤发生的时间常分为产前因素、产时因素和产后因素。以前普遍认为,产时和产后因素是脑瘫的主要原因,但近年来认为,产前因素是脑瘫的主要病因,产时和产后危险因素很可能是产前因素导致的结果变量,而不是脑瘫的直接病因。     

脑性瘫痪患儿家长社会支持与患儿遵医行为调查分析

目的:了解脑性瘫痪(CP)患儿家长的社会支持状况与患儿遵医行为关系。方法:采用社会支持评定量表(SSRS)和自行设计调查问卷对62例CP患儿家长进行调查分析。结果:SSRS高分组与低分组相比,高支持组患儿家长完全按时复诊(70.97%)、完全遵照日常指导进行功能锻炼(51.61%),完全不按时复诊(0.00%)、完全不遵照日常指导进行功能锻炼(0.00%)与低支持组(分别为29.03%、6.45%、35.48%、45.16%)比较,差异均有统计学意义(P<0.001),而不完全按时复诊(29.03%),不完全遵照日常指导进行功能锻炼(48.39%)与低支持组(分别为35.48%、48.39%)比较差异无统计学意义(P>0.05)。结论:社会支持对CP患儿遵医行为有明显促进作用,通过加强CP患儿家长社会支持的一系列有效措施,可以提高遵医行为,医护人员在患儿家长社会心理护理中起到重要作用。     

脑瘫儿童父母睡眠质量的调查分析

目的 了解脑瘫儿童父母的睡眠情况.方法 采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表作为调查工具,对36例脑瘫儿童的父母和36例正常儿童的父母的睡眠情况进行调查.结果 脑瘫儿童父母睡眠质量问题报告率为34.72％,正常儿童父母睡眠质量问题报告率为19.44％,差异有统计学意义(x2=4.255,P＜0.05).脑瘫儿童父母PSQI总分(5.72±3.54 vs 3.19±2.76,t=3.380,P＜0.01)、主观睡眠质量(1.33±0.83 vs 0.78±0.34,t=3.371,P＜0.01)、入睡时间(1.28±0.88 vs 0.72±0.36,t=3.027,P＜0.01)、睡眠时间(1.16±0.72 vs l.01±0.62,t=2.278,P＜0.05)、睡眠障碍(1.23±0.56 vs 0.75±0.28,t=2.949,P＜0.01)得分与正常儿童父母相比,差异有统计学意义；脑瘫儿童母亲PSQI总分(6.21±0.85 vs 4.32±0.73,t=3.380,P＜0.01)、主观睡眠质量(1.14±0.73 vs 0.89±0.66,t=2.986,P＜0.01)、入睡时间(1.22±0.81 vs 0.96±0.83,t=2.853,P＜0.01)、睡眠时间(1.09±0.66 vs 0.85±0.71,t=2.136,P＜0.05)、睡眠障碍(1.15±0.63 vs 0.83±0.62,t=2.513,P＜0.01)、日间功能影响(1.19±0.43 vs0.88±0.62,t=2.586,P＜0.01)得分与父亲相比,差异有统计学意义.结论 脑瘫儿童父母存在一定的睡眠质量问题,值得关注.     

糖尿病酮症酸中毒合并脑瘫患儿1例护理体会

报道1例糖尿病酮症酸中毒合并脑瘫患儿的护理。根据糖尿病酮症酸中毒合并脑瘫患儿的病情,提出切实有效的护理措施,促进患儿康复。     

脑性瘫痪致病因素与干预措施

目的:探讨小儿脑性瘫痪(脑瘫)相关的致病危险因素,制定降低脑性瘫痪发生率的相关措施。方法:对2002年6月～2005年6月在湖北省妇女儿童医院小儿神经康复科就诊的560例脑瘫致病危险因素进行回顾性分析。结果:560例脑瘫的致病因素按发生频度,排在前6位的分别是早产、低出生体重、窒息、母亲因素、多胎、黄疸。结论:加强孕期和围产期母婴保健,不断提高产前诊断水平,加强地区性新生儿急救转运网络建设,提高新生儿急救水平和基层医务人员业务水平是降低脑瘫发生率的重要措施。     

50例脑瘫患儿母亲心理健康评价

目的：了解脑瘫患儿母亲的心理健康状况。方法：对我院门诊确诊的50例脑瘫患儿母亲采用与正常儿童母亲1：1配对方法，填写症状自评量表(SCL—90量表)。结果：脑瘫患儿母亲SCL—90量表评分除因子9(精神病性)外，各因子得分均高于对照组，2组相比差异均有显著性(P＜0．01)；脑瘫患儿母亲年龄越大、文化程度越低，SCL—90得分越高，差异有显著性(P＜0．0l，P＜0．05)，母亲职业、家庭人均月收入、居住地不同，SCL—90得分比较差异无显著性(P＞0．05)。结论：脑瘫患儿母亲较正常儿童母亲出现更多、更为严重的躯体、情感等方面的症状。     

Psychological well‐being among mothers of children with cerebral palsy

Little is known about the proportion of mothers of children with cerebral palsy (CP) who experience distress, particularly in terms of depressed and anxious moods. The present study aimed to address this issue by examining the level of maternal anxious and depressed moods. The associations between maternal psychological well‐being and self‐efficacy and perception of children’s eating, sleeping and mobility were also examined. The sample comprised 78 mothers (mean age, 37 years; standard deviation, 7.91) of children with CP aged < 16 years of age. Data were collected by self‐administered questionnaires based on standard measures of anxious and depressed moods that were mailed to mothers. Results showed 29.8%, 26% and 11.7% of mothers were at low, moderate, and high risk of clinically anxious mood compared with population female norms of 23%, 13%, and 3%, respectively. A total of 22.1% and 19.5% of mothers were at low and moderate risk of clinically depressed mood compared with norms of 9% and 4%, respectively. Anxious and depressed moods were inversely associated with generalised self‐efficacy (p = 0.001) and anxious mood was inversely associated with children’s sleeping difficulties. In conclusion, levels of maternal psychological well‐being are a cause for concern and warrant exploration of interventions that will reduce maternal distress, and increase self‐efficacy.     

Factors associated with self-esteem in pre-adolescents and adolescents with cerebral palsy

Predictors of self-esteem were examined in 50 pre-adolescents and adolescents with cerebral palsy. On average, self-esteem was high, although 30% scored below a cut-point for low self-esteem. Self-esteem was bivariately associated with female gender, better physician-assessed functional ability, greater perception of the impact of the disability, and higher perceived parent overprotectiveness. In a multivariate model, only perceived impact of the disability remained significant.     

Factors affecting social participation of Iranian children with cerebral palsy

Abstract

The purpose of this study was to identify the factors affecting the social participation of Iranian children with cerebral palsy (CP). Participants were 274 (male?=?62%; female?=?38%) children with CP, 6- to 12-years old (mean?=?1.64) and their parents. Several standardized measures were used to assess social participation, gather environmental factors, and demographic questionnaires. The results of stepwise linear regression analysis indicated that the type of CP, Manual ability level and cognitive level (IQ) appear to be strong predictors of social participation between personal and environmental factors.     

脑性瘫痪危险因素分析

目的探讨脑性瘫痪的危险因素。方法利用本省病残儿数据库资料,应用Logistic回归模型,对992例脑性瘫痪患儿和627例后天伤残儿童做对照进行危险因素分析。结果脑性瘫痪组患儿分娩方式异常(26.3%)、异常分娩(44.3%)、母亲患先天性遗传性疾病(1.4%)、母亲孕期感染(23.5%)、母亲孕期服药(13.1%)、妊娠合并症(31.6%)、父亲工作环境接触化学物质(32.5%)和有烟酒嗜好(55.3%)与对照组(6.7%、11.8%、0.6%、10.0%、4.3%、19.9%、10.4%和25.8%)比较,差异有统计学意义(P<0.01);Logistic回归模型分析,分娩方式异常、异常分娩、母亲患有先天性遗传性疾病、母亲孕期服药、孕期感染、妊娠合并症、父亲工作接触化学物质及烟酒嗜好进入模型。结论在母亲患有先天性遗传性疾病、孕前用药、感染、父亲工作环境接触化学物质及患病等情况下,建议不要受孕,一旦受孕应当进行产前诊断和孕期诊断。     

小儿脑性瘫痪危险因素研究

目的探讨小儿脑性瘫痪（简称脑瘫）发病的危险因素。方法对51例脑瘫患儿及102例对照进行以医院为基础的1∶2配比病例对照研究,所获数据采用条件Logistic回归分析。结果单因素分析提示,类似疾病家族史、孕母高龄、孕母反复阴道流血、早产、低出生体重、新生儿窒息、核黄疸、颅内出血,特别是新生儿窒息和早产（OR=11.043和OR=5.975）与小儿脑瘫的发生有关联。多因素分析结果显示,低出生体重、类似疾病家族史、早产、新生儿窒息、孕母高龄为其发病的主要危险因素。结论脑瘫发病的相关危险因素主要集中在孕期和围产期,积极预防和消除各种致病危险因素,可降低脑瘫的发病率。     

Early indicators of cardiovascular disease are evident in children and adolescents with cerebral palsy

BackgroundCardiovascular disease (CVD) is a leading cause of early mortality among young adults with cerebral palsy. While low physical activity in childhood has been hypothesized as a potential contributor to increased CVD risk in early adulthood, little is known about timing of vascular disease progression and the presence of subclinical atherosclerosis has not been extensively evaluated in children with cerebral palsy.ObjectiveThe aim of this study was to determine if measures of vascular structure and function are different between children and adolescents with and without cerebral palsy.MethodsIn this cross-sectional study, we measured carotid intima-media thickness (CIMT), and brachial artery flow-mediated dilation (FMD) of children with and without cerebral palsy. Group means for CIMT and brachial artery FMD absolute (FMDA) and percent of relative change (FMDR%) were compared using Wilcoxon rank-sum tests.ResultsA total of 26 children and adolescents with cerebral palsy (46.1% girls, mean age = 15.0 ± 2.0 years) and 19 controls (68.4% girls, mean age = 13.3 ± 2.6 years) participated. Children with cerebral palsy had significantly greater average CIMT (0.43 ± 0.02 mm) than children without cerebral palsy (0.41 ± 0.01 mm, p = 0.04), and lower FMDA (0.16 ± 0.15 mm vs. 0.29 ± 0.20 mm; respectively, p = 0.03).ConclusionsChildren and adolescents with cerebral palsy may exhibit impairments in vascular structure and function which represent an increased risk of premature atherosclerosis compared to children without cerebral palsy. Additional research to identify risk factors specific to children with cerebral palsy that would support the development of effective screening processes for early identification would enable clinicians to implement targeted preventive strategies.     

应用Peabody量表指导脑瘫患儿康复的效果观察

目的:探讨Peabody运动发育量表(PDMS-2)评估方法对脑瘫患儿各运动能区发育水平的判断,评价其配套训练方案在改善患儿运动技能中的应用价值。方法:选取0～6岁脑瘫患儿200例,随机分成两组,观察组和对照组,用PDMS-2量表进行运动发育水平评估,对照组采用常规康复治疗,包括运动疗法(主要是Bobath疗法)、理疗等,观察组采用在常规康复治疗的基础上,指导家长参与根据PDMS-2评估结果运用其配套训练方案对观察组进行干预,6个月后再次运用PDMS-2量表对两组患儿各运动能区发育水平进行评估。结果:干预前对照组粗大运动商(GMQ)、精细运动商(FMQ)和总运动商(TMQ)与干预组之间差异无统计学意义(P0.05);干预后评估显示两组患儿运动技能都有所提高,但观察组GMQ,FMQ和TMQ均显著大于对照组(P0.05)。结论:PDMS-2评估方法对脑瘫患儿各运动能区发育水平有很好的评估作用,其配套训练方案对提高患儿的运动技能很有价值。     

Time use patterns in ambulatory adolescents with cerebral palsy

Background No studies to date have examined the daily time spent across a variety of activity types (sleep, screen time, physical activity, domestic and school‐related) in children with cerebral palsy (CP). Aim To investigate the activity patterns of adolescents with CP and contrast them with those of typically developing (TD) adolescents, using a use‐of‐time approach. Methods Forty‐one Australian adolescents with CP and 82 TD adolescents matched for age, sex, weight status and socio‐economic status undertook structured interviews using a validated computerized use of time recall administered over 4 days. Time devoted to sleep, screen time, physical activity, domestic and school‐related activity were compared using anova and Mann–Whitney tests. Results Adolescents with CP spent less time in physical activity (91 vs. 147 min/day, P= 0.0003), and in particular, its sub‐components of active transport (28 vs. 52 min/day, P= 0.0013) and team sports (25 vs. 39 min/day, P= 0.04). They experienced significantly more quiet time (116 vs. 80 min/day, P= 0.0025) but spent less time in social interaction (6 vs. 22 min/day, P= 0.0016). There were no significant differences in sleep, screen time, domestic activities or school‐related time. Conclusions By and large, the activity patterns of ambulatory adolescents with CP were similar to their TD peers. Results highlight physical activity in younger adolescents (11–13 years) as an area for targeted interventions.     

小儿脑性瘫痪的防治进展

脑性瘫痪（cerebral palsy,CP,以下简称脑瘫）是以非进展性中枢运动障碍和姿势异常为主要表现的临床综合征,本文就脑性瘫痪的治疗进展和预防进行复习并综述。