Special considerations in counseling clients with cerebral palsy

Written from a professional and personal perspective, this article describes some of the key social and sexual issues facing people with cerebral palsy. Clients with cerebral palsy, disabled from birth and thus likely to have been socialized into a disabled, asexual role, often struggle with putting their disability into its proper perspective, demystifying sexuality, developing a positive body image, mastering essential social skills, and understanding their own sexual functioning. To be helpful, psychotherapists and counselors must sensitively address these issues while dealing with their own stereotypes and attitudes. Although the discussion focuses on cerebral palsy, there is considerable overlap and applicability to clients with other types of disabilities as well.ACSWThe term cerebral palsy, as used in this article, refers to amotor disability caused by brain damage, usually occurring at birth or in early childhood.     

Sexual counseling for cerebral palsied adults: Case report and further suggestions

A mildly cerebral palsied woman was seen for premarital counseling regarding sexuality and the bearing and rearing of children. A multidisciplinary approach was used; sexual counselors, a gynecologist, an orthopedist, and a geneticist met with the client for a total of 8 hr counseling time. This approach is suggested for sexual counseling for the more severely handicapped, as well as in cases of mild and moderate disability.     

Quantity concept development in individuals with cerebral palsy

Only a very small number of studies have been reported examining understanding of quantity conservation in individuals with cerebral palsy. The present investigation builds on two initial studies and breaks new ground focusing on order of concept development in this population compared to a non-handicapped one. Fifteen subjects, diagnosed as having spastic cerebral palsy from birth and attending the same special school or day unit, were tested on a wide range of quantity conservation tasks: number, substance, length, area, weight and volume. These individuals showed a similar sequence, in development of quantity concepts, to those without a handicap; scalogram analysis supported similarity in sequence. Indications of other similarities and differences were noted.     

Energy intakes of children with cerebral palsy

The energy intakes of 13 children [seven girls, six boys, mean age 10 years (s.d. 4; range 4–15 years)] with cerebral palsy attending a residential school were measured by 3-day weighed dietary record. Energy intake averaged 340 kj/kg per day (s.d. 93; range 102–424) which was higher than the group mean estimated energy requirement (271 kj/kg per day, s.d. 70; range 144–395). The mean coefficient of variation for day to day energy intake was 14%, and food energy not consumed (plate waste and food unsuccessfully ingested) averaged 22% of energy intake. Within the group there was little evidence of marked differences in energy intake between different diagnostic types of cerebral palsy or between children of different feeding/eating ability, although the sample size was too small to detect small between-group differences in intake. Energy intake was somewhat higher than that reported in some other studies, but there was no evidence of the unusually high energy intakes which have been reported previously in some groups of children with cerebral palsy.     

小儿脑性瘫痪病因学的研究进展

该文系统的介绍了脑瘫在早产、低出生体重、脑室周白质软化、孕期感染等病因方面所取得的最新研究进展，并讨论了研究时应注意的几个问题。脑瘫病因中遗传和环境因素致胚胎发育作用的研究亟待重视，制备并应用动物模型研究脑瘫已成为今后进一步研究的重要手段之一。     

脑性瘫痪儿童合并视功能障碍临床分析

【目的】对脑性瘫痪儿童视功能障碍的发生及相关因素进行探讨。【方法】对347例脑性瘫痪儿童进行常规眼科检查,并对其中合并视功能障碍的患儿的病因、其他并发症及脑瘫类型进行统计分析。【结果】脑瘫患儿视功能障碍的发病率为14.41%,其中主要的视功能障碍为斜视,发病率为11.53%。【结论】视功能障碍的康复是脑性瘫痪患儿整体康复的重要内容之一。     

脑瘫患儿的社区管理

目的:通过对脑瘫患儿进行社区化管理,提高脑瘫患儿的康复效果。方法:2010年1月～2012年1月选取某社区25例脑瘫患儿作为研究对象,将患儿进行分组,其中观察组患儿15例,对照组患儿10例。观察组患儿进行社区化管理康复培训,对照组患儿进行普通家庭式康复训练。利用GMFM级别评分对患儿进行粗运动评分,比较两组患儿的康复效果。结果:两组患儿治疗前GMFM评分不存在统计学差异(P>0.05),而观察组患儿经过6个月的个体化社区管理康复化训练后,其GM-FM的评分明显高于对照组患儿(P<0.05)。结论:有效的社区化脑瘫患儿康复管理有助于脑瘫患儿身体功能的恢复,目前越来越受到社区脑瘫家庭的重视。     

神经节苷脂对脑瘫患儿疗效的Meta分析

目的 评价神经节苷脂对脑瘫患儿的疗效及安全性,为其临床应用提供参考。方法 检索Pubmed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库及万方数字化全文期刊数据库,检索时间为建库至2015年10月。纳入有关神经节苷脂治疗脑瘫患儿的随机对照试验,对显效、有效率进行有序分类变量的Meta分析;对总有效率进行二分类变量的Meta分析;对患儿发育商评分(developmental quotient,DQ)进行连续变量的Meta分析。结果 共纳入10个随机对照试验,共计806例患儿,对显效、有效率分析,其相对危险度(odds ratio,OR)为2.63,95%CI:1.95~3.53;对总有效率进行分析,其OR值为4.74,95%CI:2.99~7.52;神经节苷脂使DQ评分提高,SMD=1.30,95%CI:0.33~2.27。结论 神经节苷脂对脑瘫患儿治疗效果良好,可改善患儿的症状。     

Children with cerebral palsy: severity and trends over time

Increasingly, more very-low-birthweight infants in the developed world are now expected to survive the neonatal period than was previously the case. There are concerns that there may be a related increase in the number of infants developing severe sensorimotor impairments. Pooled data from five registers contributing to the UK Network of Cerebral Palsy Registers, Surveys and Databases were used to identify patterns of motor impairment in relation to additional impairments and to birthweight, and to assess whether prevalence of cerebral palsy (CP) by birthweight and by severity of motor impairment had changed over time. Low-birthweight infants are at greater risk of developing CP than larger-birthweight babies.
The CP rate amongst children with birthweights <2500 g was significantly higher at 16 per 1000 livebirths [95% confidence interval (CI) 14.9, 16.2] than 1.2 per 1000 livebirths [95% CI 11, 1.2] for normal-birthweight children. Despite being at greater risk of developing CP, smaller-birthweight babies are proportionately less likely to develop the most severe forms of motor impairment. Of those born weighing ≥2500 g, 23% compared with 15% weighing <1000 g ( P  < 0.001) were in the most severely motor impaired group. Severe motor impairment is associated with higher levels of additional impairments. CP rates for each motor impairment group in the 1990s were similar to those in the late 1970s. Rates of CP among infants born below normal birthweight are high but have decreased over time. The CP rate for infants weighing 1000–1499 g at birth decreased from around 180 per 1000 livebirths in 1979 to around 50 per 1000 livebirths from the early 1990s onwards.     

Health status of caregivers of children with cerebral palsy

Background and Aims While a ‘Family‐Centered’ approach to care is accepted as best practice in the context of childhood disability, it may lead to increased demands on family members by requiring them to be active participants in their child's care. This may impact upon the physical and mental health of the caregiver and therefore needs to be investigated. This study aimed to assess the health status of caregivers of children with cerebral palsy (CP) in Ireland and to identify vulnerable subgroups. Methods A cross‐sectional postal survey was conducted using a questionnaire incorporating the SF‐36v2.0. The sample consisted of male and female caregivers of children with CP, representing all levels of ability. Two questionnaires were sent to each child's home; a total of 312 questionnaires were sent to the homes of 156 children. Results Completed questionnaires were returned by 161 caregivers (100 women, 61 men) of 101 children, giving a response rate of 65%. Caregivers of children with CP were found to have poorer health than the Irish general population, for whom normative data exist. Female caregivers had poorer health than male caregivers in both the physical (P < 0.05) and mental health (P < 0.001) domains of the SF‐36. Caregivers spending more time caring had significantly poorer mental health than those spending less time caring (P < 0.05). There was no difference in the health of caregivers of ‘more independent’ versus ‘more dependent’ children, apart from the latter group reporting higher levels of bodily pain (P < 0.05). Conclusion This study provides evidence of the inferior health status of caregivers of children with CP in Ireland, particularly that of women.     

高压氧治疗脑性瘫痪患儿疗效和安全性的Meta分析

目的评价高压氧对脑性瘫痪患儿的疗效及安全性,为临床应用提供指导。方法检索Pubmed、Embase、Cochrane library、CNKI、CBM、VIP、万方等数据库,筛选高压氧治疗脑瘫患儿的随机对照研究,由两位研究者评价纳入研究的质量、提取数据,采用RevMan 5.2.7软件统计分析。结果共纳入10项研究,含1 111例患儿。Meta分析结果显示:高压氧治疗并不能改善脑瘫患儿运动功能(MD=-5.64,95%CI:-13.98~2.71,P=0.19)、日常生活功能;能够改善肌张力(RR=3.38,95%CI:2.05~5.58,P0.05),提高发育商的显效率(RR=1.31,95%CI:1.02~1.69,P=0.04),降低无效率(RR=0.30,95%CI:0.19~0.50,P0.001),但原始研究质量低,可信度差。同时高压氧治疗过程中存在中耳气压伤、耳痛等不良反应。结论高压氧治疗对于可提高脑瘫患儿的各项功能状态的证据尚不充分,安全性也有待进一步评估,临床应用需谨慎。需要更多高质量临床研究进一步评价其疗效及安全性。     

脑性瘫痪患儿共患癫痫的危险因素

目的 了解脑瘫患儿高危因素、临床特点及其与癫痫发生的关系,探讨脑瘫患儿共患癫痫的危险因素。方法 回顾性收集从2019年1月—2022年2月在郑州大学第三附属医院住院治疗的脑瘫患儿的病例资料,将患儿分为脑瘫共患癫痫组和未共患癫痫组,采用χ²检验分析两组间高危因素、临床特点等资料,应用多因素Logistic回归对共患癫痫的危险因素进行分析。结果 共纳入630例脑瘫患儿,其中男421例,女209例;脑瘫共患癫痫组患儿155例,未共患癫痫组患儿475例,癫痫发生率24.6%。脑瘫共患癫痫组患儿在宫内窘迫、窒息、多胎及新生儿先天性畸形史方面的发生率高于未共患癫痫组患儿(χ²=4.788、9.368、5.255、12.111,P<0.05),两组患儿在脑瘫分型、头颅MRI分类、粗大运动功能分级方面差异有统计学意义(χ²=213.686、14.640、481.531,P<0.05)。多因素Logistic回归结果显示,痉挛型四肢瘫(OR=14.090,95%CI:1.950～101.813)、新生儿先天性畸形史(OR=1....     

Evaluating therapy in cerebral palsy

Summary The optimal design for most clinical trials of treatment is the randomized controlled group trial. This methodology is not, however, uniformly applicable or appropriate. The evaluation of physiotherapy in the management of cerebral palsy in childhood is a good example of treatment for which modification of this trial design is needed. Some of the problems with eight studies in this field published between 1960 and 1993 are reviewed here and an alternative approach proposed. A representative series of single case studies with individual goal setting and a validated outcome measurement, using randomized treatment, would overcome many of the disadvantages of published studies at a greatly reduced cost. The results would enable more effective group trials to be mounted in due course to evaluate the probable impact of providing treatment to a defined population of subjects.     

The development of understanding of quantity in children with cerebral palsy

Very few studies have been reported examining understanding of quantity conservation in children who are physically handicapped. Even fewer focus on conservation concepts in children with cerebral palsy. One study has attempted to teach three such children. There is a clear need to explore the extent of development of conservation in cerebral palsied children and to reveal processes in their developing understanding when they are given specific teaching. Individual differences are particularly great and appropriate adaptation of task presentation and criteria for understanding are necessary. Detailed case studies are important. Here two boys, close in age, diagnosed as having spastic cerebral palsy from birth, and attending the same special school, are studied. Pretested for conservation of six attributes, given teaching designed to advance their understanding from their initial level, and posttested, they were found to have increased their understanding. They both improved their performance on conservation tasks, showed generalised understanding, and clearly gained from the experiences and explanations of conservation included in the teaching. The findings have both theoretical and practical implications which encourage further investigation.     

脑性瘫痪儿童胃食管返流的研究

[目的]探讨脑性瘫痪对胃食管返流的影响,为临床及时干预提供依据.[方法]利用便携式食管24h连续PH动态监测仪分别检测20例脑性瘫痪组儿童及20名无胃食管返流症状儿童的24 h食管PH值.[结果]脑性瘫痪组儿童的各项参数均明显高于对照组,两组总PH值＜4的时间百分比(%)脑性瘫痪组、对照组分别为(15.89±11.04)与(1. 88±1. 01)、酸性返流发生的总次数为(次/24 h)309.02±165.60与14.73±7.20、返流持续超过5 min的次数为(次/24 h)5.64± 3.52与1. 02±0.90、返流持续的最长时间(min)为23.38±1 3.40与4.50±1.90、DeMeester评分为61. 42±58.15与2.20±3.50,差异均有非常显著性(P＜0.01).[结论]脑性瘫痪可以引起胃食管返流,应及时给予干预治疗.     

Coping with chronic pain associated with cerebral palsy

Fifty-nine adults with cerebral palsy (CP) were administered, via in-person interviews, measures of pain intensity, pain-related disability, and psychological functioning, in addition to a measure of pain coping (Waldron/Varni Pediatric Pain Coping Inventory; PPCI). Regression analyses indicated that the PPCI scales made a nonsignificant contribution to the prediction of pain intensity, but did make a significant contribution to the prediction of psychological functioning when controlling for pain intensity. Only the PPCI Catastrophizing subscale made a significant independent contribution to the prediction of psychological functioning, and only the PPCI Seek Social Support subscale made a significant independent contribution to the prediction of pain-related disability. These findings support a link between coping and functioning among adults with CP, and suggest that catastrophizing responses and some aspects of support seeking may be maladaptive for coping with CP-related pain. Limitations of the study include a correlational design, a reliance on self-report data, and a small subject population. Experimental research is needed to determine if changes in coping lead to changes in psychological and physical functioning.     

Feeding problems in a child with cerebral palsy

This case study describes the feeding problems that occurred in a child with cerebral palsy as a result of severe gastro-oesophageal reflux, oral-motor dysfunction and behavioural aversion. Nutritional management over the first(r)2 years of life is discussed. It illustrates the benefit of working in a multi-disciplinary team.     

Gastrooesophageal reflux in children with cerebral palsy

Summary Feeding difficulties, vomiting and recurrent chest infections associated with poor growth and nutrition are common in children with cerebral palsy (CP). However, the role of gastrooesophageal reflux as a possible cause has been little studied. We therefore investigated 23 children with cerebral palsy (median age 2–3 years, range 0–6-11-8) whose symptoms were consistent with gastrooesophageal reflux (severe feeding difficulties 70%, failure to thrive 52%, anaemia 31% and recurrent chest infections 31%). Using 24-hour ambulatory oesophageal pH monitoring, we determined the relationship between gastrooesophageal reflux and: (a) developmental age (Griffith's scales); (b) feeding behaviour skills score; (c) nutritional status and (d) clinical assessment of cerebral palsy (type and severity). Abnormal gastrooesophageal reflux (i.e. reflux index > 5%) was detected in 16 (70%) patients (median reflux index 11–4%; range 5·4–59%).
Reflux was unrelated to chronological or developmental age, but there was a significant, unexplained association with male gender ( P < 0·01). No correlation was found with feeding behaviour skills score, malnutrition (which was commonly severe) and type and severity of cerebral palsy. We conclude that gastrooesophageal reflux is common and should be sought in symptomatic, neurologically handicapped children as effective treatment is likely to improve quality of life.