Longitudinal study evaluating a seating system using a sacral pad and kneeblock for children with cerebral palsy

Purpose. Adaptive seating systems using sacral pads and kneeblocks are commonly used throughout the UK with children with complex motor disorders to improve their posture and stability in sitting. We sought to evaluate how effective these systems are for a group of children with cerebral palsy.

Method. A six-visit trial was performed to examine whether this combination controls pelvic and hip positioning. Twenty-three children with cerebral palsy aged 7 – 14 years participated (11 females and 12 males). The kneeblocks (active intervention) were removed for a period in the middle of the trial. Force exerted through the kneeblock, pressure exerted on the sacral pad and postural alignment was measured for change.

Results. Statistically significant differences before and after kneeblock removal were found for force at the kneeblock, but no difference was found in pressure at the sacral pad. No statistically significant correlations between force and pressure or posture were found.

Conclusion. The results indicate that seating systems using a sacral pad and kneeblock may not improve overall posture but may improve hip position in children with cerebral palsy.     

A preliminary study describing body position in daily life in children with severe cerebral palsy using a wearable device

Purpose.?The effects of gravity and immobilisation are regarded as factors in the development of spinal deformity in cerebral palsy (CP). This study was to assess the body positions in daily life of children with CP using a wearable device.

Method.?Four institutionalised children with severe quadriplegic CP participated in this study. Four age-matched children without disability also participated as healthy controls. The participants wore a body position recorder throughout their normal daily activities for a period of 24?h. After the body position data were recorded, the amount of time spent by each subject in upright, supine, prone, and left and right lateral lying positions and the frequency of positional change were computed.

Results.?The pattern of body position change in daily life was clearly different among children with CP and between children with CP and healthy controls. Children with CP spent less time in the upright position and remained in one position for longer periods of time than the control children.

Conclusions.?Twenty-four-hour monitoring could provide quantitative information about body position, the frequency of body position changes and the period of time spent in a preferred body position, with possible implications for preventing spinal deformity.     

Effects of lateral electrical surface stimulation on scoliosis in children with severe cerebral palsy: a pilot study

Purpose: To evaluate the effects of lateral electrical surface stimulation (LESS) on scoliosis and trunk balance in children with severe cerebral palsy (CP).

Methods: Children with severe CP (GMFCS level IV or V) and stationary or progressive scoliosis were enrolled. Children were recommended of two sessions of LESS/day, 1?h/session, for 3 months at home: at 40–80?mA intensity, 200?μs pulse width, 25?Hz frequency, on for 6?s and then off for 6?s on the convex side of the trunk curve. Radiologic (Cobb’s, kyphotic, and sacral angles) and functional [gross motor function measurement (GMFM)-88 sitting score, and trunk control measurement scale (TCMS)] measurements were evaluated at 4 periods: (a) 3 months before, (b) just before, (c) 1 month after, and (d) 3 months after LESS.

Results: The median Cobb’s angle of 11 children (median age, 9 years) was 25°, and it showed significant improvements after both 1 and 3 months of LESS. The LESS intensity correlated with the improvement of GMFM-88 siting score. The parents or main caregivers of the children believed LESS had several positive effects without major adverse effects.

Conclusions: LESS is effective in scoliosis in children with severe CP and it may improve trunk balance.

• Implications for rehabilitation

• Scoliosis is a very complicated problem for the children with severe CP.

• They do not have many options for treatments and scoliosis is usually refractory.

• Lateral electrical surface stimulation (LESS) is effective in scoliosis in children with severe CP and it may improve trunk balance.

• LESS may be another option of managing stationary or progressive scoliosis in the children with severe CP who are unable to undergo surgery.

     

A comparative exploration of the thoughts of parents and therapists regarding seating equipment for children with multiple and complex needs

Purpose. We investigated the opinions of parents and therapists of children using adaptive seating systems in order to understand their common areas of interest or disagreement.

Method. Parents and therapists participated in answering a questionnaire regarding their child's response to, and comfort in their individual adaptive seating system. The children all had a motor disorder involving all four limbs and did not have verbal communication skills. Questionnaire was analysed using non-parametric statistics for quantitative questions and by keyword analysis of qualitative questions. The results were then further categorized into the domains of the International Classification of Functioning, Disability and Health (ICF).

Results. Parents and therapists showed differences in key areas: Parents concentrated on personal and environmental factors to explain their satisfaction or otherwise of the chair, whereas therapists concentrated on body function and structures; to the exclusion of all other domains of seated function.

Conclusions. Based on these findings, we suggest further investigation of these seating systems, concentrating on the activity and participation of the children themselves, although considering all domains of functioning.     

Management of seating posture of children with cerebral palsy by using thoracic-lumbar-sacral orthosis with non-rigid SIDO frame

Purpose. To investigate the effects of a special seating device: Thoracic-lumbar-sacral orthosis with non-rigid SIDO® frame (TLSO-SIDO®) in non-ambulant children with cerebral palsy.

Method. A prospective study with matched pairs (the same subject pre- and post-intervention) was carried out. A comparison of the lateral view of thoracic-lumbar spine X-ray before and after TLSO-SIDO® application was made. The assessment of changes in daily activities, posture was recorded by questionnaires. A total of 47 children with cerebral palsy at a mean age of 53.2 months ± 30.1 SD were involved in the study; 15 (35.71%) of the 42 children showed significant problems in feeding at the beginning of the study period, they were identified as a special subgroup with feeding difficulties.

Results. The mean pre-TLSO-SIDO® thoracic kyphosis was 53.7 ± 16.2 in Cobb angle, while the post-TLSO-SIDO® thoracic kyphosis was 47.2 ± 12.1. The lumbar lordosis was 21.3 ± 13 and in the TLSO-SIDO® 17.8 ± 11.9. The majority of the children have shown improvement in the feeding items and in posture (trunk, head and extremities). The overall satisfaction of the parents with the TLSO-SIDO® was very good, namely 3.972 ± 0.796 on the 5-point analogue scale. We did not find a direct correlation with the improvement in the separate items and the overall satisfaction.

Conclusion. It is extremely difficult to measure the effect of the postural management on the development of children with cerebral palsy. According to the results of the study, regular application of the TLSO-SIDO® in children with spastic cerebral palsy had a beneficial effect on feeding problems and on posture.     

Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia cerebral palsy

Purpose: Early identification and intervention with conservative measures is important to help manage hip dysplasia in children with a high adductor and iliopsoas tone and delay in weight bearing. The effect of a daily standing program with hip abduction on hip acetabular development in ambulatory children with cerebral palsy was studied. Method: The participants were 26 children with spastic diplegia cerebral palsy (CP), classified at Level III according to the Gross Motor Function Classification System (GMFCS). Thirteen children stood with hip abduction at least 1 h daily from 12 to 14 months of age to 5 years with an individually fabricated standing frame with hip abduction. Results: At the age of 5 years, radiologic results of the study group were compared with a comparison group of 13 children with spastic diplegia CP who had not taken part in a standing program. The migration percentage in all children who stood with abduction remained within stable limits (13–23%) at 5 years of age, in comparison to children who did not stand in abduction (12–47%) (p?Conclusions: The results indicate that a daily standing program with hip abduction in the first 5 years may enhance acetabular development in ambulatory children with spastic diplegia CP.

• Implications for Rehabilitation

• Abnormal acetabular development is a problem related to mobility problems and spasticity muscles around the hip.

• The literature suggests that postural management and standing programs could reduce levels of hip subluxation and increase function in children with cerebral palsy.

• A standing program with hip abduction can be a beneficial to develop more stable hips in children with spastic diplegic GMFCS level III.

     

The use of pressure mapping for seating posture characterisation in children with cerebral palsy

Purpose.?To investigate the feasibility of using pressure mapping for the characterisation of the seated posture of children with cerebral palsy (CP).

Method.?Analysis of pressure mapping readings and video of children seated in a seating system during two assessments: The first assessment involved the pressure mapping of non-disabled children during a standardised protocol, and the second one involved the pressure mapping of children with CP performing daily life activities.

Results.?It was possible to detect periods of activity of the children from pressure readings using the mean variation of pressure. Additionally, several parameters stemming from pressure readings were shown to be successful in assessing the posture of the children. The centre of pressure when positioned relative to the ischial tuberosities, allowed for recognition of ‘adverse postures’ involving pelvic obliquity/medio-lateral trunk flexion or antero-posterior pelvic tilt/trunk flexion-extension, as deviations from the centre point. The angle between the principal axis of the sensors' pressure and the medio-lateral axis of the seat was also proposed to characterise pelvic transverse rotation but could not be tested with the actual protocol.

Conclusions.?Pressure monitoring can be used to assess qualitatively and quantitatively sitting posture of children with CP.     

Changes in postural alignment when using kneeblocks for children with severe motor disorders

Purpose. Children with severe motor disorders often use adaptive seating devices to improve their postural alignment with aim of helping to prevent the development of deformity. Little objective evidence exists about their effectiveness, and this study sought to measure changes in postural alignment when using/not using the active element in one adaptive seating system.

Method. A seating system that uses a sacral pad and kneeblock was examined. This seating device aims to neutralize the angular deviation of the hips and pelvis in order to give a stable base for functional sitting. Change in postural alignment was measured in 23 children with severe motor impairment (GMFCS 5) when using and when not using the kneeblock devices, immediately, and after a delay of one month.

Results. We found that the removal or replacement of kneeblocks effected hip abduction and rotation on one side only, but no other immediate effect on joint angles and overall body posture.

Conclusions. The postural management of children with neurological conditions requires further objective outcome measurement on which to base clinical practice, and improvement of posture is one of a number of factors which should be considered when providing adaptive seating to this group of children.     

The psychosocial well-being of parents of children with cerebral palsy: a comparison study

Purpose.?Parents of children with cerebral palsy (CP) may be at risk from poor psychosocial well-being, compared with parents of children without a long-term health condition (LTHC). However, research has produced some conflicting findings on the topic and no comparison studies have been conducted in the UK. Furthermore, studies have only used measures of negative psychosocial well-being. The aim of this study was to conduct a comparative study of parents of children with CP and parents of children without a LTHC in the UK.

Method.?Seventy parents of children with CP and 70 parents of children without a LTHC completed self-administered questionnaires, comprising measures of psychosocial distress and positive psychosocial well-being.

Results.?This study demonstrated that parents of children with CP have significantly poorer psychosocial well-being compared with parents of children without a LTHC: parents of children with CP had lower satisfaction with life and higher levels of anxious and depressed mood.

Conclusions.?These results suggest caring for a child with CP may put parents at risk from poor psychosocial well-being. Interventions to improve parental well-being are urgently needed.     

What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR)

Purpose: To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh.

Materials and methods: We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0–18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software.

Results: A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were ?2.8 (standard deviation 1.8), ?3.1 (standard deviation 2.2) and ?1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy.

Conclusions: The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh.

• Implications for Rehabilitation

• Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh.

• Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs.

• Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries.

• Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population.

     

Pain and fatigue consistency in adults with cerebral palsy

Purpose.?To examine the consistency of pain and fatigue and describe pain interference with daily activities in ambulatory (AMB) and non-ambulatory (non-AMB) adults with cerebral palsy (CP) over a 3-month period.

Method.?A repeated measures design with 26 participants (12 AMB, 14 non-AMB) acting as their own controls. Pain and fatigue data were collected once per month for three consecutive months using the FACES pain scale and PedsQL? Multidimensional Fatigue Scale. Pain interference with daily life was assessed using the Pain Disability Index (PDI).

Results.?No significant differences were found in maximum pain intensity. AMB reported significantly fewer pain sites in the whole body during month 1 than non-AMB. Fatigue was consistent across months; however, AMB reported significantly more General fatigue. Across groups, significant correlations were found between PDI and General, Resting, and Overall fatigue. Non-AMB exhibited significant correlations between total number of pain sites and General and Cognitive fatigue, as well as PDI and Overall fatigue. For the AMB group, PDI and total number of pain sites were significantly correlated.

Conclusions.?Pain and fatigue consistently and significantly affect adults with CP. Both factors impact the ability of adults, who have CP, to participate in daily life.     

Test-Retest repeatability of gluteus maximus strength testing using a fixed digital dynamometer in children with cerebral palsy

OBJECTIVE: To investigate the test-retest repeatability of the measurement of the gluteus maximus strength using a fixed digital dynamometer. DESIGN: Test-retest design. The strength of the gluteus maximus was measured in prone position during 2 sessions an average of 6 days apart. SETTING: Gait analysis laboratory. PARTICIPANTS: Eleven children with spastic diplegic (n=10) and hemiplegic (n=1) cerebral palsy (CP), age 6 to 14 years, and 11 aged-matched children. All were able to walk independently, but 2 in the CP group used walking aids. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: On 2 occasions, gluteus maximus strength was measured 3 times in 2 positions of the hip joint. Repeatability of the measurements was assessed by intraclass correlation coefficients (ICCs), coefficients of variation, and the coefficient of repeatability. RESULTS: When normalized to body mass, children with CP had significantly less gluteus maximus strength compared with the controls. The ICCs for the control group ranged from .76 to .85 and from .75 to .83 for the involved leg in the CP group. CONCLUSIONS: The reliability of measurement of gluteus maximus strength was good for both control group and the involved leg of the CP group. The normalized values for gluteus maximus strength and measures of reproducibility can be used when measuring gluteus maximus strength in children with CP.     

痉挛型脑性瘫痪患儿静脉输液方法的研究

目的探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果。方法将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例，按护理基本技术操作规程实施常规输液；干预组81例，在姿势控制后进行输液。比较2组输液时间和一次性穿刺成功率。结果常规组一次穿刺成功率64．3％，干预组一次穿刺成功率88．3％，2组比较差异有统计学意义（P〈0．05）。常规组平均耗时（5．77±3．60）min，干预组平均耗时（4．92±3．21）min，2组比较差异无统计学意义（P〉0．05）。结论对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液．可有效提高穿刺成功率。     

3D-Quantitative evaluation of a rigid seating system and dynamic seating system using 3D movement analysis in individuals with dystonic tetraparesis

To improve postural stability in individuals with dystonic cerebral palsy, the concept of a dynamic seat has been suggested as a potential solution. An experimental set-up for the acquisition of movement during extensor thrusts while sitting on a seating system was defined and applied on a group of dystonic individuals, to compare a dynamic versus a rigid seat system, using quantitative movement analysis. The seating system in dynamic configuration is able to reduce the extensor thrust experienced by the consumers, as well as to increase range of motion in the anterior–posterior direction, limiting the sliding down of trunk and showing better upper limb smoothness during extensor thrusts. The procedures used in this study appear to provide a useful tool for better understanding how the concept of a dynamic back in a seat system may affect and influence position and stability of individuals with dystonia on the seat system.     

家庭髋关节姿势管理对痉挛型双瘫脑瘫儿童髋关节发育的影响:前瞻性随机对照研究

目的:观察家庭髋关节姿势管理对痉挛型双瘫脑瘫儿童髋关节发育的影响。方法:选取2013年12月—2014年10月在我院治疗的2—4岁痉挛型双瘫儿童32例,粗大运动功能分级(gross motor function classification scale,GMFCS)Ⅲ-Ⅳ级,采用随机数字表法将上述患者分为试验组及对照组,对照组在我院行常规康复治疗,每年≥6个疗程,每个疗程10—14天,试验组在常规康复治疗基础上指导患儿监护人使用矫形器行家庭髋关节姿势管理,包括夜间髋关节外展位睡眠,白天髋关节外展位站立,每日髋外展站立时间≥1h。分别于治疗前、治疗后18—24个月拍摄骨盆平片,测量并比较两组患儿的双髋关节股骨头偏移百分比(migration percentage,MP)和髋臼指数(acetabular index,AI)。结果:治疗前,试验组MP值和AI值与对照组比较,差异无显著性意义。治疗后,试验组MP值为:20.96±6.35,对照组MP值为:29.78±9.38,试验组AI值为:18.53±2.54,对照组AI值为:21.17±2.73,治疗组均优于对照组,差异均有显著性意义。结论:家庭髋关节姿势管理可有效减轻较小年龄痉挛型脑瘫儿童髋关节的进行性移位,有助于患儿髋关节正常发育。     

Hip subluxation and dislocation in cerebral palsy – a prospective study on the effectiveness of postural management programmes

Background and Purpose . Hip subluxation and dislocation are common sequelae in children with bilateral cerebral palsy and are currently managed by surgical interventions. This study aimed to investigate the effectiveness of early postural management programmes on hip subluxation and dislocation at five years, and the need for treatment in children with bilateral cerebral palsy, and to compare these findings with a historical control group. Methods . A prospective cohort study followed 39 children who commenced using postural management equipment under 18 months of age. Levels of ability, type and amount of equipment use and treatments were recorded every three months. At 30 and 60 months, the hips were X‐rayed and the hip migration percentage was measured. The results were compared with the historical control group. Results . Children who used equipment at recommended and moderate levels had significantly less chance of both hips being subluxed than those using equipment at minimal levels (two‐tailed Fisher's exact χ² p = 0.024). The frequency of children with hip problems was significantly less in the intervention group in comparison to the historical control group at five years (χ² = 11.53, df = 2, p = 0.006). The frequency of children receiving bilateral or unilateral treatments, i.e. surgery, use of a hip and spinal orthosis and/or botulinum toxin injections, in the intervention group was significantly less compared to the historical control group (two‐tailed Fisher's exact p = 0.001). Conclusion . The early provision of postural management equipment has a role to play in reducing the number of hip problems and therefore the need for treatment of hip subluxation/dislocation in cerebral palsy at five years of age. Copyright © 2009 John Wiley & Sons, Ltd.     

Prospective longitudinal study of gross motor function in children with cerebral palsy

OBJECTIVES: To describe the course of gross motor function over 2 years in children with cerebral palsy (CP) aged 9 to 15 years, and to investigate its relationship with impairments and age. DESIGN: Prospective cohort study. SETTING: Rehabilitation department of a university medical center in the Netherlands. PARTICIPANTS: Seventy boys and 40 girls with CP (mean age +/- standard deviation, 11.2+/-1.7y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Gross Motor Function Measure (GMFM). RESULTS: GMFM item scores were stable over the 2 years for the whole group. No difference was found in the course of GMFM item scores between the Gross Motor Function Classification System (GMFCS) levels. We found significant differences in the course of GMFM item scores (corrected for GMFCS) for the different levels of limb distribution, selective motor control, muscle strength, range of motion in the hip and knee, spasticity of the hamstrings, and type of education. There were significantly larger decreases in the more severely affected children. Multivariable analysis showed that a poor selective motor control was the most important determinant of a less favorable course of gross motor function. CONCLUSIONS: Some impairment characteristics may be used to identify children who are at risk for deterioration in gross motor function, and may serve as a guide for interventions.