新型神经电生理监测协议指导下微创入路选择性神经后根离断术治疗儿童痉挛型脑瘫的多中心临床研究CSCD

目的通过多中心临床研究,探讨新型神经电生理监测协议指导下微创入路选择性神经后根离断术(single-level laminectomy selective dorsal rhizotomy,SL-SDR)联合康复治疗对于痉挛型脑瘫儿童的近期疗效。方法回顾性分析上海市儿童医院、重庆医科大学附属儿童医院及湖南省儿童医院等于2015年11月至2021年8月期间收治的所有在新型神经电生理监测协议指导下行SL-SDR联合康复治疗,并获得至少6个月随访的痉挛型脑瘫患儿临床资料。收集患儿手术前及手术后末次随访时目标肌群肌张力、肌力、关节活动度、粗大运动功能分级系统(gross motor function classification system,GMFCS)分级及粗大运动功能66项(gross motor function measure-66 items,GMFM-66)评分情况,并评估患儿手术后运动功能变化。结果共有435例符合入组标准的痉挛型脑瘫患儿纳入研究,其中男249例,女186例;手术年龄(8.2±2.3)岁(3.2~15.5岁)。术前标记目标肌群2523组,受累关节2133个。术中离断神经后根(小根)数为(9.3±3.8)枚/例,其中3849枚(3849/4059,94.8%)符合离断50%神经截面积的标准。术后83例(83/435,19.1%)出现短期下肢浅感觉异常,经对症治疗1周后症状缓解,无一例出现长期并发症。患儿均获随访,随访时间(13.1±8.3)个月,目标肌群肌张力、肌力、关节活动度、GFMCS分级及GMFM-66评分均显著改善;术前GMFCS分级为Ⅱ、Ⅲ级者术后粗大运动功能改善情况优于Ⅳ、Ⅴ级者(134/309比8/105,P<0.01);术前GMFM-66评分≥50分者术后GMFM-66评分提升值高于术前CMFM-66评分<50分者[(7.65±3.39)分比(5.01±2.18)分,P<0.01];手术时年龄小于6岁者术后GMFCS分级改善情况好于年龄大于6岁者(106/249比36/165,P<0.01);术后GMFCS分级获改善患儿的平均年龄小于术后GMFCS分级无改善患儿的平均年龄[(6.1±1.0)岁比(11.6±1.7)岁,P<0.01]。结论新型神经电生理监测协议指导下SL-SDR联合康复治疗肢体痉挛瘫痪型脑瘫安全、有效,术后近期预后良好。     

运动发育推拿法对脑瘫患儿粗大运动功能的影响

目的 分析运动发育推拿法对脑瘫患儿粗大运动功能的影响。方法 从2000年8月至2006年9月在复旦大学附属儿科医院康复中心接受康复治疗的脑瘫患儿中依照纳入和排除标准确定总体研究对象，通过粗大运动功能测试量表（GMFM）分值的前后变化，分析经过运动发育推拿法治疗后脑瘫患儿粗大运动功能的改变状况；在总体研究对象中按照纳入和排除标准确定基线组和随访组的分析样本，比较基线阶段、治疗阶段及随访阶段的GMFM分值改变程度之间的差异，采用相对效度（RV）确定反映总体研究对象粗大运动功能改变最为显著的GMFM功能区；使用Rasch分析法分析粗大运动功能改变最为显著的功能区项目在治疗前、后的难度改变状况，进一步分析运动发育推拿法对脑瘫患儿粗大运动功能的影响。结果 研究期间共纳入142例总体研究对象，其中男性93例，女性49例；包括126例痉挛型，8例徐动型，7例混合型，1例共济失调；接受治疗前平均年龄21.84(5~95)个月。142例总体研究对象在接受了（3.3±1.4）个月治疗后，与治疗前相比GMFM各项分值在治疗后明显上升（P<0.001）。共确定26例基线组和31例随访组分析样本。26例基线组研究对象GMFM-66和88分值在治疗阶段［（2.4±1.0）个月］的平均每月改变值明显高于基线阶段［（1.9±1.1）个月］（P<0.05）；在GMFM 5个功能分区中除A区外其余4个功能分区治疗阶段的平均每月改变值均高于基线阶段，尤其以D区和E区更为明显（P<0.05）。31例随访组研究对象GMFM各项分值除A区外治疗阶段［（2.7±1.1）个月］的平均每月改变值明显高于随访阶段［（2.5±1.2）个月］（P<0.05）。在评价总体研究对象治疗前、后粗大运动功能改变状况时，GMFM-B区分值RV最高(100%)，其次为GMFM-88分值（94%）和GMFM-66分值（79%）。Rasch分析结果显示总体研究对象治疗前、后GMFM-B区20个项目难度与个体能力分布具有良好的相似性，20个项目治疗前、后难度值经配对t检验显示17个项目差异无统计学意义，同时治疗前、后项目难度值也表现出很高的相关性（r=0.992 1），表明运动发育推拿法并没有显著改变GMFM-B区20个项目的难度分布、难度值以及难度顺序。结论 运动发育推拿法在短期内能有效地提高脑瘫患儿的整体粗大运动功能，而且获得的粗大运动功能提高可以在短期内得到维持。     

虚拟现实训练对痉挛型双瘫脑瘫患儿肢体运动功能的影响

目的 观察虚拟现实（VR）训练对痉挛型双瘫脑瘫患儿上肢精细运动和下肢粗大运动的影响。方法 选取痉挛型双瘫脑瘫患儿35 例,随机分为VR 训练组（n=19）和常规训练组（n=16）,常规训练组给予3 个月的常规运动疗法和作业疗法训练;VR 训练组给予3 个月的VR 训练和作业疗法训练。采用Peabody 运动发育量表的抓握、视觉-运动整合分测试对患儿治疗前后精细运动进行评价,采用88 项粗大运动功能量表（GMFM-88）的D 区及E 区、改良Ashworth 量表（MAS）、Berg 平衡量表（BBS）对患儿治疗前后粗大运动进行评价。结果 治疗前两组患儿抓握、视觉-运动整合、精细运动发育商、GMFM-88 之D 区、E 区评分、MAS评分、BBS 评分无明显差异（P > 0.05）;治疗后,VR 训练组抓握、视觉-运动整合、精细运动发育商、GMFM-88D 区评分、E 区评分、BBS 评分、MAS 评分较常规训练组明显改善（P 结论 VR 训练可有效提高痉挛型双瘫脑瘫患儿上肢精细运动功能和下肢粗大运动功能。     

中文版脑瘫儿童粗大运动功能分级系统的信度和效度研究

目的 确定中文版脑瘫儿童粗大运动功能分级系统（Gross Motor Function Classification System ,GMFCS）的信度和效度。方法 共有来自上海三家康复机构的91名0-12岁脑瘫儿童参加了此项研究，选择35名脑瘫儿童测定GMFCS的重测信度；以66名脑瘫儿童为对象测定GMFCS的评价者间信度；分别以88名脑瘫儿童的粗大运动功能评估量表（GMFM）和54例脑瘫儿童的Peabody粗大运动发育量表（PDMS-GM）的各项测试结果为效标确定GMFCS的平行效度；对88例同时接受GMFCS和GMFM评价的儿童的测试结果进行结构效度检测，以GMFCS为应变量，GMFM五个功能区的百分比为自变量进行多重逐步回归分析，判断粗大运动中五个分区功能对GMFCS的影响程度。结果 GMFCS具有良好的重测信度（ICC值为0.99），同时具有良好的评估者间信度（ICC为0.95-0.98）；GMFCS与GMFM和PDMS-GM各项分值之间有良好的平行效度，Spearman相关系数在-0.57到-0.84在之间；粗大运动功能中的坐位能力和行走能力是影响GMFCS的主要因素，校正决定系数为0.709（p<0.001）。 结论 中文版脑瘫儿童粗大运动功能分级系统的具有良好的信度和效度，适用于国内对脑瘫儿童进行功能分级。     

粗大运动功能分类系统在痉挛型脑性瘫痪儿童中的信度和效度

目的 探讨粗大运动功能分类系统(GMFCS)在痉挛型脑性瘫痪儿章中的信度和效度.方法 收集2005年2月-2007年2月北京儿童医院神经康复病房收治的116例痉挛型腑性瘫痪儿童的临床资料,其中因不同原因退组并完成部分评估33例,参与全部评估过程83例.由神经内科医师和康复训练师分别使用GMFCS对人组儿童进行分级.在康复治疗前及治疗后4、8、12、16、28周,分别使用粗大运动功能量表(GMFM-66)评价人组儿童粗大运动能力,使用PEDI评价入组儿童日常生活能力.结果 GMFCS Ⅰ、GMFCSⅡ、GMFCSⅢ代表不同粗大运动能力水平,具有良好的评价者间信度(Kappa=0.881).GMFCS与GMFM-66均值呈负相关(rs=-0.742,P<0.05).GMFCS与PEDI各组,即与功能性活动-自我照顾、功能性活动-移动、功能性活动-社会功能、看护者帮助-自我照顾、看护者帮助-移动、看护者帮助-社会功能原始分呈负相关(rs=0.491～-0.713,P均<0.05);与功能性活动-移动相关性最高.结论 GMFCS对痉挛型脑性瘫痪儿童具有良好的信度和效度,该评价方法简单易行,适合推广使用.     

脑瘫共患病及其与脑瘫类型和粗大运动功能分级的关系

目的 探讨脑性瘫痪(简称脑瘫)患儿常见共患病及其与脑瘫类型和粗大运动功能分级水平的关系.方法 对2007年1月至2009年6月在我院脑瘫康复中心住院治疗的脑瘫患儿进行智力测查、眼科检查、语言测查、听觉诱发电位、脑电图及粗大运动功能分级评估等,从临床分型和粗大运动功能分级两个角度分析脑瘫共患疾病.结果 354例脑瘫患儿中,共患智力低下166例(46.89%)、听觉障碍15例(4.24%)、视觉障碍138例(38.98%)、语言-言语障碍216例(61.02%)、癫癎82例(23.16%).相关分析显示,痉挛型双瘫与视觉障碍相关性最强,痉挛型偏瘫与癫癎相关性最强,痉挛型四肢瘫与癫癎和智力低下最相关,不随意运动型及混合型均与语言障碍最相关.除视觉障碍在不同GMFCS分级间的分布差异无统计学意义(χ~2=1.90,P>0.05)外,其他共患病的发生情况与脑瘫类型、GMFCS分级水平明显相关(P均<0.05),四肢瘫、不随意运动型和混合型脑瘫患儿及GMFCS分级水平Ⅳ～Ⅴ级者多重障碍率明显高于痉挛型双瘫、偏瘫患儿及GMFCS分级水平Ⅰ～Ⅲ级者(P<0.05).结论 脑瘫患儿共患病的发生率和病种与脑瘫类型以及GMFCS分级水平有关,建议临床医生充分认识脑瘫患儿的临床分型、运动水平以及共患病,多学科协作全面评价和康复,以改善不良预后.     

不同运动功能分级脑瘫患儿步态分析中时-空与运动学参数的对比研究CSCD

目的比较2019年3月至2021年3月上海市儿童医院骨科收治的不同运动功能分级脑瘫患儿步态分析中时-空与运动学参数的差异,探索通过三维步态分析中时-空与运动学参数来定量评价痉挛型脑瘫患儿下肢运动功能,为痉挛型脑瘫的病情评估提供客观定量方法。方法选取年龄6~12岁、经粗大运动功能分级系统(gross motor function classification system,GMFCS)分级为Ⅰ、Ⅱ、Ⅲ级的痉挛型脑瘫患儿为研究对象,共90例,GMFCS分级为Ⅰ级(Ⅰ级组)、Ⅱ级(Ⅱ级组)、Ⅲ级(Ⅲ级组)各30例。选取30例正常儿童作为正常对照组。通过三维步态分析系统采集90例脑瘫患儿和正常对照组儿童步态分析中的时-空与运动学参数,利用方差分析和多样本均数间多重比较,分析不同运动功能分级脑瘫患儿之间以及与正常对照组儿童之间的差异。结果脑瘫患儿步态分析时-空参数中步长、步宽、步速、步频、跨步长较正常对照组儿童明显减小(P<0.05),且随GMFCS分级的升高而逐渐减小;脑瘫患儿步态周期和双支撑时间较正常对照组儿童明显延长(P<0.05),且随GMFCS分级的升高而逐渐延长。运动学参数中,脑瘫患儿髋关节、膝关节和踝关节活动角度较正常对照组儿童明显减小(P<0.05),髋关节最大屈曲角度、膝关节最大和最小屈曲角度、踝关节最大背屈角度明显减小,而髋关节最小屈曲角度明显增大(P<0.05);随GMFCS分级的升高,关节活动角度逐渐减小,髋关节最大屈曲角度、膝关节最大和最小屈曲角度、踝关节最大背屈角度逐渐减小,而髋关节最小屈曲角度逐渐增大;仅踝关节最大跖屈角度在不同GMFCS分级患儿中无明显差异(P>0.05)。结论步态分析中时-空参数和运动学参数可以定量评估痉挛型脑瘫患儿的下肢运动功能。GMFCS分级越高的脑瘫患儿与正常儿童之间的差异越大,下肢的运动功能越差。     

痉挛型偏瘫儿童上肢精细运动功能发育进程研究

目的 采用非线性混合效应模型评估痉挛型偏瘫患儿的患侧和对侧上肢精细运动功能发育进程,进一步明确痉挛型偏瘫患儿的精细运动功能发育特性。方法 纳入2000至2012年在上海地区8家儿童康复机构和6所特殊教育学校接受康复治疗和教育的先天性痉挛型偏瘫连续病例。采用脑瘫患儿精细运动功能测试量表（FMFM）进行精细运动功能评估,分别测定以患侧和对侧为主导的FMFM分值。以非线性混合效应模型构建患侧和对侧的精细运动发育曲线,获得FMFM极限值以及达到极限值90％时的年龄（年龄-90）用于临床解释。结果 536例偏瘫患儿进入分析,男360例（67.2%）,女176例,右偏瘫284例(53.0%),左偏瘫252例。首次评估时年龄最小5个月,最大17.8 岁,平均年龄为（3.4±3.2）岁。共有792对FMFM测试结果用于模型构建,平均每例患儿有1.48对FMFM测试结果,其中73例完成了2次测试,54例完成3次以上测试。采用Stable limit模型拟合对侧精细运动发育模型,采用Peak/decline模型拟合患侧精细运动发育模型,两模型均拟合成功。对侧的FMFM极限值为73.4分,明显高于患侧的64.0分。年龄-90对侧为2.7岁,患侧为3.3岁。患侧FMFM分值在到达极限值后呈缓慢下降趋势,降幅约为12%（极限值64.0分降至56.5分）。结论 痉挛型偏瘫患儿患侧上肢的精细运动功能发育极限低于对侧,到达发育极限的时间晚于对侧,且在到达极限后呈逐步下降趋势。针对偏瘫患儿的精细运动功能训练应充分重视两侧功能发育的特性。     

全身振动训练对痉挛型脑瘫患儿20例步行速度及粗大运动功能影响研究

目的 探究全身振动训练对痉挛型脑瘫患儿步行及粗大运动能力的影响.方法 选取2019年1月至2019年12月在上海市第一人民医院康复医学科门诊行康复治疗的痉挛型脑瘫患儿40例,随机(抛硬币法)分为试验组(全身振动训练结合常规康复治疗)20例,对照组(常规康复训练)20例.分别于干预前、干预12周后评估粗大运动功能评定(G...     

中文版脑瘫粗大运动功能测试量表项目难度改良及反应度和精确度研究

目的：重新确定复旦中文版GMFM的项目难度顺序,并与GMFM-66进行反应度和精确度比较,改良后的GMFM项目难度顺序可以更好地适宜所有年龄脑瘫患儿。 方法：本研究用于分析的数据来自于2001至2017年复旦大学附属儿科医院（我院）康复中心及其上海儿童康复合作群中的21家合作单位接受康复治疗和教育的脑瘫患儿,每例至少有1次诊断脑瘫18个月以后的评估数据。粗大运动功能评估由指定治疗师或医师在安静、独立、采光较好的房间采用复旦中文版GMFM-88进行。由GMAE（version1.0）得出GMFM-66分值。分别将每个GMFM-88项目转化为3个小项,从而将GMFM-88转化为含264个测试小项的GMFM-264,每项1个评分点（0、1）。采用Rasch分析中的等级量表模型分析GMFM-264测试结果与264个小项,生成经改良的复旦中文版GMFM量表项目难度顺序。采用分层随机抽样方法确定纳入反应度和精确度分析的研究对象,通过分析＜3岁和~6岁组各次评估结果间的GMFM-264与GMFM-66的分值差异比较两种计分方法的反应度和精确度。 结果：1 198例脑瘫患儿3 498次GMFM评估结果纳入分析,男801例,首次评估时平均年龄（4.5±3.8）岁。Rasch分析结果显示,GMFM-264小项中不适合项目占总项目的2.3%(6/264),表明本量表中的绝大多数项目具有良好的单维性,最终形成包括264小项的复旦中文版GMFM改良项目难度顺序,＜3岁组中,GMFM-264的反应度和精确度明显高于GMFM-66。 结论：改良后复旦中文版GMFM项目难度顺序扩展了与标准化评估相结合的脑瘫患儿粗大运动干预目标制定项目池,提升了GMFM在脑瘫患儿尤其是婴幼儿脑瘫儿童中的反应度和精确度,为进一步推进智能化脑瘫患儿粗大功能评估与干预系统提供了基础模型与数据。     

Cerebral palsy in Victoria: motor types, topography and gross motor function

Objectives:   To study the relationships between motor type, topographical distribution and gross motor function in a large, population-based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries.
Methods:   An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990–1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS).
Results:   Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large majority of young people having the spastic motor type (86%).
Conclusions:   The VCPR is ideal for population-based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.     

Bilateral spastic cerebral palsy--prevalence through four decades, motor function and growth.

The aim was to depict changes in the prevalence and severity of bilateral spastic cerebral palsy (CP) over a 40-year period. Another objective was to characterise the group born in 1991-1998 with respect to gross motor function, spasticity and growth. Data were obtained from the CP register of western Sweden and rehabilitation records. RESULTS: After a rise to 1.27 per 1000 live births in 1983-1986, the prevalence decreased significantly, in children born both preterm and at term, to 0.69 in 1995-1998. After 1975, more children were born preterm than at term. There was a significant decrease in severe bilateral spastic CP during the same period, mainly in children born at term. In all, 46% of the children born at term and 33% of those born preterm had a severe motor impairment, i.e. no walking ability. In the 167 children born in 1991-1998, the gross motor function classification system (GMFCS) level was I in 14%, II in 34%, III in 10%, IV in 25% and V in 17%. The GMFCS level correlated with the gross motor function measure (GMFM) and the Ashworth spasticity scores, as well as with the deviation in postnatal weight and height. We conclude that the prevalence of bilateral spastic CP has decreased since the mid-1980s, parallel to a reduction in the severity of the motor impairment. Children born preterm have predominated since the mid-1970s. The severity of the motor impairment correlated with the degree of spasticity, GMFM and growth. The percentage of children who were underweight was substantial.     

Botulinum neurotoxin treatment in children with cerebral palsy: a population-based study in Norway

Background/aimTo study proportions and characteristics of children treated and un-treated with Botulinum neurotoxin (BoNT) in a population-based cohort of children with cerebral palsy (CP).MethodsAll children with CP born during 1999–2003, recorded in the Norwegian CP Register were included (N = 411). Gross motor function was assessed using the gross motor classification system (GMFCS).ResultsSixty-eight percent of children with bilateral spastic, 63% with unilateral spastic and 41% with dyskinetic CP had received BoNT. The percentage of children treated increased from 62% at GMFCS level I to 88% at level IV, but was only 38% among children at level V. A similar trend was seen for fine motor function. Ninety-four percent of the children received BoNT in their lower limbs. Children without significant cognitive impairment were more often treated than children with such impairment (OR: 2.61; 95% CI: 1.49–4.58).InterpretationIn this first population-based study, approximately 2/3 of all children with spastic CP were treated with BoNT. The results suggest preference for treatment of children with potential for functional improvement, while treatment to relieve pain and facilitate care, and of children with cognitive impairment appeared to be less common. Whether the latter groups are treated appropriately requires further studies.     

Change in Parent-Identified Goals in Young Children with Cerebral Palsy Receiving a Context-Focused Intervention: Associations with Child,Goal and Intervention Factors

ABSTRACT

The purpose of this study was to examine the relationship between goal achievement measured by the Canadian Occupational Performance Measure (COPM) and child, goal, and intervention factors. Participants were 41 preschool children with cerebral palsy (CP) who were in the context-focused therapy arm of a randomized controlled trial. Factors including child age, Gross Motor Function Classification System (GMFCS) level, type and complexity of goals, and intervention strategies were analyzed. Children made large, positive mean changes on the COPM over 6 months (Performance = 3.8, SD = 1.9; Satisfaction = 4.3, SD 4.3) with younger children showing greater change. The COPM scores had low to moderate correlations with change on the Pediatric Evaluation of Disability Inventory and the Gross Motor Function Measure (GMFM-66). Regression analysis indicated that age, but not GMFCS level influenced COPM change scores. Goal complexity and intervention strategies were not significantly related to COPM change scores. The results provide support for using the COPM as an individualized measure of change in young children with CP receiving intervention.     

Validity and Responsiveness of the Trunk Impairment Scale and Trunk Control Measurement Scale in Young Individuals with Cerebral Palsy

Aim: This study examines construct validity and responsiveness of the Trunk Impairment Scale (TIS) and Trunk Control Measurement Scale (TCMS) in individuals with cerebral palsy (CP). Methods: Twenty-six individuals with CP (nine males), 8–29 years (mean age 17.6) with gross motor function corresponding to GMFCS I–IV, participated in three weeks of intensive and varied physical training at a health sports center. Trunk control was assessed with the TIS (includes three subscales) and TCMS (includes three subscales), and gross motor function with the Gross Motor Function Measure 66 item set (GMFM-66-IS), before and after the training period. The GMFM-66-IS was used as a comparison measure. Results: The median score of the TCMS subscale dynamic sitting balance, reaching (DSB-R), increased from 6 to 7 (range: 1–10; p = .031), and there was a median change of 3 points in GMFM-66-IS score (p = .036). There were no significant changes in the TIS. The correlations (Spearman's rho), between the TIS, TCMS, and the GMFM-66-IS (pre-scores), ranged between 0.57 and 0.75 (p< .003). Correlations between change scores (pre- and post-scores) were low, and not statistically significant. However, the TCMS DSB-R change score correlated significantly with hours spent on “trunk-targeted training” like paddling/rowing (rho = 0.66; p = .003) and horseback riding (rho = 0.54; p = .011). Conclusions: Our results support construct validity of the TIS and TCMS in young individuals with CP, whereas responsiveness could not be documented. However, the correlations between the TCMS DSB-R change score and hours spent on ‘‘trunk-targeted training’’ suggest that this subscale may have the potential to be used in intervention studies.     

Communication ability in cerebral palsy: A study from the CP register of western Sweden

BackgroundCommunication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support.AimTo study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden.MethodsSixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded.ResultsHalf the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I–II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p = 0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p < 0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p < 0.01).ConclusionCommunication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester.     

Grafikgestützter Konsensus für die Behandlung von Bewegungsstörungen bei Kindern mit bilateralen spastischen Zerebralparesen (BS-CP)

An interdisciplinary group of German experts in the field of movement disorders was assembled under the auspices of the Society for Neuropediatrics to develop a graphically based guideline for a multidisciplinary treatment regime in the management of motor dysfunction in children with bilateral spastic cerebral palsy (BS-CP). The present consensus was accomplished by a cooperation including neuroscience and rehabilitation medicine. The aim of the “motor treatment curves in CP” is to present age- and severity-specific therapy options for the treatment of motor dysfunction in children with BS-CP on the basis of the GMFCS development curves from Peter Rosenbaum’s group in Canada (www.canchild.ca). An interdisciplinary team is required to set up and implement an optimal treatment plan for each individual patient. The motor treatment curves in CP are designed to help physicians, therapists and parents to choose the best therapy options and to decide when, for how long and to what extent therapy should be administered.