Communication Skills in Children with Cerebral Palsy and Autism Spectrum Disorder

While the literature focusing on communication deficits in children with cerebral palsy (CP) is extensive, few researchers have analyzed this construct in individuals with CP and a comorbid Autism Spectrum Disorder (ASD). Therefore, the purpose of the current study was to examine impairments in communication in infants and toddlers (18 to 35 months of age) who had CP and comorbid autism, CP and comorbid pervasive developmental disorder-not otherwise specified (PDD-NOS), and CP alone. A total of 42 children met inclusion criteria for this study. Those diagnosed with CP and a comorbid ASD were found to possess significantly greater communication impairments as assessed by the Baby and Infant Screen for aUtIsm Traits-Part 1 (BISCUIT-Part 1) than participants who only had a diagnosis of CP. The autism and PDD-NOS groups did not significantly differ from one another on the communication domain of this measure, however. Implications of these results are discussed.     

Effects of Cerebral Palsy on Neuropsychological Function

Cerebral Palsy (CP) is a muscle and movement disorder that affects children and is the result of early brain injury. The causes and nature of the brain damage may vary considerably, which renders children with cerebral palsy a heterogeneous group. Only recently has research begun to utilize technology to determine the nature of the brain injury and the relation to clinical observations. This paper reviews neuropsychological findings on children with a diagnosis of CP with regard to the spastic, dyskinetic, and ataxic types. Specifically, areas of sensorimotor functioning, language and verbal skills, visual-spatial and perceptual skills, learning and memory, and executive functioning are reviewed. Implications for learning as well as a neurobiological cause of executive function deficits are discussed.     

Cognitive and academic profiles in children with cerebral palsy: A narrative review

BackgroundConsiderable effort has recently been made to improve the accurate diagnosis of cerebral palsy (CP) in childhood and to establish early intervention aiming to improve functional outcome. Besides the visible motor impairments, cognitive abilities are frequently affected but might remain unrecognised in children with mild forms. On the other hand, some severely disabled children with presumed intellectual disabilities might demonstrate normal-range reasoning capacities. Most studies on this topic have emphasized a variety of cognitive profiles (cognitive level) related to the type of cerebral palsy and the underlying brain lesions (biological level). However, little is known at the behavioural level, namely learning skills and educational achievement.ObjectiveThis narrative review aimed to discuss cognitive and scholastic skills typically affected in children with CP.MethodsOnline literature research for studies of cerebral palsy, cognition and academic achievement, extracting all relevant articles regardless of article type.ResultsIn children with CP, intellectual disability is frequent and correlated with the degree of motor impairment and early epilepsy. Speech and language problems are prevalent in all forms of CP and might hamper everyday participation on varying levels depending on the degree of motor disability. Most children with CP have neuropsychological deficits affecting predominantly visuospatial functions, attention, and/or executive functions. These problems relate to academic performance and social participation.DiscussionAn adequate interdisciplinary follow-up of children with CP requires a sensitization of clinicians to the complex topic of cognitive and academic problems in this population and a better synergy between the medical and educational worlds.     

Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function

We delineate the methodology for constraint-induced movement therapy (CIMT) modified for children with hemiplegic cerebral palsy (CP) and describe important considerations that need to be made when testing this intervention in children. The resulting intervention evolved from piloting and testing it with 38 children with hemiplegic CP who were between the ages of 4 and 14 years. Thirty-seven successfully completed the treatment protocol. The intervention retains the 2 major elements of the adult CIMT (repetitive practice, shaping) and was constructed to be as child-friendly as possible. It involves restraining the noninvolved extremity with a sling and having the child engage in unimanual activities with the involved extremity 6 hours a day for 10 days (60 h). Specific activities are selected by considering joint movements with pronounced deficits and improvement of which interventionists believe have greatest potential. The activities are chosen to elicit repetitive practice and shaping. The intervention is conducted in groups of 2 to 3 children to provide social interaction, modeling, and encouragement. Each child is assigned to an interventionist to maintain at least a 1:1 ratio. CIMT can be modified to be child-friendly while maintaining all practice elements of the adult CIMT. The modified therapy is tolerated by most children. Further modifications will likely be required to hone in on the specific components of the intervention that are most effective before applying them to children who are most likely to benefit.     

Kinematic characteristics of arm and trunk when drinking from a glass in children with and without cerebral palsy

BackgroundChildren with cerebral palsy (CP) often have difficulty with activities that require the upper extremities secondary to deficits in strength and range of motion, spasticity, and poor timing and coordination of movement. This study aimed to identify and compare timing and coordination of the trunk and upper extremity in children with and without CP during a functional task.MethodsEighteen children, N = 9 with CP and N = 9 with typical development were enrolled. Participants were seated in a standard chair and instructed to drink from a glass placed at a distance of 75% of available arm length. The task was divided into 3 Phases: 1) reaching to the glass, 2) transporting the glass to the mouth, and 3) returning the glass to the table. The spatiotemporal and angular variables were analyzed with 3D kinematics of movement using a 4-camera Qualysis Motion System.FindingsChildren with CP demonstrated poor upper extremity timing and coordination. Despite significant trunk displacement used as a compensation in Phase 1, children with CP demonstrated a significantly lower mean velocity and velocity peak during Phases 2 and 3; and demonstrated less straight motion which required more time and movement units in all phases.InterpretationChildren with CP demonstrated poor upper extremity timing and coordination when drinking (even when they successfully completed the task) measured by more trunk displacement, slower, less straight movements, and more movement units. Current rehabilitation strategies could consider training speed and use functional tasks that require different strategies across multiple phases.     

Effect of rhythmic auditory stimulation on gait performance in children with spastic cerebral palsy

The purpose of this study was to use Rhythmic Auditory Stimulation (RAS) for children with spastic cerebral palsy (CP) in a clinical setting in order to determine its effectiveness in gait training for ambulation. RAS has been shown to improve gait performance in patients with significant gait deficits. All 25 participants (6 to 20 years old) had spastic CP and were ambulatory, but needed to stabilize and gain more coordinated movement. Participants were placed in three groups: the control group, the therapist-guided training (TGT) group, and the self-guided training (SGT) group. The TGT group showed a statistically significant difference in stride length, velocity, and symmetry. The analysis of the results in SGT group suggests that the self-guided training might not be as effective as therapist-guided depending on motivation level. The results of this study support three conclusions: (a) RAS does influence gait performance of people with CP; (b) individual characteristics, such as cognitive functioning, support of parents, and physical ability play an important role in designing a training application, the effectiveness of RAS, and expected benefits from the training; and (c) velocity and stride length can be improved by enhancing balance, trajectory, and kinematic stability without increasing cadence.     

小儿脑瘫矫形器治疗应用的研讨

本文以探讨脑瘫等肢残患儿应用矫形器治疗效果为目的,对４６名患儿通过步态分析、平衡测试及综合能力ＡＤＬ的评定等方法进行矫形器穿戴前后对比。结果综合有效率达９４．２５％。结论对脑瘫等肢残患儿有必要辅以矫形器治疗以提高疗效。文中阐明了应用矫形器治疗时应注意的问题及踝足矫形器的制作经验     

Cerebral palsy: postural-locomotor prognosis in spastic diplegia

Prognosis of locomotion in children with cerebral palsy (CP) is complicated by the variety of motor and other neurologic deficits in each case. Children presenting with spastic diplegic (SD) CP related to prematurity generally demonstrate more uniform and comparable neuromotor abnormalities. In this study, longitudinal data were collected on the early postural-locomotor development of children with spastic diplegic cerebral palsy (SDCP). The data were then correlated with the level of ambulatory function attained. Fifty spastic pediatric patients, aged 5 to 19 years, were included in the study completed in 1982. The duration of follow-up ranged from 4 to 16 years. The study is based upon a method of assessing preambulatory milestones, a classification of ambulatory function into four levels of ability, and correlates these two sets of data. The results indicate that the motor control of sitting and crawling at 1 1/2 to 2 1/2 years was predictive of the eventual level of ambulatory function the child was able to attain and maintain.     

Muscle strengthening in children and adolescents with spastic cerebral palsy: considerations for future resistance training protocols

Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy (CP). However, the effectiveness of this type of training is still disputed. The most recently published systematic review with meta-analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP. Thus, the aim of this article is to evaluate the extent to which training protocols from the most recent randomized controlled trials are in keeping with the evidence for effective resistance training in children who are developing typically, as reflected in the training guidelines of the National Strength and Conditioning Association. RECOMMENDATIONS: for resistance training protocols, based on this evidence and appropriate to children with CP, are provided to help guide both future research and clinical practice for resistance training in children with CP.     

Health-related quality of life in childhood cerebral palsy

OBJECTIVE: To describe the health-related quality of life (HRQOL) of a cross-section of children with cerebral palsy (CP) using the Child Health Questionnaire. DESIGN: Survey of the parents or guardians of children with CP. SETTING: Outpatient clinics at a tertiary care children's hospital. PARTICIPANTS: Children (N=177; 98 boys, 79 girls; mean age +/- standard deviation [SD], 8.6+/-4.2y) with CP were enrolled as a convenience sample. Study subjects were stratified by severity of CP using the Gross Motor Function Classification System. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: HRQOL scores, as determined by the Child Health Questionnaire-Parent Form 50. RESULTS: Parents reported reduced HRQOL for their children with CP. In the physical function domain, most children scored over 3 SDs below a normative sample, and scores in parental impact domains were at least 1 SD below the normative sample. Psychosocial domains were less impaired. Most of the effects on physical and parent impact domains were greater in children with more severe CP, although they were significant in most strata of severity. CONCLUSIONS: Children with CP have reduced HRQOL and the degree to which it is reduced is related to the severity of their CP.     

Impact of tactile dysfunction on upper-limb motor performance in children with unilateral cerebral palsy

Auld ML, Boyd RN, Moseley GL, Ware RS, Johnston LM. Impact of tactile dysfunction on upper-limb motor performance in children with unilateral cerebral palsy.ObjectiveTo determine the relationship between tactile function and upper-limb function in children with unilateral cerebral palsy (CP).DesignCross-sectional study.SettingAssessments were performed in community or hospital venues or in participants' homes.ParticipantsRecruitment information was sent to 253 possible participants with unilateral CP (aged 8–18y), and N=52 participated (median age [interquartile range], 12y [9–14y]; Gross Motor Functional Classification System level I=34; II=18; Manual Abilities Classification Scale level I=36; II=16).InterventionsNot applicable.Main Outcome MeasuresTactile assessment included 1 test of registration, 5 tests for spatial perception, and 1 test for texture perception. Upper-limb motor function was assessed using 2 unimanual tests, the Melbourne Unilateral Upper Limb Assessment (MUUL) and Jebsen-Taylor Test of Hand Function (JTTHF), and 1 bimanual test, the Assisting Hand Assessment (AHA).ResultsTactile registration and all tests of spatial perception were moderately related to the MUUL, JTTHF, and AHA (P<.001). Texture perception was not related to upper-limb motor function. Regression analysis showed that single point localization, a unilateral tactile spatial perception test, contributed most strongly to unimanual capacity (29% explained variance in MUUL and 26% explained variance in JTTHF), whereas double simultaneous, a bilateral tactile spatial perception test, contributed most strongly to bimanual performance (33% for the AHA).ConclusionsSpatial tactile deficits account for approximately 30% of the variance in upper-limb motor function in children with unilateral CP. This emphasizes the need for routine tactile assessment and targeted treatment of tactile spatial deficits in this population.     

Nursing babies at risk of cerebral palsy in the neonatal period

Cerebral palsy (CP) is a leading cause of physical disability in childhood with evidence that 90% of children with the condition sustain damage or malformation to their developing brain during the antenatal period. With half of all cases of children with CP being born prematurely many need extra help and support in the neonatal period. The aims of neonatal nursing for this high risk group include prevention of further neurological complications as well as working maintain stable infant physiology and provide information and support to parents. While a diagnosis of CP is seldom welcome there is now evidence that most children with CP are mildly affected, most have a normal life expectancy, most are well adjusted and most are happy, reporting a quality of life similar to children without CP. Neonatal nurses are ideally placed to communicate and prepare parents of children at high risk of developing CP about more positive future likely outcomes than previously thought.     

Locus of Control,Perceived Parenting Style,and Anxiety in Children with Cerebral Palsy

In this study we examined interrelations among locus of control (LOC), disease severity, anxiety, and parenting style (PS) in children with cerebral palsy (CP). Thirty children with CP and their 30 healthy siblings completed self-report measures of LOC, anxiety, and perceived PS of the mother. A neurological assessment determined severity of CP. Children with CP, regardless of severity, did not differ from their siblings in LOC, anxiety, or perceived PS. Multiple-regression analyses showed that LOC was predicted only by the acceptance/rejection dimension of PS in children with CP; whereas for their siblings, age, and anxiety were the best predictors. The findings suggest a central influence of the home environment on children’s psychological development. For children with CP, experiencing parental acceptance may enhance development of resilience-related qualities, such as an internal LOC.     

Motor speech impairment,activity, and participation in children with cerebral palsy

Abstract

The present study used a population-based sample of children with cerebral palsy (CP) to estimate the prevalence of motor speech impairment and its association with activity and participation. A sample of 79 Victorian children aged 4 years 11 months to 6 years 5 months was recruited through the Victorian CP Register. The presence of motor speech impairment was recorded using the Viking Speech Scale (VSS). Activity and participation outcomes included speech intelligibility (the National Technical Institute for the Deaf rating scale, NTID), the Functional Communication Classification System (FCCS) and Communication Function Classification System (CFCS). A parent completed rating scale was used to examine the association between motor speech impairment and participation. Ninety per cent (71/79) of children demonstrated a motor speech impairment. Strong associations were found between the VSS and NTID (< .001), CFCS (< .001), and FCCS levels (<.001). VSS levels III–IV were significantly associated with restrictions in home, school, and community-based participation as perceived by parents. Although some diversity in activity and participation outcomes was observed within specific VSS levels, the results of this study suggested that children with mild motor speech impairments are more likely to demonstrate superior activity and participation outcomes compared to children with moderate or severe deficits.     

Tactile function in children with unilateral cerebral palsy compared to typically developing children

Purpose: Tactile deficits have been understudied in children with unilateral cerebral palsy (UCP) using a limited range of tactile assessments. This study aims to characterize performance across a comprehensive battery of tactile registration and perception assessments in children with UCP and typically developing children (TDC). Methods: Fifty-two children with UCP (Gross Motor Function Classification System I = 34, II = 18; Manual Ability Classification System I = 36, II = 16) and 34 TDC were assessed using Semmes Weinstein Monofilaments (tactile registration), and single-point localization, double simultaneous, static and moving two-point discrimination, stereognosis, and texture perception (tactile perception). Results: Children with UCP performed consistently worse with their impaired hand than their unimpaired hand (Z = 2.77–5.61; p < 0.005). Both hands of children with UCP performed worse than either hand of TDC (Z = ?2.08 to 5.23; p = 0.037–< 0.001). Forty percent of children with UCP had tactile registration and perception deficits, 37% had perception deficits only and 23% had no tactile deficit. The larger the tactile registration deficit, the poorer the performance on all tactile perceptual tests (r = 0.568–0.670; p < 0.001). Conclusions: Most children with UCP demonstrate poor tactile perception and over one-third also demonstrate poor tactile registration. We contend that tactile dysfunction may contribute to functional impairment and is a possible target for intervention.

Implications for Rehabilitation:

• Cerebral palsy (CP) is the most prevalent physical disability in childhood, with an incidence of approximately 2 cases per 1000 live births; about 35% of children with CP have unilateral cerebral palsy (UCP).

• Assessment and treatment has been focused on the motor impairment; however, it is known that children with UCP are also likely to have sensory impairment.

• Understanding the nature and severity of sensory, specifically tactile, impairment in children with UCP will assist therapists to direct treatment accordingly and possibly impact the motor impairment.

     

Feasibility of using a large amplitude movement therapy to improve ambulatory function in children with cerebral palsy

Abstract

Cerebral palsy (CP) is the most common cause of motor disability among children. Limited evidence exists regarding the efficacy of traditional rehabilitation strategies on improving ambulatory function in this population. The purpose of the study was to investigate the feasibility and short-term effects of a novel large amplitude movement therapy on ambulatory functions in children with CP. Temporal-spatial gait characteristics were examined before and after a single intervention session, replicated over five children. Five children with CP (7.0?±?1.0 years); Gross Motor Function Classification System Levels I–II, participated. Baseline gait parameters were obtained as the participant walked across an instrumented walkway at self-selected and fast speeds. Children then participated in a 20–30?min intervention focused on making body and limb movements as large as possible with gait assessment repeated immediately. All children tolerated testing and therapy with no adverse effects. Outcomes after one intervention included: significantly greater stride velocity; reduced double support time; and greater stride length after training for three of the five participants. Results for this pilot study suggested that the large amplitude movement therapy was feasible for children with CP. There is a need for a larger scale study to determine if the protocol can be effective at an appropriate clinical dose.     

Psychological Correlates of Quality of Life in Children with Cerebral Palsy

Psychosocial outcomes have come to the front as a main concern for individuals with Cerebral Palsy (CP), promoting the need to understand the quality of life experienced by children and adolescents diagnosed with CP. As a result, the current study examined the relationships among quality of life in children with CP, the psychological symptoms and parenting characteristics of the parents of these children, and the emotional and behavioral functioning of these children. Results of this study suggested that these variables are related in interesting ways. Further, parenting stress, parents’ depressive symptoms, and children’s internalizing behavior problems were significant predictors of the quality of life experienced by the children in this sample. Thus, the direct benefits from optimizing parents’ mental health as well as that of their children may prove to be an important intervention in helping to improve the quality of life of children who have been diagnosed with CP.     

Functional electrical stimulation changes dynamic resources in children with spastic cerebral palsy

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) often are faced with difficulty in walking. The purpose of this experiment was to determine the effects of functional electrical stimulation (FES) applied to the gastrocnemius-soleus muscle complex on the ability to produce appropriately timed force and reduce stiffness (elastic property of the body) and on stride length and stride frequency during walking. SUBJECTS AND METHODS: Thirteen children with spastic CP (including 4 children who were dropped from the study due to their inability to cooperate) and 6 children who were developing typically participated in the study. A crossover study design was implemented. The children with spastic CP were randomly assigned to either a group that received FES for 15 trials followed by no FES for 15 trials or a group that received no FES for 15 trials followed by FES for 15 trials. The children who were having typical development walked without FES. Kinematic data were collected for the children with CP in each walking condition and for the children who were developing typically. Impulse (force-producing ability) and stiffness were estimated from an escapement-driven pendulum and spring system model of human walking. Stride length and stride frequency also were measured. To compare between walking conditions and between the children with CP and the children who were developing typically, dimensional analysis and speed normalization procedures were used. RESULTS: Nonparametric statistics showed that there was no significant difference between the children with CP in the no-FES condition and the children who were developing typically on speed-normalized dimensionless impulse. In contrast, the children with CP in the FES condition had a significantly higher median value than the children who were developing typically. The FES significantly increased speed-normalized dimensionless impulse from 10.02 to 16.32 when comparing walking conditions for the children with CP. No significant differences were found between walking conditions for stiffness, stride length, and stride frequency. DISCUSSION AND CONCLUSION: The results suggest that FES is effective in increasing impulse during walking but not in decreasing stiffness. The effect on increasing impulse does not result in more typical spatiotemporal gait parameters.     

脑瘫患儿语言发育迟缓及其与粗大运动功能分级的关系

目的：探讨不同类型脑瘫患儿语言发育迟缓发生率、迟缓程度及其与粗大运动功能分级水平的关系。方法：采用粗大运动功能分级（GMFCS）系统、S-S语言发育迟缓检查法,对113例脑瘫患儿进行评估,分析语言发育迟缓率与脑瘫类型和GM FCS分级水平的相关关系。结果：113例脑瘫患儿中,GM FCSⅠ-Ⅱ级42例,Ⅲ级27例,Ⅳ-Ⅴ级44例。大多数偏瘫患儿属于轻度运动障碍,语言理解和表达迟缓率仅为18．75％和37．5％;痉挛型双瘫中半数为轻度运动障碍、半数为中重度运动障碍,语言理解和表达发育迟缓率分别为66．67％和83．33％;痉挛型四肢瘫、失调型、不随意运动型和混合型脑瘫患儿以中重度运动障碍为主,语言发育迟缓率依次为88．89％、75．00％、91．67％、71．43％,虽然后两者语言发育商得分理解明显高于表达（均 P＜0．05）,但语言理解与表达迟缓率相当。GMFCS和语言发育水平呈正相关（理解r＝0．402,表达r＝0．389,P＜0．01）。结论：语言发育迟缓是脑瘫患儿常见的伴发障碍,其发生率和严重程度与脑瘫类型、运动障碍程度明显相关。痉挛型四肢瘫、不随意运动型、混合型脑瘫以及GM FCS水平Ⅲ-V级的脑瘫患儿语言迟缓率高且程度重,应及早介入言语康复。