Functional balance and gross motor function in children with cerebral palsy

AimsTo compare scores of children with cerebral palsy (CP) at different levels of Gross Motor Function Classification System (GMFCS), using the Pediatric Balance Scale (PBS) and to assess whether it can be used to predict GMFCS levels in children with CP.MethodsFifty-eight children with CP levels I–V of GMFCS were assessed by PBS and grouped according to their GMFCS level.ResultsIt was observed differences in PBS scores between GMFCS I and II and between GMFCS II and III groups. Discriminant analysis indicated a 67% accuracy for the PBS instrument in assessing the GMFCS level of children with CP.InterpretationPBS is able to detect differences among GMFCS levels I, II, and III of mild and moderate impairment. Accordingly, PBS can be used reliably in clinical practice to indicate the motor impairment level of such children. The results enable specify the expected tasks that are expected to be accomplished by the children in each GMFCS level, contributing with therapeutic planning and monitoring.     

Effects of the Inerventions method on gross motor function in children with spastic cerebral palsy

Aim of the study

To investigate the effect of the Inerventions method on gross motor function in children with spastic cerebral palsy (CP).

Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy

This study examined the effect of neurodevelopmental treatment (NDT) and differences in its intensity on gross motor function of children with cerebral palsy (CP). Participants were 34 children (12 females, 22 males; mean age 7y 3mo [SD 3y 6mo], age range 3 to 14y) with mild to moderate spasticity and hemiplegia (n=10), diplegia (n=12), and tetraplegia (n=12). Gross Motor Function Classification System levels were: I (n=10), II (n=10), and III (n=14). The paired sample, which was obtained by ratio stratification and matching by sex, age, and distribution of impairment from a total of 114 children with CP, was assigned randomly to two groups: group A underwent NDT twice a week and group B five times a week for 16 weeks. The outcome measure used was the Gross Motor Function Measure, which assessed the performance of the children before and after intervention. The paired-sample t-test revealed that gross motor function of children from both groups improved significantly after intervention (p<0.05). Children in group B performed better and showed significantly greater improvement than those in group A (p<0.05). Results support the effectiveness of NDT and underline the need for intensive application of the treatment.     

Effect of cerebrolysin on gross motor function of children with cerebral palsy: a clinical trial

Gross motor dysfunction is considered as the most challenging problem in cerebral palsy (CP). It is proven that improvement of gross motor function could reduce CP-related disabilities and provide better quality of life in this group of patients. Therefore, the aim of this trial is to evaluate the effectiveness of cerebrolysin (CBL) on gross motor function of children with CP who are undergoing treatment. In this clinical trial study, paediatric patients aged 18–75 months with spastic diplegic or quadriplegic cerebral palsy, who were under rehabilitation therapy, were selected and randomly allocated in control and CBL groups. Patients in CBL group underwent treatment with standard rehabilitation therapy plus CBL. The latter was administrated intramuscularly as a single daily dose of 0.1 cc/kg for 10 days and then continued weekly for 4 months. Gross motor function of participants in the two studied groups, before and after trial, was evaluated and compared using the validated Persian version of gross motor function classification system-expanded and revised (GMFCS-E&R). During this trial, 108 patients with CP were evaluated for eligibility. From these, 50 patients were enrolled and randomly allocated in the CBL and control groups. Four months after trial, the mean level of GMFCS decreased significantly in the two groups (P < 0.05). However, it was significantly lower in the CBL group than in the control group (2.1 vs. 3.16, P < 0.05). The results of this trial indicated that CBL could improve gross motor function in patients with CP. This finding is consistent with neurotrophic and neuroprotective effects of CBL, which have been reported in various clinical trials in other neurological disorders. Further studies are recommended to establish the value of continued neuroprotection and to determine the pharmacokinetics/dynamics of CBL in this group of patients.     

Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

BACKGROUND: The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed. OBJECTIVE: To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy. DESIGN: A case-controlled analysis. SETTING: Qilu Children's Hospital of Shandong University. PARTICIPANTS: Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0–2 years old, 47 cases of 2–4 years and 36 cases of 4–6 years. Informed contents were obtained from relatives of all the children. METHODS: ① Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub, pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was assessed using the Chinese version of gross motor function classification system (GMFCS). The gross motor functions of the children with cerebral palsy were assessed before rehabilitation treatment and 12 months after rehabilitation treatment by using gross motor function measure (GMFM). The improved GMFM total score was calculated. Developmental quotient was evaluated using Gesell developmental schedules (GDS) after 12-month rehabilitation treatment. Univariate analysis of variance was performed using the improved GMFM total score with age, GMFCS grade and developmental level (developmental quotient). MAIN OUTCOME MEASURES: Effects of age started to accept rehabilitation treatment, GMFCS grade and developmental level on the recovery of gross motor function in children with cerebral palsy. RESULTS: All the 138 children with cerebral palsy were involved in the analysis of results. The improved GMFM total scores were significantly different among the children with cerebral palsy of different ages started to accept treatment, GMFCS grades and developmental levels (F=13.464, 37.283, 30.814, P < 0.01). The younger the children started to accept treatment, the lower the their GMFCS grades and the higher their developmental levels, then the higher their improved GMFM total scores. CONCLUSION: The recovery of gross motor function is better in younger children started to accepted treatment with cerebral palsy with lower GMFCS grades and higher developmental levels.     

Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities

In this study we assessed the distribution of spasticity, range of motion (ROM) deficits, and selective motor control problems in children with cerebral palsy (CP), and examined how these impairments relate to each other and to gross motor function and everyday activities. Ninety-five children (55 males, 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) were evaluated with the modified Ashworth scale (MAS), passive ROM, the Selective Motor Control scale (SMC), the Gross Motor Function Measure (GMFM), and the Pediatric Evaluation of Disability Inventory (PEDI). Types of CP were hemiplegia (n=19), spastic diplegia (n=40), ataxic diplegia (n=4), spastic quadriplegia (n=16), dyskinetic (n=9), and mixed type (n=7). Severity spanned all five levels of the Gross Motor Function Classification System (GMFCS). The findings highlight the importance of measuring spasticity and ROM in several muscles and across joints. Wide variability of correlations of MAS, ROM, and SMC indicates a complex relationship between spasticity, ROM, and selective motor control. Loss of selective control seemed to interfere with gross motor function more than the other impairments. Further analyses showed that motor impairments were only one component among many factors that could predict gross motor function and everyday activities. Accomplishment of these activities was best predicted by the child's ability to perform gross motor tasks.     

The effect of training in an interactive dynamic stander on ankle dorsiflexion and gross motor function in children with cerebral palsy

Objective: To study the effect of active stretching of ankle plantarflexors using an interactive dynamic stander in children with cerebral palsy (CP).

Methods: Six children in Gross Motor Function Classification System classes I–III, aged 4–10 years, trained intensive active dorsiflexion in an interactive dynamic stander using ankle movement to play custom computer games following a 10-week control period. Gross Motor Function Measure Item Set, gait performance and passive and active dorsiflexion with extended and flexed knee were chosen as outcome parameters.

Results: Median active and passive ankle dorsiflexion increased significantly (5 and 10 degrees, respectively) with extended knee. There was a small but clinically significant increase in gross motor function. The intervention had no effect on temporospatial gait parameters.

Conclusion: In spite of the low number of participants, these results may indicate that intensive active stretching in an interactive dynamic stander could be an effective new conservative clinical treatment of ankle plantarflexor contracture in children with CP.     

Development and reliability of a system to classify gross motor function in children with cerebral palsy

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability ( k ) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.     

Structural equation modeling of motor impairment,gross motor function,and the functional outcome in children with cerebral palsy

Physical therapy intervention for children with cerebral palsy (CP) is focused on reducing neurological impairments, improving strength, and preventing the development of secondary impairments in order to improve functional outcomes. However, relationship between motor impairments and functional outcome has not been proved definitely. This study confirmed the construct of motor impairment and performed structural equation modeling (SEM) between motor impairment, gross motor function, and functional outcomes of regarding activities of daily living in children with CP. 98 children (59 boys, 39 girls) with CP participated in this cross-sectional study. Mean age was 11y 5mo (SD 1y 9mo). The Manual Muscle Test (MMT), the Modified Ashworth Scale (MAS), range of motion (ROM) measurement, and the selective motor control (SMC) scale were used to assess motor impairments. Gross motor function and functional outcomes were measured using the Gross Motor Function Measure (GMFM) and the Functional Skills domain of the Pediatric Evaluation of Disability Inventory (PEDI) respectively. Measurement of motor impairment was consisted of strength, spasticity, ROM, and SMC. The construct of motor impairment was confirmed though an examination of a measurement model. The proposed SEM model showed good fit indices. Motor impairment effected gross motor function (β = ?.0869). Gross motor function and motor impairment affected functional outcomes directly (β = 0.890) and indirectly (β = ?0.773) respectively. We confirmed that the construct of motor impairment consist of strength, spasticity, ROM, and SMC and it was identified through measurement model analysis. Functional outcomes are best predicted by gross motor function and motor impairments have indirect effects on functional outcomes.     

Impact of malnutrition on gastrointestinal disorders and gross motor abilities in children with cerebral palsy

Children with cerebral palsy (CP) often demonstrate abnormal feeding behaviours, leading to reduced food consumption and malnutrition. Moreover, most of them present with gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and/or chronic constipation (CC), and poor motor function rehabilitation. The aim of our study was to assess the possible relationship between malnutrition and gastrointestinal problems and to evaluate the role of nutrition on their gross motor abilities in a population of children with CP and mental retardation. PATIENTS: Twenty-one consecutive children (10 boys; mean age: 5.8+/-4.7 years; range: 1-14 years) with CP and severe mental retardation. METHODS: Nutritional assessment included the measurement of body mass index (BMI=W/H2), fat body mass (FBM) and fat free mass (FFM). Children with symptoms suggesting GERD underwent prolonged 24h intraesophageal pH monitoring and/or upper GI endoscopy with biopsies before and after a 6 months of pharmaceutical (omeprazole) and nutritional (20% increment of daily caloric intake) treatments. The motor function was evaluated by "The Gross Motor Function Measure" (GMFM) before and after the 6 months on nutritional rehabilitation. RESULTS: BMI for age was or=25 degrees percentile, five of nine (55.5%) patients had persistent GERD when they were taken off the medication. CONCLUSIONS: Malnutrition and gastrointestinal disorders are very common in children with cerebral palsy. Improved nutritional status, particularly fat free mass gain, appears to have an impact on motor function in children with CP.     

Knee muscle strength at varying angular velocities and associations with gross motor function in ambulatory children with cerebral palsy

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.     

Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: A follow-up study

Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6–15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks–Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R² = 0.07–0.19, P < 0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R² = 0.08, P < 0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.