Age‐related changes in energy efficiency of gait,activity, and participation in children with cerebral palsy

Aim The aim of this study was to use a prospective longitudinal study to describe age‐related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP). Method Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire‐Cerebral Palsy (LAQ‐CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4–16y) with CP. Ninety‐four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty‐seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment. Results Significant improvements in mean raw scores for GMFM, PEDI, and LAQ‐CP were recorded; however, mean raw oxygen cost deteriorated over time. Age‐related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (κ_lw=0.74–0.76). Interpretation These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.     

Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1

International Journal of Paediatric Dentistry 2011; 21: 13–22 Introduction. The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes. Materials and methods. The study group consisted of 52 children and adolescents, 3–16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF‐index both at cavity and non‐cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes‐related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc. Conclusion. It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes‐associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.     

Pattern of Growth in Children with Cerebral Palsy

Objective To provide a growth reference standard for children with quadriplegic cerebral palsy (QCP). Growth references specific to children with cerebral palsy would facilitate uniformity in clinical appraisal of their growth and nutritional status and would simplify comparative interpretation of growth data.Design Weights and lengths were obtained according to standardized procedures. Measurements were taken at time of visit to an orthopedic clinic and from retrospective review of charts.Subjects Three hundred sixty children with QCP. Growth data were based on 1,630 observations. Analysis Growth curves representing the 10th, 50th, and 90th percentiles were estimated using a smoothing splines technique. Statistical bootstrapping was performed to confirm significant differences from the growth charts of the National Center for Health Statistics (NCHS).Results Growth charts were constructed for boys and girls, aged 0 to 120 months, depicting length for age, weight for age, and weight for length. Average differences in length for age, weight for age, and weight for length between children with QCP and NCHS standards were −2.3z, −2.4z, −1.3z for boys, and −2.1 z, −2.1z, −1.1z for girls. Children with QCP fell progressively behind in stature and weight. Compared with their NCHS counterparts, they were 5% shorter at 2 years of age and more than 10% shorter at 8 years of age.Application Charts representing the pattern of growth in children with QCP should be accessible to parents and health care professionals to facilitate evaluation and monitoring of nutritional status. J Am Diet Assoc. 1996; 96:680-685.     

Antibody-dependent cellular cytotoxicity of Trypanosoma theileri mediated by purified bovine isotypes and subisotypes

Summary Bovine neutrophils, eosinophils and macrophages mediated in vitro cytotoxicity against Trypanosoma theileri in the presence of purified IgM, IgGl and IgG2 from immune bovine serum. When the immunoglobulin fractions were assayed at similar concentrations, IgM was the most effective isotype mediating killing with all three effector cell types. Using the ELISA with monospecific antisera against the different bovine isotypes and subisotypes, IgM was shown to be contaminated by < 1%. The addition of 0·08 M 2-mercaptoethanol inhibited IgM-mediated ADCC but not that of IgGl or IgG2, and the cytotoxicity occurred in the absence of complement. The presence of isotype and subisotype specific Fc receptors on the bovine effector cells was investigated using a totally homologous erythrocyte-antibody (EA) resetting technique. FC receptors for bovine IgM, IgG1 and IgG2 were detected on bovine neutrophils. Very few FcM receptors were detected on either eosinophils or macrophages, but FcG2 receptors were detected on both cell types, and FcG1 receptors on macrophages. However, eosinophils showed very few FcG1 receptors. The failure to detect all types of Fc receptor on the three different effector cells is discussed.     

Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study

Aim To report the prevalence, clinical associations, and trends over time of oromotor dysfunction and communication impairments in children with cerebral palsy (CP). Method Multiple sources of ascertainment were used and children followed up with a standardized assessment including motor speech problems, swallowing/chewing difficulties, excessive drooling, and communication impairments at age 5 years. Results A total of 1357 children born between 1980 and 2001 were studied (781 males, 576 females; median age 5y 11mo, interquartile range 3–9y; unilateral spastic CP, n=447; bilateral spastic CP, n=496; other, n=112; Gross Motor Function Classification System [GMFCS] level: I, 181; II, 563; III, 123; IV, 82; IV, 276). Of those with ‘early‐onset’ CP (n=1268), 36% had motor speech problems, 21% had swallowing/chewing difficulties, 22% had excessive drooling, and 42% had communication impairments (excluding articulation defects). All impairments were significantly related to poorer gross motor function and intellectual impairment. In addition, motor speech problems were related to clinical subtype; swallowing/chewing problems and communication impairments to early mortality; and communication impairments to the presence of seizures. Of those with CP in GMFCS levels IV to V, a significant proportion showed a decline in the rate of motor speech impairment (p=0.008) and excessive drooling (p=0.009) over time. Interpretation These impairments are common in children with CP and are associated with poorer gross motor function and intellectual impairment.     

Echocardiography of the Inferior Vena Cava, Superior Vena Cava, and Coronary Sinus in Right Heart Failure

Echocardiographic evaluation of the three major systemic venous channels that drain directly into the right atrium has hitherto received less attention than it deserves. Attention had been paid initially to inferior vena cava dilatation and lack of collapsibility (plethora) as signs of systemic venous congestion. Superior vena cava imaging has not been part of routine echographic evaluation; however, our recent observations on superior vena cava appearance by the right supraclavicular approach provide evidence that dilatation of superior vena cava correlates with that of inferior vena cava as a marker for venous congestion. The coronary sinus caliber, which has been virtually ignored, may also provide echographic signs of systemic congestion, namely, dilatation and lack of normal narrowing during atrial contraction.