date: 06/01/2001
author: Liptak GS, O’Donnell M, Conaway M, Chumlea WC, Wolrey G, Henderson RC, Fung E, Stallings VA, Samson-Fang L, Calvert R, Rosenbaum P, Stevenson RD.
publication: Dev Med Child Neurol. 2001 Jun;43(6):364-70. Comment in: Dev Med Child Neurol. 2001 Jun;43(6):363.
pubmed_ID: 11409824
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/11409824
The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition-specific measures, and assessments of health care use. A multicenter population-based cross-sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n = 56), IV (n = 55), and V (n = 122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty-nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health-related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well-being and should be used in combination to reflect children’s overall health status.
Category: Research and Articles
The effect of positioning on the hand function of boys with cerebral palsy.
date: 08/01/1989
author: Noronha J, Bundy A, Groll J.
publication: Am J Occup Ther. 1989 Aug;43(8):507-12.
pubmed_ID: 2774051
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2774051
The effect of positioning (sitting and prone standing) on the hand function of 10 boys (mean age = 12.5 years, SD = 1.2 years) with spastic diplegic cerebral palsy was studied. Two groups of subjects were tested twice (Tests 1 and 2) with the Jebsen-Taylor Hand Function Test (Jebsen, Taylor, Treischmann, Trotter, & Howard, 1969; Taylor, Sand, & Jebsen, 1973) to measure rate of manipulation. In addition, a scale modified from Hohlstein (1982) was used to measure quality of grasp on each subtest of the Jebsen-Taylor test. No significant differences between the mean scores of the two groups were found on the total scores of the Jebsen-Taylor test, either between Tests 1 and 2 or between sitting and prone standing. When the data from Tests 1 and 2 were combined, it was found that on one subtest–simulated feeding–the subjects performed significantly faster while in a prone standing position. On another subtest–picking up small objects–the subjects performed significantly faster while in a sitting position. Except during the simulated feeding subtest, the quality of the subjects’ grasp was observed to be mature and tailored to the objects manipulated. This paper presents considerations for analyzing positioning in relation to upper extremity tasks.
Pathologic fractures in severely handicapped children and young adults.
date: 08/01/1990
author: Lee JJ, Lyne ED.
publication: J Pediatr Orthop. 1990 Jul-Aug;10(4):497-500.
pubmed_ID: 2358490
The incidence (42%) of vitamin D abnormalities is high in severely handicapped children and young adults who sustain fractures, especially those who sustain multiple fractures. Fractures occur primarily in the lower extremity and heal with simple immobilization. In patients with normal vitamin D levels, a history of a significant traumatic event should be identified and child abuse ruled out. Vitamin D-deficient patients respond to nutritional and vitamin D supplementation, with decreased fracture incidence.
Measurement of muscle thickness as quantitative muscle evaluation for adults with severe cerebral palsy.
date: 09/01/2006
author: Ohata K, Tsuboyama T, Ichihashi N, Minami S.
publication: Phys Ther. 2006 Sep;86(9):1231-9.
pubmed_ID: 16959671
BACKGROUND AND PURPOSE: The muscle strength of people with severe cerebral palsy (CP) is difficult to quantify because of cognitive and selective motor control problems. However, if muscle strength is related to muscle atrophy caused by activity limitation, quantitative morphological analysis such as analysis of muscle thickness (MTH), measured by ultrasound imaging, may be used to examine the muscle condition in daily use. The primary purpose of this investigation was to clarify the difference in MTH of several muscles by the motor functions used in daily activity in adults with CP with different levels of severity of involvement. The secondary purpose was to examine whether MTH is associated with age, body characteristics, and muscle spasticity. SUBJECTS: Data were collected from a convenience sample of 25 adults with severe CP. METHODS: The MTH of the biceps brachii (BB), quadriceps femoris (QF), triceps surae (TS), and longissimus (LO) muscles was measured with an ultrasound imaging device. The severity of the condition was classified with the Gross Motor Function Classification System (GMFCS), and functional status in sitting and standing was evaluated with a questionnaire administered to the staff assisting in the care of the subjects. Muscle spasticity was assessed with the Modified Ashworth Scale (MAS). RESULTS: The MTH of the QF, LO, and TS showed significant differences according to the GMFCS level, and the MTH of the QF and LO differed significantly depending on functional status during activities of daily living. Age and body mass index showed no significant correlation with the MTH of any muscle. Body weight was correlated with the MTH of the BB and LO. The girth of the extremity was correlated only with the MTH of the BB. There was no relationship between MTH and MAS scores. DISCUSSION AND CONCLUSION: These results suggest that the MTH of the QF and LO differed significantly depending on the subjects’ motor function during daily activity. The measurement of MTH may be an alternative method of quantitative muscle evaluation for people with severe CP for whom direct measurement of muscle strength is difficult.
Spontaneous fractures in the brain-crippled, bedridden patient.
date: 10/01/1976
author: Miller PR, Glazer DA.
publication: Clin Orthop Relat Res. 1976 Oct;(120):134-7.
pubmed_ID: 975648
Outside_URL:
This report deals with the treatment of 31 spontaneous fractures which occurred in 50 institutionalized patients who were bedridden primarily because of severe cerebral palsy associated with brain injury. More than one-half of the group sustained a spontaneous fracture. Satisfactory healing of all fractures with a minimum of complications occurred without any immobilization or realignment. In 4 patients with delayed compound wounds, the treatment consisted of resection of the protruding portion of the bone after allowing the bony protrusion to wall itself off.
Cardiac output and blood pressure during active and passive standing.
date: 03/16/1996
author: Tanaka H, Sjöberg BJ, Thulesius O.
publication: Clin Physiol. 1996 Mar;16(2):157-70.
pubmed_ID: 8964133
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/8964133
The present study compared the haemodynamic pattern of active and passive standing. We used non-invasive techniques with beat-to-beat evaluation of blood pressure, heart rate and stroke volume. Seven healthy subjects, aged 24-41 (mean 30) years were examined. Finger blood pressure was continuously recorded by volume clamp technique (Finapres), and simultaneous beat-to-beat beat stroke volume was obtained, using an ultrasound Doppler technique, from the product of the valvular area and the aortic flow velocity time integral in the ascending aorta from the suprasternal notch. Measurements were performed at rest, during active standing and following passive tilt (60 degrees). Active standing caused a transient but greater reduction of blood pressure and a higher increase of heart rate than passive tilt during the first 30s (delta mean blood pressure: -39 +/- 10 vs. -16 +/- 7 mmHg, delta heart rate: 35 +/- 8 vs. 12 +/- 7 beats m-1 (active standing vs. passive tilt; P < 0.01). There was a significantly larger increase in cardiac output during active standing (37 +/- 24 vs. 0 +/- 15%, P < 0.01) and a more marked decrease in total peripheral resistance (-58 +/- 11 vs. -16 +/- 17%, P < 0.01). A precipitous rise in intra-abdominal pressure (43 +/- 22 mmHg) could be observed upon rising only in active standing. This was interpreted as an indication of translocation of blood to the thorax. There was no significant difference in haemodynamic changes during the later stage of standing (1-7 min) between both manoeuvres. These results suggest that active standing causes a marked blood pressure reduction in the initial phase which seems to reflect systemic vasodilatation caused by activation of cardiopulmonary baroreflexes, probably due to a rapid shift of blood from the splanchnic vessels in addition to the shift from muscular vessels associated with abdominal and calf muscle contraction. Moreover, the ultrasound Doppler technique was found to be a more adequate method for rapid beat-to-beat evaluation of cardiac output during orthostatic manoeuvres.
Effectiveness of static weight-bearing exercises in children with cerebral palsy.
date: 03/01/2007
author: Pin TW.
publication: Pediatr Phys Ther. 2007 Spring;19(1):62-73. Erratum in: Pediatr Phys Ther. 2007 Summer;19(2):172-8.
pubmed_ID: 17304099
PURPOSE: Physiotherapists commonly use static weight-bearing exercises in children with cerebral palsy, which are believed to stimulate antigravity muscle strength, prevent hip dislocation, improve bone mineral density, improve self-esteem, improve feeding, assist bowel and urinary functions, reduce spasticity, and improve hand function. The effectiveness of these exercises has not been thoroughly investigated. This systematic review aimed to examine the research evidence of the effectiveness of static weight-bearing exercises in children with cerebral palsy. METHODS: Ten studies met the inclusion criteria for this review. RESULTS: The evidence supporting the effectiveness of static weight-bearing exercises in children with cerebral palsy, except the findings of increased bone density and temporary reduction in spasticity, remains limited because of an inadequate number of studies undertaken, inadequate rigor of the research designs and the small number of subjects involved. CONCLUSION: Clinicians should carefully consider all available evidence before making a decision regarding the potential effectiveness of static weight-bearing for the targeted outcomes.
Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children.
date: 08/01/1975
author: Tolman KG, Jubiz W, Sannella JJ, Madsen JA, Belsey RE, Goldsmith RS, Freston JW.
publication: Pediatrics. 1975 Jul;56(1):45-50.
pubmed_ID: 1161362
A survey of 289 severely retarded inpatients at a school for retarded children in American Fork; Utah revealed 67 patients with osteomalacia as defined by hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and appropriate bone changes. Investigation of the variables which might influence bone mineralization revealed no differences in age, sex, physical activity, sunshine exposure, or dietary intake of vitamin D between the osteomalacia and nonosteomalacia groups. However, all of the patients with osteomalacia were receiving anticonvulsant medications, either phenobarbital, diphenylhydantoin, or both. Duration of anticonvulsant therapy was the most important contributing factor to the development of osteomalacia. Seventy-five percent of patients who had received anticonvulsants for more than ten years had osteomalacia. The single most costly medical problem at the school is the treatment of pathologic bone fractures due to demineralized bone.
Management of hip dislocation with postural management.
date: 03/01/2002
author: Pountney T, Mandy A, Green E, Gard P.
publication: Child Care Health Dev. 2002 Mar;28(2):179-85.
pubmed_ID: 11952654
BACKGROUND: Hip dislocation in children with cerebral palsy has a well-documented history and morbidity. OBJECTIVE: This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants’ postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment. METHODS: The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers’ hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed. RESULTS: Children using ‘All CAPS’ before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05). CONCLUSIONS: Postural management interventions have an important role in the prevention of hip dysplasia.
Fractures in patients with cerebral palsy.
date: 03/01/2007
author: Presedo A, Dabney KW, Miller F.
publication: J Pediatr Orthop. 2007 Mar;27(2):147-53.
pubmed_ID: 17314638
Fractures in children with cerebral palsy (CP) constitute a common clinical problem. The purpose of this retrospective study is to analyze the demographics, identify risk factors, and delineate guidelines for treatment in 156 children with CP who were treated for fractures. To identify changes in demographics, children treated before 1992 (56 patients) were compared with those treated from 1992 to 2000. The latter group of children was compared with an age- and gender-matched group of CP children without fractures. Ambulatory status, the presence of contractures, nutritional status, seizure medication, the type of treatment received, final outcomes, and complications were recorded and statistically analyzed. The mean age at the time of the first fracture was 10 years. Sixty-six percent of patients had spastic quadriplegia, of whom 83% were nonambulatory. Eighty-two percent of fractures occurred in the lower limbs. Forty-eight percent were delayed in diagnosis with no cause determined. Children treated after 1992 had higher incidence of multiple fractures, lower incidence contractures, and a younger age at first fracture. This group showed a statistically significant difference for anticonvulsant therapy (P=0.001), CP pattern (P=0.005), ambulatory status (P=0.001), and osteopenia (P=0.001) when compared with the group of CP patients without fractures. Eighty percent of fractures were treated with a soft bulky dressing. Complications occurred in 17% of patients. The greatest risk factor for fracture is the nonambulatory CP child on anticonvulsant therapy. These risk factors seem to have increased, resulting in a higher prevalence of low energy fractures. Future research must focus on the underlying mechanisms and prevention of this condition.