This book is a derivative of the author's well-regarded Cerebral Palsy and focuses on rehabilitation techniques. The book discusses the theory and techniques used by physical and occupational ...therapists, and also provides suggestions for implementing an Individual Education Plan. The book includes chapters on rehabilitation techniques. Tables and algorithms are included to help in the decision-making process for determining what treatment would be most beneficial. On the accompanying CD there are more than 100 case studies, as well as videos of children with gait disorders.
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PART I Nature of the Defect.- 1 Cerebral Palsy Detection: from John Little to the Present.- 2 Guide to the Interpretation of Cerebral Palsy.- PART II Function Analysis.- 3 Functional Diagnosis in ...Infants and in Very Young Children: Early Predictive Signs.- 4 Motor Defects.- 5 Perceptive Defects.- 6 Praxic Organization Disorders.- 7 Visual and Oculomotor Disorders.- 8 Neuropsychological Evaluation.- 9 Emotional, Behavioral and Social Disorders in Children and Adolescents with Cerebral Palsy.- 10 Observing Interactions.- PART III Classification of Spastic Syndromes and Clinical Forms.- 11 Critical Aspects of Classifications.- 12 Kinematic Classification.- 13 Tetraplegic Forms.- 14 Dysperceptive Forms.- 15 Forms of Diplegia.- 16 Forms of Hemiplegia.- Subject Index
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Twenty-one papers on caring for children with cerebral palsy are organized into four sections, including: (1) cerebral palsy and the interdisciplinary team approach; (2) management of impairments ...related to cerebral palsy; (3) preventing disability by optimizing function of the child with cerebral palsy; and (4) preventing handicap by creating opportunities for the child with cerebral palsy. The papers are: "Definitions, Etiology, and Epidemiology of Cerebral Palsy" (Louis Pellegrino and John P. Dormans); "Making the Diagnosis of Cerebral Palsy" (Louis Pellegrino and John P. Dormans); "Interdisciplinary Care of the Child with Cerebral Palsy" (Louis Pellegrino and Gretchen Meyer); "Well-Child Care and Health Maintenance" (Louis Pellegrino); "The Management of Spasticity" (Stephanie Ried, Louis Pellegrino, Shirley Albinson-Scull, and John P. Dormans); "Musculoskeletal Impairments: Introduction to the Orthopedics of Cerebral Palsy" (John P. Dormans and Lawson A. Copley); "Orthopedic Approaches to Treatment" (John P. Dormans and Lawson A. Copley); "Gait Analysis in Cerebral Palsy" (Freeman Miller); "Postsurgical Management of Cerebral Palsy" (Sandy McGee, Johanna E. Deitz Curry, and John P. Dormans); "Neurosurgical Treatment of Spasticity" (Ann-Christine Duhaime and Shirley Albinson-Scull); "Nutrition and Feeding" (Peggy S. Eicher); "Promoting Functional Mobility" (Johanna E. Deitz-Curry); "Promoting Function in Daily Living Skills" (Lesley A. Geyer, Lisa A. Kurtz, and Lynette E. Byarm); "Promoting Function: Communication" (Cynthia B. Solot); "Assistive Technology" (Jennifer Rauck Burstein, Mary Lisa Wright-Drechsel, and Audrey Wood); "Orthotic Management" (James S. Walker and Meg Stanger); "The Family" (Symme W. Trachtenberg and Christine F. Rouse); "The School" (Susan K. Effgen); "Public Policy: Disability-Related Legislation" (Linda Hock-Long); "Transitions to Adulthood: The Adult with Cerebral Palsy" (Adadot Hayes); and "Epilogue" (John P. Dormans and Louis Pellegrino). (Individual papers contain references). (DB)
Cerebral palsy (CP) has been recognized as a group of neurologic disorders with varying etiologies and ontogenies. While a percentage of CP cases arises during labor, the expanded use of electronic ...fetal monitoring (EFM) to include prevention of CP has resulted in decades of vastly increased interventions that have not significantly reduced the incidence of CP for infants born at term in the USA. Litigation alleging that poor obstetrical practice caused CP in most of these affected children has led to contentious arguments regarding the actual etiologies of this condition and often resulted in substantial monetary awards for plaintiffs. Recent advances in genetic testing using whole exome sequencing have revealed that at least one-third of CP cases in term infants are genetic in origin and therefore not labor-related. Here, we will present and discuss previous attempts to sort out contributing etiologies and ontogenies of CP, and how these newer diagnostic techniques are rapidly improving our ability to better detect and understand such cases. In light of these developments, we present our vision for an overarching spectrum for proper categorization of CP cases into that the following groups: (1) those begun at conception from genetic causes (nonpreventable); (2) those stemming from adverse antenatal/pre-labor events (possibly preventable with heightened antepartum assessment); (3) Those arising from intrapartum events (potentially preventable by earlier interventions); (4) Those occurring shortly after birth (possibly preventable with closer neonatal monitoring); (5) Those that appear later in the postnatal period from non-labor-related causes such as untreated infections or postnatal intracranial hemorrhages.
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5.
Cerebral Palsy: An Overview Vitrikas, Kirsten; Dalton, Heather; Breish, Dakota
American family physician,
02/2020, Volume:
101, Issue:
4
Journal Article
Peer reviewed
Cerebral palsy, which occurs in two to three out of 1,000 live births, has multiple etiologies resulting in brain injury that affects movement, posture, and balance. The movement disorders associated ...with cerebral palsy are categorized as spasticity, dyskinesia, ataxia, or mixed/other. Spasticity is the most common movement disorder, occurring in 80% of children with cerebral palsy. Movement disorders of cerebral palsy can result in secondary problems, including hip pain or dislocation, balance problems, hand dysfunction, and equinus deformity. Diagnosis of cerebral palsy is primarily clinical, but magnetic resonance imaging can be helpful to confirm brain injury if there is no clear cause for the patient's symptoms. Once cerebral palsy has been diagnosed, an instrument such as the Gross Motor Function Classification System can be used to evaluate severity and treatment response. Treatments for the movement disorders associated with cerebral palsy include intramuscular onabotulinumtoxinA, systemic and intrathecal muscle relaxants, selective dorsal rhizotomy, and physical and occupational therapies. Patients with cerebral palsy often also experience problems unrelated to movement that need to be managed into adulthood, including cognitive dysfunction, seizures, pressure ulcers, osteoporosis, behavioral or emotional problems, and speech and hearing impairment.
Objectives To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks’ gestation in 2011, and to evaluate changes since ...1997.Design Population based cohort studies, EPIPAGE and EPIPAGE-2.Setting France.Participants 5567 neonates born alive in 2011 at 22-34 completed weeks’ gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies.Main outcome measures Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals.Results Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks’ gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks’ gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks’ gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks’ gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks’ gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks’ gestation, but no change was observed at 22-24 weeks’ gestation. At 32-34 weeks’ gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01).Conclusions In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
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The complex aetiology of cerebral palsy Korzeniewski, Steven J; Slaughter, Jaime; Lenski, Madeleine ...
Nature reviews. Neurology,
09/2018, Volume:
14, Issue:
9
Journal Article
Peer reviewed
Open access
Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this ...Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.
Cerebral palsy Colver, Allan, Prof; Fairhurst, Charles, FRCPCH; Pharoah, Peter O D, Prof
The Lancet (British edition),
04/2014, Volume:
383, Issue:
9924
Journal Article
Peer reviewed
Summary The syndrome of cerebral palsy encompasses a large group of childhood movement and posture disorders. Severity, patterns of motor involvement, and associated impairments such as those of ...communication, intellectual ability, and epilepsy vary widely. Overall prevalence has remained stable in the past 40 years at 2–3·5 cases per 1000 livebirths, despite changes in antenatal and perinatal care. The few studies available from developing countries suggest prevalence of comparable magnitude. Cerebral palsy is a lifelong disorder; approaches to intervention, whether at an individual or environmental level, should recognise that quality of life and social participation throughout life are what individuals with cerebral palsy seek, not improved physical function for its own sake. In the past few years, the cerebral palsy community has learned that the evidence of benefit for the numerous drugs, surgery, and therapies used over previous decades is weak. Improved understanding of the role of multiple gestation in pathogenesis, of gene environment interaction, and how to influence brain plasticity could yield significant advances in treatment of the disorder. Reduction in the prevalence of post-neonatal cerebral palsy, especially in developing countries, should be possible through improved nutrition, infection control, and accident prevention.
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Babies born preterm are at an increased risk of dying in the first weeks of life, and those who survive have a higher rate of cerebral palsy (CP) compared with babies born at term. The aim of this ...individual participant data (IPD) meta-analysis (MA) was to assess the effects of antenatal magnesium sulphate, compared with no magnesium treatment, given to women at risk of preterm birth on important maternal and fetal outcomes, including survival free of CP, and whether effects differed by participant or treatment characteristics such as the reason the woman was at risk of preterm birth, why treatment was given, the gestational age at which magnesium sulphate treatment was received, or the dose and timing of the administration of magnesium sulphate.
Trials in which women considered at risk of preterm birth (<37 weeks' gestation) were randomised to magnesium sulphate or control treatment and where neurologic outcomes for the baby were reported were eligible for inclusion. The primary outcomes were infant death or CP and severe maternal outcome potentially related to treatment. Studies were identified based on the Cochrane Pregnancy and Childbirth search strategy using the terms antenatal or prenatal and magnesium and preterm or premature or neuroprotection or 'cerebral palsy'. The date of the last search was 28 February 2017. IPD were sought from investigators with eligible trials. Risk of bias was assessed using criteria from the Cochrane Collaboration. For each prespecified outcome, IPD were analysed using a 1-stage approach. All 5 trials identified were included, with 5,493 women and 6,131 babies. Overall, there was no clear effect of magnesium sulphate treatment compared with no treatment on the primary infant composite outcome of death or CP (relative risk RR 0.94, 95% confidence interval (CI) 0.85 to 1.05, 6,131 babies, 5 trials, p = 0.07 for heterogeneity of treatment effect across trials). In the prespecified sensitivity analysis restricted to data from the 4 trials in which the intent of treatment was fetal neuroprotection, there was a significant reduction in the risk of death or CP with magnesium sulphate treatment compared with no treatment (RR 0.86, 95% CI 0.75 to 0.99, 4,448 babies, 4 trials), with no significant heterogeneity (p = 0.28). The number needed to treat (NNT) to benefit was 41 women/babies to prevent 1 baby from either dying or having CP. For the primary outcome of severe maternal outcome potentially related to magnesium sulphate treatment, no events were recorded from the 2 trials providing data. When the individual components of the composite infant outcome were assessed, no effect was seen for death overall (RR 1.03, 95% CI 0.91 to 1.17, 6,131 babies, 5 trials) or in the analysis of death using only data from trials with the intent of fetal neuroprotection (RR 0.95, 95% CI 0.80 to 1.13, 4,448 babies, 4 trials). For cerebral palsy in survivors, magnesium sulphate treatment had a strong protective effect in both the overall analysis (RR 0.68, 95% CI 0.54 to 0.87, 4,601 babies, 5 trials, NNT to benefit 46) and the neuroprotective intent analysis (RR 0.68, 95% CI 0.53 to 0.87, 3,988 babies, 4 trials, NNT to benefit 42). No statistically significant differences were seen for any of the other secondary outcomes. The treatment effect varied little by the reason the woman was at risk of preterm birth, the gestational age at which magnesium sulphate treatment was given, the total dose received, or whether maintenance therapy was used. A limitation of the study was that not all trials could provide the data required for the planned analyses so that combined with low event rates for some important clinical events, the power to find a difference was limited.
Antenatal magnesium sulphate given prior to preterm birth for fetal neuroprotection prevents CP and reduces the combined risk of fetal/infant death or CP. Benefit is seen regardless of the reason for preterm birth, with similar effects across a range of preterm gestational ages and different treatment regimens. Widespread adoption worldwide of this relatively inexpensive, easy-to-administer treatment would lead to important global health benefits for infants born preterm.
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Aim
To examine the evolution of child–parent discrepancy in reporting quality of life (QoL) between childhood and adolescence in children with cerebral palsy (CP) and to investigate potential factors ...associated with such a discrepancy.
Method
We used data from the SPARCLE (Study of PARticipation of Children with CP Living in Europe) study, a population‐based cohort study of children with CP, aged 8 to 12 years at baseline (in 2004–2005), in nine European centres, who were followed up at the age of 13 to 17 years. The KIDSCREEN‐52 Quality of Life measure was used at baseline and follow‐up; 354 child–parent dyads out of 500 eligible dyads were followed up (201 males, 153 females). We used intraclass correlation coefficients (ICCs) to examine agreement between parent proxy‐reports and self‐reported QoL. We used linear regression to examine factors associated with child–parent discrepancy in QoL reporting.
Results
Agreement was low to moderate (ICC=0.16–0.48) in childhood and in adolescence across all QoL domains. In four domains (moods and emotions, self‐perception, relationship with parents and home life, and social support and peers), the extent of the discrepancy increased significantly between childhood and adolescence. Parenting stress, child pain, and child behaviour problems influenced parent proxy‐reports during both childhood and adolescence.
Interpretation
The points of view of the child and their parents should be treated as complementary to obtain better knowledge regarding the QoL of children and adolescents with CP.
This article is commented on by Harris on pages 9 of this issue.
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