Research has established inflammation in the pathogenesis of brain injury and the risk of developing cerebral palsy (CP). However, it is unclear if inflammation is solely pathogenic and primarily ...contributes to the acute phase of injury, or if inflammation persists with consequence in CP and may therefore be considered a comorbidity. We conducted a scoping review to identify studies that analyzed inflammatory biomarkers in CP and discuss the role of inflammation in the pathogenesis of CP and/or as a comorbidity. Twelve included studies reported a range of analytes, methods and biomarkers, including indicators of inflammatory status, immune function and genetic changes. The majority of controlled studies concluded that one or more systemic biomarkers of inflammation were significantly different in CP versus controls; most commonly serum or plasma cytokines such as tumor necrosis factor, Interleukin (IL)-6 and IL-10. In addition, differences in inflammation were noted in distinct subgroups of CP (e.g., those with varying severity). The available evidence supports the pathogenic role of inflammation and its ongoing role as a comorbidity of CP. This review shows that inflammation may persist for decades, driving functional impairment across development and into adulthood. However, inflammation is complex, thus further research will increase our understanding.
The general movements (GMs) assessment is recognised as one of the most important tools in the early detection of cerebral palsy (CP). However, there remains a paucity of data on its application to ...infants with congenital anomalies requiring surgery. This was a prospective study of 202 infants (mean gestation 38 weeks, SD 2.2) who had undergone major surgery for congenital anomalies in the neonatal period. Infants were assessed at three months of age (mean 12 weeks, SD 1.6) and GMs videos were independently rated by three clinicians, two blinded to clinical details. Developmental follow-up was at three years of age. Of the twenty-five infants (9%) rated as having an absence of fidgety movements, 22 were seen at 3 years, and 17 had an abnormal outcome: 11 with CP, and 6 with a developmental disability. Infants with absent fidgety movements were 21.5 (95% CI 7.3-63.8) times more likely to have an abnormal outcome including CP. None of the infants with normal fidgety movements had a diagnosis of CP and 86% were assessed to be developing normally. The GMs assessment has predictive value for cerebral palsy and neurodevelopment for infants with congenital anomalies, and should be incorporated into routine follow-up to facilitate early referral.
ABSTRACT
The aim of this preliminary study was to describe parent views about implementing effective home programs to inform practice recommendations. Semi-structured interviews were conducted with ...10 parents of children with cerebral palsy (2 fathers and 8 mothers) who had participated in a home program by using a partnership-based approach. Transcripts were analyzed using grounded theory to the level of open coding of categories. Parents believed practice of home program activities was a part of life, to maximize progress, gain guidance, and manage time. Partnership-based home programs provided benefits including support, realism, flexibility, motivation, generalisable activities, practice reminders, progress updates, and role clarification. Parents advised other parents to accept their child's disability, never refuse help, be honest, develop routines, and consider programs essential. Parents advised professionals that parents want support, interdisciplinary coordination, and prognostic information, without pressure to comply. The findings suggest that parents experienced benefits using partnership home programs. Parents used these programs to help parent their child. Provision of ongoing support to parents was vital for motivation.
Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves ...cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP).
A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; >25% participants ≤2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.
A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05-0.72; I(2) = 3%; P = .02) CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.
To summarize evidence on the rates of co-occurring impairments, diseases, and functional limitations with cerebral palsy into succinct clinical messages.
A search was conducted of the databases ...PubMed, Medline, CINAHL, and PsycINFO, and the results were supplemented with hand searches. Two independent reviewers determined whether retrieved abstracts met the following inclusion criteria: human subjects; >90% were children or adults with cerebral palsy; published after 1999; and population-based data. Articles were appraised, analyzing design, participants, level of evidence, rates of impairments, and functional implications. Methodologic quality was rated by using a standardized checklist.
A total of 1366 papers were identified in the search; 82 were appraised and 30 were included in the meta-analyses. High-level evidence existed, as rated on the Oxford 2011 LEVELS OF EVIDENCE: 97% of prevalence studies were level 1. The data were of a moderate to high quality grade (with the exception of sleep disorders), allowing plain English clinical messages to be developed.
Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.
Rouabhi et al present a novel prognostic tool for identifying the risk of cerebral palsy (CP) in a "low-risk" term newborn, using a large sample of population register data from Canadian infants. ...Selected clinical variables based on published risk factors were used to build and test a model. Variables not contributing to the model were removed, enabling development of a streamlined prognostic tool. The authors identified 12 clinical variables for inclusion within the tool, all of which are routinely collected clinical information about pregnancy and maternal history, labor and delivery history, and infant characteristics. The tool calculates a prediction value for risk of CP and gives corresponding ranges from lower than normal to much higher than normal. Importantly, there are recommendations for the additional screening needed at each risk range. This enables streamlined resource use, from routine developmental screening by primary care professionals to referral for specialized assessments such as the General Movements Assessment (GMA) and Hammersmith Neurological Examination (HINE). Term infants with highest risk for CP (those with neonatal encephalopathy and seizures) were not included in the model as it was assumed these infants meet criteria for routine developmental screening as per clinical guideline recommendations.
Objective: To summarize evidence on effective home programme intervention for adults and describe characteristics of successful home programmes.
Data sources: A search was conducted of MEDLINE, ...CINAHL, PsycINFO, EMBASE, DARE, The Physiotherapy Evidence Database, Cochrane Database of Systematic Reviews, OTSeeker and Google Scholar and references in manuscripts retrieved.
Review methods: Two independent reviewers determined whether retrieved study abstracts met inclusion criteria: human subjects; adults; home programme intervention; systematic reviews, randomized controlled trials or controlled trials. Included papers were appraised for study design, participants, type and intensity of intervention, and outcomes. Methodological quality of trials was rated using the PEDro scale (1–10 highest).
Results: Thirty-two papers were retrieved (6 systematic reviews, 26 trials). The 23 randomized controlled trials and 3 controlled trials were appraised. All the retrieved papers were level 1a, 1b or 2b evidence. Major findings were: (a) home programme intervention was more effective than no intervention at all; (b) home programme intervention was equally effective to expert-provided therapy, except when therapeutic modalities were used; and (c) different instruction formats produced similar outcomes. Home programmes with favourable outcomes were more likely to: involve the patients in establishing the programme; intervene on the person, task and environment; and provide feedback about progress. Dose did not appear to be related to outcome.
Conclusion: There is grade 1A evidence supporting the effectiveness of home programmes for adults. Home programmes are as effective as expert-provided therapy.
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