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Objective:To explore any effect of the single- and dual-task treadmill training on the functioning of children with bilateral spastic cerebral palsy.Methods:Fifty children with bilateral spastic cerebral palsy were randomly divided into a single-task treadmill training group (the control group, n=25) and a dual-task treadmill training group (the observation group, n=25). All of the children also received routine rehabilitation training, and the control and observation groups also conducted single- and dual-task treadmill training in addition to the routine rehabilitation training, respectively. Before and after 2 months of treatment, each child′s gross motor functioning was quantified using sections D (standing) and E (walking, running and jumping) of the Gross Motor Function Measurement-88 (GMFM-88) instrument. Balance was quantified using the Pediatric Balance Scale (PBS) and walking mobility was quantified using a 1 minute walking test (1MWT). Modified and dual task Timed Up and Go (mTUG) tests and dual-task effects (DTE) tests were also administered. Results:There were no significant differences in average test scores between the two groups before the treatment. After the treatment significant improvement was observed in both groups. There was no significant difference between the two groups in terms of average GMFM-88, PBS and 1MWT scores, but significantly greater improvement was observed in the average dual-task mTUG and DTE results of the observation group.Conclusion:Both single- and dual-task treadmill training are effective supplements to routine rehabilitation training for children with bilateral spastic cerebral palsy. Dual-task treadmill training is more effective than the single-task version.
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Objective:To investigate the gross motor function, manual ability and language communication of children with cerebral palsy (CP) and their correlation.Methods:A total of 318 children with CP (132 with spastic diplegia, 27 with spastic quadriplegia, 32 with spastic hemiplegia, 54 with dyskinesia, 41 with ataxia and 32 children with multiple difficulties) aged 4 to 12 years were classified according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). Spearman correlation coefficients were used to analyze the correlation among the three ratings.Results:Only 125 of the 318 children (39%) had the same classification level according to all three scales, showing moderate correlation and different levels for patients with different types of disability. The GMFCS and MACS levels of the subjects with spastic quadriplegia and those with dyskinesia were highly correlated. The GMFCS and CFCS levels of the hemiplegic children and those with spastic quadriplegia were also highly correlated. The MACS and CFCS levels were strongly correlated for children with spastic quadriplegia and multiple disabilities.Conclusions:The functioning of children with CP differs with their CP subtype. Correlations among the three functional assessments also differ for children with different subtypes. Combining the three classification systems provides a more comprehensive picture of the children′s ability to function in daily life.
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Infantile spasms (IS) is an age dependent epileptic encephalopathy in early infancy. Early diagnosis and treatment (within 4 weeks of onset) are beneficial to the termination of seizures and long-term cognitive protection. This paper reviewed the related literatures in the treatment of infantile spasms, mainly including the first-line and second-line drugs, the ketogenic diet and surgical treatment, to discuss the recent advances in the treatment of infantile spasms.
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Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.
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Objective To investigate neuroimaging and its correlation with clinical aspects of cerebral palsy (CP).Methods A retrospective study of 295 children with CP was conducted.Magnetic resonance imaging (MRI),the gross motor function classification system (GMFCS) and intelligence testing were administered,and any correlations among these measures was analysed.Results Among the 295 cases,257 presented abnormal MRIs (87.1％) due to brain maldevelopment (n =11),periventricular leukomalacia (PVL) (n =173),cortical/subcortical lesions (n =17),basal ganglia lesions (n =26),cerebellar maldevelopment (n =11) or others lesions (n =19).Thirty-nine presented with normal MRIs.About 26％ were rated at GMFCS level 1,18％ at level 2,17％ at level 3,19％ at level 4 and 20％ at level 5.Almost 82％ of the children presented with brain maldevelopment and 84.4％ with PVL-induced spastic bilateral paralysis.In 41％ of the children with cortical or subcortical lesions,induced spastic hemiplegia was observed,whereas 47％ had induced spastic bilateral paralysis.In 77％ of the children with basal ganglia lesions induced involuntary movement was observed,and all of those with maldevelopment of the cerebellum were ataxic.Most of those with spastic hemiplegic,bilateral paralysis,involuntary movement and ataxia were on GMFCS levels 1 or 2,with only 3.7％,33.5％,64.1％ and 46.2％ respectively on GMFCS level 4 or 5.Among those in whom the MRI revealed brain maldevelopment,9.1％ were on GMFCS level 1 or 2.The corresponding percentage for PVL was 43.9％,for cortical or subcortical lesions 58.8％,for basal ganglia lesions 19.2％ and for cerebellar maldevelopment 27.3％.The balance in each category were on GMFCS level 4 or 5.Epilepsy was most common in the children with brain maldevelopment (36.4％) or cortical or subcortical lesions (41.2％).Mental retardation was most common in cases of brain maldevelopment (45.5％),cortical or subcortical lesions (41.2％) or cerebellum maldevelopment (36.4％).The incidence of epilepsy and mental retardation was higher among the children on levels 4 and 5 than on levels 1 and 2.Conclusions Neuroimaging correlates significantly with the type of CP and GMFCS level.Epilepsy and mental retardation are most common in children with brain maldevelopment or lesions.The incidence of epilepsy and mental retardation is higher among children rated at GMFCS level 4 or 5 than among those on levels 1and 2.
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@#ObjectiveTo determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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Objective To analyze the comorbidities and gross motor function classifications (GMFCs) of premature children with cerebral palsy (CP) in terms of neurological subtype and gestational age in search of some relationship. Methods Children with cerebral palsy treated at the Qingdao Children's Hospital from 2006 to mid2009 received intelligence capacity tests, ophthalmological consultations, language/speech tests, brainstem auditory evoked potential measurements, electroencephalograms and GMFC evaluations. All of the children were stratified according to neurological subtype, gestational age, comorbidities and gross motor function classification. Results Of all 258 children, spastic diplegic cerebral palsy predominated (183 case, 70.9% ). 124 cases (48.1% ) had visual disorders, 121 (46.9%) had language or speech disorders and 103 (39.9%) showed mental retardation. The frequencies of individual comorbidities were distributed disproportionately between the different neurologic subtypes.GMFC levels also differed with the different CP types. The GMFC levels of diplegics were significantly better than those of the other types. The distribution of comorbidities such as visual disorders, language or speech disorders, and mental retardation was not related to gestational age or type of CP. Conclusions There is some correlation between the neurological subtype, comorbidities and the GMFC levels. But there is no significant correlation between gestation age and the severity of CP.
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Objective To study the clinical features of visual dysfunction in children with cerebral palsy (CP) and related factors. Methods Between 2006 and 2009, one hundred and sixty-three children (aged 4 to 108months, mean age 29.05 ± 20.51 months) with CP at Qingdao's Rehabilitation Center for Disabled Children were enrolled into this study, including 117 boys and 46 girls. All the children were retrospectively reviewed for perinatal risk factors. Ophthalmologists examined their visual parameters, including refraction, visual acuity, eye position and movement, and fundoscopy. Results Among the 163 children, 61 had visual dysfunctions, an occurrence rate of 37.4%. They included refractive errors in 39 (23.9%) , strabismus in 50 (30.7%) , abnormal eye movement in 26(15.9%) , and abnormal fundoscopic findings in 13 (7.9%). Thirty-seven children's visual acuity was examined,and 19 of them (51.4%) had low visual acuity. Patients who showed periventicular leukomalacia (PVL) or lesions in the occipital lobe on MRI examination had a high incidence of visual dysfunction. Preterm and low birth-weight were risk factors for visual dysfunction in these CP children. Conclusions Visual dysfuntion is a common complication in CP children. Early ophthalmological assessment and intervention are important for CP children.
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@#Objective To explore the effects of earlier oral-motor exercise on swallowing and feeding capability of children with cerebral palsy. Methods 36 children accepted oral-motor exercise performed by speech-language therapist once a day for 3 months. They were assessed for oral motor and feeding before and after treatment, and compared with other 36 controls matched with age and type. Results The oral motor in treatment group improved significantly （t=2.184,P<0.05） after treatment, but merely in control. The difference of scores of oral motor before and after treatment was (9.89±4.33) in treatment group, and (3.38±1.56) in control group (t=7.423, P<0.01). Conclusion Early oral-motor exercises is effective to improve oral motor function and feeding capability.
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@#Objective To explore the clinical aspects and related EEG characteristics of epilepsy (EP) in children with cerebral palsy (CP).Methods The clinical data and the EEG Results of seizure-interictal-period in 84 CP children complicated with EP were collected and compared with the data of 124 CP children without EP.Results Among 84 CP children complicated with EP, 46 cases (54.76%) were partial seizures. Followed 26 cases (30.95%) were infantile spasms, 6 cases (7.14%) were tonic-clonic seizures. Spastic CP children tended to be the most patients seizures in EP, it was 82.14%. Children with teraplegia CP were the most type among the spastic CP children compliated with EP. The abnormal rate of EEG of CP children complicated with EP was significantly higher than that of CP children without EP ( P＜0.001), and local epilptiform discharges and multilocal epileptiform discharges were main types.Conclusion Partial seizures is the most epilepsy type in CP children complicated with EP, and spastic CP is the main type. EEG abnormal ratio is obviously higher in the CP children complicated with EP than the CP children without EP. The types of abnormal EEG are mainly local epilptiform discharges and multilocal epileptiform discharges.
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@#Objective To investigate the relationship between magnetic resonance imaging(MRI) and the type of cerebral palsy (CP) and gestational age at birth.MethodsThe MRI and clinical data of 224 CP children with spastic type were analyzed retrospectively.ResultsAmong these children, 27 cases had spastic hemiplegia, 149 had spastic diplegia, and 48 had spastic tetraplegia. 201 cases (89.7%) had abnormal MRI result. The abnormal rate of MRI in spastic hemiplegia, diplegia and tetraplegia were 100%, 87.2% and 91.7%, respectively. Periventricular leukomalacia (PVL) was observed mostly in children with spastic diplegia, other types of brain lesions were uncommon. In spastic tetraplegia the lesions were more varied. Three predominated types of MRI abnormalities were: PVL (45.8%), term-type brain injuries (20.8%) and congenital brain abnormalies (18.8%). Unilateral lesions were observed mostly in children with hemiplegia spastic diplegia born at term who showed unilateral motor disorder and upper extremity were heavier than lower extremity. Unilateral and bilateral PVL were observed in children with hemiplegia spastic diplegia born at preterm who showed lower extremity were heavier than upper extremity. Of 152 cases with PVL, 108 cases (71.1%) were preterm infants and 44 cases (28.9%) were term infants. Of 22 cases with term-type brain injuries, 20 cases (90.9%) were term infants. PVL was most observed in preterm brain injuries and was observed most in preterm children but was also in term children. Term-type brain injuries (border-zone infarct, basal ganglia-thalamic lesion, subcortical leukomalacia, and multicystic encephalomalacia) were observed most in term and rare in preterm children.ConclusionThe MRI findings in CP show a good correlation with type of CP and gestational age.