Relationship between Gross Motor Function, Oromotor Function and Nutritional Status in Children with Cerebral Palsy

OBJECTIVE: To investigate the non-speech mechanism function in relation with functional status and find out the relationship between nutritional status and non-speech mechanism function in children with cerebral palsy (CP). METHOD: Eighty four children with CP were participated in this study. Non-speech mechanism function was investigated with a simple scale of oral motor status (OMS) and a feeding-swallowing evaluaton protocol for children (FEP-C). Higher score represents more severe in dysfunction in both tests. As well, Gross motor function classification system (GMFCS), the nutritional status based on body mass index were assessed in these subjects. GMFCS level I to III were grouped into high functioning group while GMFCS level IV and V were grouped into low functioning group. RESULTS: Fifty seven (67.9%) individuals with CP showed dysphagia symptoms (OMS sore > or =1). The mean scores of non-speech mechanism function in low functioning group were higher than in high functioning group (p<0.05). The mean scores of both OMS and FEP-C were higher in individuals with underweight (p<0.05). Compared to high functioning individuals with CP, underweight was more prevalent along with higher scores in oral motor function in low functioning group. OMS scores were significantly correlated with the mean scores of non-speech mechanism in all subareas (p<0.05). CONCLUSION: Non-speech mechanism function was closely related with GMFCS level. As well, this study revealed that the oromotor function and nutritional status in these individuals with CP related with non-speech mechanism function.

Is Electrical Stimulation Beneficial for Improving the Paralytic Effect of Botulinum Toxin Type A in Children with Spastic Diplegic Cerebral Palsy?

PURPOSE: The purpose of the present study was to investigate whether electrical stimulation (ES) improves the paralytic effect of botulinum toxin type A (BTX-A) and evaluate the differences between low frequency (LF) and high frequency (HF) ES in children with spastic diplegic cerebral palsy (CP). MATERIALS and METHODS: Twenty-three children with spastic diplegia CP who had BTX-A injections into both gastrocnemius muscles were assessed. Following the toxin injection, electrical stimulation was given to 1 side of the injected muscles and a sham-stimulation to the other side for 30 min a day for 7 consecutive days [HFES (25Hz) to 11 children, LFES (4Hz) to 12 children]. The compound motor action potentials (CMAP) from the gastrocnemius muscle were assessed before injection and at 5 time points (days 3, 7, 14, 21, and 30) after injection. The clinical assessments of spasticity were performed before and 30 days after injection. RESULTS: The CMAP area became significantly lower in both LFES and HFES sides from 3 days after injection compared to baseline values. In other words, the CMAP area of the sham-stimulated side showed a significant decrease at 7 or 14 days after injection. However, there were no significant differences in clinical assessment of spasticity between the stimulated and sham-stimulated sides. CONCLUSION: Short-term ES in both LF and HF to the spastic muscles injected with BTX-A might induce earlier denervating action of BTX-A. However, it does not necessarily lead to clinical and electrophysiological benefits in terms of reduction of spasticity.

Acoustic Analysis of Vowel Sound in Children with Spastic Cerebral Palsy

OBJECTIVE: To investigate the acoustic characteristics of the vowel phonation in children with spastic cerebral palsy (CP) and normal children METHOD: Twenty-six children with spastic diplegic CP and seventeen normally developed children were recruited as subjects. Voice samples were collected by pronouncing at full length /a/, /i/, and /u/ three times each into a microphone. With these samples, maximum phonation time using Multi-speech model 3,700, fundamental frequency, jitter percent, shimmer percent, noise to harmony ratio using Multi-Dimensional Voice Program model 5105, and 1st formant, 2nd formant using PraatTM were measured. RESULTS: Maximum phonation time was significantly shorterin the CP group than normal group (p<0.05). Jitter percent and Shimmer percent were significantly increased in the CP group than in the normal group (p<0.05). Fundamental frequency, 1st formant and 2nd formant were not significantly different between the two groups. CONCLUSION: Relatively short duration of maximum phonation time in the CP group suggests poor respiratory control and capacity in children with CP. Higher level of shimmer percent in CP group indicates instability of voice quality that result from poor laryngeal function. No significant difference in 1st formant and 2nd formant between the CP and control group suggests similar vowel articulatory ability.

Changes of Kinematic Parameters on Transverse Plane after Orthopaedic Surgery in Children with Spastic Diplegic Cerebral Palsy

OBJECTIVE: The aim of this study was to evaluate the effect of orthopaedic surgery for correcting gait deviation on transverse plane with regard to the kinematic parameters in children with spastic diplegic cerebral palsy (CP). METHOD: Forty-one children with spastic diplegic CP were included. They were divided into 3 groups: femoral derotaional osteotomy (FDRO) group, multiple hip internal rotator lengthening (without FDRO) group and medial hamstring lengthening only group. Gait analysis was done before and at least 6 months after operation using Vicon 370 system (Oxford Metrics Ltd., Oxford, UK). RESULTS: In FDRO group, average values of hip internal rotation and foot progression internal rotation were significantly improved (from 12.3degrees to 0.5degrees and from 6.5degrees to -11.2degrees), but pelvic rotation was not changed. In another 2 groups without FDRO, there was no significant change in all kinematic parameters on transverse plane after surgery. CONCLUSION: In children with spastic diplegic CP, there were improvements in kinematic parameters of hip and foot on transverse plane after FDRO. However, the lengthening of medial hamstrings and other hip internal rotator muscles without FDRO had no significant effect on kinematic parameters on transverse plane.

Comparison of Postural Control Mechanisms during Quiet Standing between Healthy Children and Children with Spastic Diplegic Cerebral Palsy

OBJECTIVE: To identify the difference of postural control mechanisms between healthy children and children with spastic diplegic cerebral palsy (CP) METHOD: Nineteen children with spastic diplegic CP and 22 healthy children were enrolled. Pressure data were recorded while subjects stood on the dual force platform and net body coordinates of center-of-pressure (COP) were calculated. Outcome measurements included net body COP calculations for path length, medio-lateral and antero-posterior displacements, and correlation coefficients between parameters representing ankle, hip and transverse body rotation mechanisms. RESULTS: Children with CP showed more medio-lateral and antero-posterior displacements compared to healthy children. The coordinate of net body COP showed more correlation with transverse body rotation parameters for both medio-lateral and antero-posterior rections, and less correlation with ankle mechanism parameters for medio-lateral direction in children with CP. The visual information did not show a significant influence on keeping balance during quiet standing in children with CP. CONCLUSION: This study revealed that the ankle control mechanism for medio-lateral balance control during quiet standing was less used in children with CP. The transverse body rotation mechanisms contributed more significantly to postural control during quiet standing in children with CP.

The Changes of Foot Pressure Distribution in Spastic Cerebral Palsy with Equinus Deformity following Corrective Surgery

OBJECTIVE: The aim of this study was to identify the changes of pressure distribution on the foot after orthopaedic surgery for equinus deformity in spastic cerebral palsy using F-scan system. METHOD: Twenty-one children with spastic cerebral palsy were participated in this study. They had equinus deformity on foot and received soft tissue surgery. Pressure distribution on foot was measured before and after operation using F-scan system (Tekscan Inc., USA). Paired t-test was used in comparison of preoperative and postoperative measurements for statistical analysis. RESULTS: Total contact area, contact length, midfoot and hindfoot contact width were significantly increased after operation. Relative impulses of medial and lateral forefoot were significantly decreased and relative impulse of hindfoot significantly increased after operation (p<0.05). Anteroposterior distance of center of pressure (COP) and velocity of COP were significantly increased and mediolateral distance and slope of COP were significantly decreased after operation (p<0.05). CONCLUSION: This study revealed that patterns of foot pressure distribution during walking were significantly improved after operation. Therefore, these findings suggested that F- scan system might be useful for surgical outcome measurement for foot deformities in the children with spastic cerebral palsy.