Study on Etiological Factors, Clinical Pattern and Comorbidities in Cerebral Palsy Children of North Bihar Region.

Cerebral palsy (CP) is a form chronic motor disability in children. It is a non-progressive disorder of posture and movement, often associated with epilepsy and abnormalities of speech, vision and intellect. It results from a defect or lesion of growing brain before or during birth or in postnatal period. The damage to brain is permanent and cannot be cured but the consequences can be minimized. Cerebral palsy (CP) is a disorder of development in which abnormalities of motor function are the main characteristic features. Severity varies from mild to severe. Cerebral palsy is a very challenging disability for parents and professionals. Cerebral palsy is a heterogeneous group of disorders caused by intrapartum asphyxia and exposure to maternal infection such as chorioamnionitis, sepsis, urinary tract infection, and prematurity. The incidence of Cerebral Palsy is 2 to 2.5 per 1000 live births. During the past twenty years, there have been increases in the incidence and prevalence of CP that may be associated to enhanced records of cases, advances in neonatal health care and other factors.METHODSThis cross-sectional study was conducted in the Department of Paediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, from October 2018 to September 2019. A total of 100 Cerebral Palsy cases coming from various districts to inpatient and outpatient department of hospital were selected.RESULTSIn this study a total 100 CP children up to 12 years of age was included. 60% were boys and 40% were girls. The causes of CP included birth asphyxia (47%), prematurity (22%), pyogenic meningitis (8%), genetic (7%), neonatal sepsis (6%), intracranial bleed (5%), and idiopathic (5%). Among these cases, spastic type (65%), ataxic (15%), dyskinetic (10%) and mixed (10%) varieties were found. Among spastic, quadriplegic subtype was seen in 69%, diplegia in 23%, and hemiplegia in 8%. Comorbidities associated with CP patients were speech problem (80%), pain (75%), cognitive disability (50%), hip displacement (30%), seizure (25%), behavioural disorders (25%), sleep disturbances (20%), visual impairment (19%) and hearing impairment (4%).CONCLUSIONSPerinatal asphyxia is a leading and preventable cause of cerebral palsy. Spastic type was the most common type and in spastic type, quadriplegic subtype was most common. Mental retardation, speech problems, pain, cognitive disability, hip displacement and seizure were the major co-morbidities in children with cerebral palsy. Early diagnosis and appropriate management are important in such children to limit morbidity.

Effectiveness of Rebound Therapy along with Conventional Physiotherapy for Muscle Tone Management in Children with Cerebral Palsy

Background: According to world health organization globally 15% of populations are disabled and in Bangladesh 10% are disabled and among them, 42% child has a disability related to CP. The study purpose was to explore the effectiveness of rebound therapy along with conventional physiotherapy for muscle tone management in children with Cerebral palsy (CP). Methodology: Study used Randomized control trial (RCT) at CRP pediatric department at Dhaka Bangladesh. Results: Statistical analysis was done by using Mann Whitney “U” test. Where in experimental group, mean difference of muscle tone at the following of quadriceps femoris (Right), quadriceps femoris (Left), Hamstrings (Right), Hamstrings (Left), Gastrocnemius (Right), Gastrocnemius (Left), Biceps brachi (Right), Biceps brachi (Left), Wrist flexors (Right) and Wrist flexors (Left) was 1, 1, 1.5, 1.4, 1.9, 1.9, 0.5, 0.7, 0.3 and 0.5 more than control group. Pre-test and post-test score ensure rebound therapy more significant for the management of lower limbs muscle tone than upper limbs. Significant improvement wasn’t found (p>0.05). So improvement was not statistically significant. According to mean difference study has found greater improvement in the experimental group by applying rebound therapy to CP child. Conclusion: This true experimental study concludes that rebound therapy with conventional physiotherapy is more effective than only conventional physiotherapy.

Clinical analysis of children with cerebral palsy complicated by microcephaly in Chengdu / 中国实用儿科杂志

OBJECTIVE:(CP);to provide evidence for rehabilitation management. METHODS: To summarize the results of a cross-sectional survey of a total of 422 children(0-18 years old)who were registered as cerebral palsy by Disabled Persons' Federation of Chengdu from February to April in 2013. All children were grouped according to head circumference. We analyzed the correlation between head circumference with gross motor function classification system(GMFCS),intelligence and complications. RESULTS: There were statistically significant between the two different degrees of head circumference group and the classification of GMFCS and cognition respectively(P<0.001). Spearman correlation analysis showed that the number of comorbidities,GMFCS and degree of cognitive damage in children with cerebral palsy with microcephaly were negatively correlated with head circumference(P<0.001). CONCLUSION: The degree of head circumference reduction in children with cerebral palsy complicated by microcephaly is negatively correlated with GMFCS,the number of comorbidities and the degree of cognitive impairment.

Proposed Definition and Classification of Cerebral Palsy-Understanding Report of International Workshop on Definition and Classification of Cerebral Palsy April 2006 / 中国康复理论与实践

@#Proposed definition of cerebral palsy(CP) is a group of disorders of the development of movement and posture, that are attributed to non-progressive disturbances that occurred in the developing fetal and infant brain. Types of cerebral palsy are divided into spastic(diplegia, hemiplegia, quatriplegia), dyskinetic(athetotic, dystonic), ataxic (simple ataxia, ataxic diplegia), and mixed CP(primarily spasticity with athetosis).

Burden and Social Support of Mothers with Cerebral Palsy Children / 재활간호학회지

PURPOSE: The purpose of this study was to identify the level of burden and social support of mothers with Cerebral Palsy (CP) children, and to determine whether providing social support is an effective strategy to relieve the burden of those mothers. METHOD: From October to November 2007, the data were collected from 63 mothers with CP children who were admitted and treated for CP at Y rehabilitation center in Seoul. The data were analyzed with t-test, ANOVA, Scheffe's test, Pearson's Correlation Coefficient, and Stepwise Multiple Regression using SPSS 12.0. RESULTS: Burden of mothers was related to the Gross Motor Function Classification System (GMFCS) of the CP children. Social support was negatively correlated and GMFCS was positively correlated with burden of mothers. Social support and GMFCS was statistically significantly related with burden of mothers with CP children by multiple regression analysis. CONCLUSION: There was a significantly negative correlation between social support and burden. It demonstrated that social support, an important factor relating to burden imposed on mothers of CP children, can be considered as an intervening variable which can contribute to decrease of burden. In addition, applying developmental screening measures are needed to decrease disability severity.

Gross Motor Function and Manual Ability Classification in 4～12 Year Old Children with Cerebral Palsy of Different Types / 中国康复理论与实践

@#Objective To explore the distribution and correlation of gross motor function and manual ability in 4～12 year old children with cerebral palsy of different types. Methods 143 children with cerebral palsy (CP) were recruited according to the inclusion and exclusion criterions. They were assessed with Chinese version of Gross Motor Function Classification System （GMFCS） and Manual Ability Classification System （MACS）. Results The classification of GMFCS and MACS was Ⅰ～Ⅱ in 33 (60.0%) children with spastic diplegia; Ⅲ～Ⅴ in 28 (75.7%) children with spastic quadriplegia; Ⅰ in 21 (55.3%) children with spastic hemiplegia, and GMFCS Ⅱ in 2 children, MACS Ⅱ in 14 children. There was moderate correlation between GMFCS and MACS （r=0.67，P<0.05）. Conclusion GMFCS and MACS can be used to determine the gross motor function and manual ability in CP children of different types.

Effect of Meridian-thumbing Therapy on Flexion Deformity on Knees of Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effect of meridian-thumbing therapy on flexion deformity on knees of children with cerebral palsy(CP).Methods The therapy of thumbing the points from Chengfu to Chengshan of the meridian of Foot Taiyang Bladder was used for 40 CP children with flexion deformity on knees.Results After three months treatment,the positive flexion of knee joint in 40 children improved significantly than before(P<0.001).Conclusion The therapy of meridian-thumbing has obvious effect on flexion deformity on knees of CP children.

Effect of Partial Body Weight Support Training on Cerebral Palsy Children with Spasticity Diplegia / 中国康复理论与实践

@#Objective To observe the effect of partial body weight support training (PBWST) on walking ability of cerebral palsy (CP) children with spasticity diplegia.Methods 60 CP children with spasticity dilegia were randomly divided into the PBWST group and control group with 30 cases in each group. All cases were treated by traditional physical treatment, but those of the PBWST group were added with PBWST. The changes of walking ability and endurance of all cases before and after treatment were observed.Results After treatment, the walking ability and endurance of the cases in two groups improved significantly, but the effect of the PBWST group was obviously superior to the control group ( P<0.05), especially in walking endurance ( P<0.001).Conclusion PBWST can improve the walking ability of CP children with spasticity diplegia and already having walking ability.

Effects of Constraint-induced Movement Therapy on Upper-extremity Function of Children with Hemiplegic Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo observe the effects of a modified version of constraint-induced movement therapy (CIMT) on upper-extremity function of children with hemiplegic cerebral palsy.Methods22 patients were divided randomly into treatment group (n=10) and control group (n=12). Cases of control group received routine rehabilitation therapy, otherwise, those of treatment group were treated with CIMT. It involved restraining the unimpaired extremity with a restraining-instrument, and having the child engage in activities with the involved extremity 4 hours a day for 2 months repeatedly. Before and after treatment, affected upper-extremity function of all children were assessed with the Fine Motor Function Measure (FMFM) scale.ResultsThe fine motor function of all children in two groups improved significantly(P<0.05), but effect of treatment group was better than that of control group (P<0.05).ConclusionThe treatment of CIMT can improve upper-extremity function of children with hemiplegic cerebral palsy.

Role of Overexpressed Proinflammatory Cytokines in the Pathogenesis of Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo investigate the role of overexpressed proinflammatory cytokines in the pathogenesis of cerebral palsy (CP).MethodsLevels of tumor necrotic factor-α (TNF-α) and interleukin-6 (IL-6) in serum of 31 CP children, 20 healthy children (as controls), 37 neonates with CP risk factors such as hypoxic-ischemic injury and/or perinatal infection, and 20 healthy neonates (as controls) were measured by enzyme-linked immunosorbent assays (ELISA) retrospectively.ResultsLevels of TNF-α and IL-6 of CP children and neonates with CP risk factors were significantly higher than that of healthy controls (P<0.05). TNF-α level of CP children was significantly higher than that of neonates with CP risk factors (P<0.05), but there was no significant difference in IL-6 level between two groups.ConclusionOverexpressed proinflammatory cytokines play an important role in the pathogenesis of CP and may be an independent risk factor of CP.

Analysis of nosocomial infection of cerebral palsy children / 中国康复理论与实践

@# ObjectiveTo investigate the influencing factors of nosocomial infection in rehabilitation department of children in our hospital.MethodsThe clinical data including infection part,infection time,immunoglobulin and length of stay of 532 cerebral palsy(CP) children was retrospectively investigated.ResultsSixty-one CP children got nosocomial infection.The nosocomial infection rate was 11.47%,the most common infection sites was respiratory tract(86.89%).March,April and November were the seasons easy to occur nosocomial infection.The levels of immunoglobulin of the infected children were lower than the normal children.ConclusionThe lower level of immunoglobulin,longer hospitalization,ventilation obstructed indoor,and season change maybe the important factors which leading a higher nosocomial infection rate for CP children.

Comparison of costs of combined intravenous and inhalation general anesthesia and total intravenous anesthesia / 中国康复理论与实践

@#ObjectiveTo compare costs of combined intravenous and inhalation anesthesia (CIIA) and total intravenous anesthesia (TIA) when lower limbs orthopedics (LLO) performed on cerebral palsy children (CPC).MethodsTo analyze data of 49 CPC who received LLO under CIIA and TIA,and compare costs of two anesthetic styles.ResultsTIA had a significantly lower cost than CIIA (P<0.001),and showed a lower incidence of post-operation nausea and vomiting.ConclusionTIA can decrease cost of anesthesia and post-operation nursing compared with CIIA.

Assistant therapic effect of the botulinum toxin A on tiptoe after cerebral palsy / 中国康复理论与实践

@#ObjectiveTo study the assistant therapic effect of the Botulinum toxin A (BTA) on tiptoe after cerebral palsy(CP).MethodsMulti point injection of BAT into the musculus gastrocnemius combined with the rehabilitate therapy was used on 35 children(39 feet)with tiptoe after CP.The therapeutic effect was evaluated after a month.ResultsThe efficiency rate is 25.6%,the slight efficiency rate is 71.8%,the ineffective rate is 2.6%.There is no toxic or side effect was observed.Conclusions The BTA can relieve spasm of musculature and redress abnormality from convulsing of musculature.