Quality of life in children with cerebral palsy

Background: Cerebral palsy (CP) is the most common motor disability in childhood. Quality of life (QOL) has emerged as an important concept in childhood, especially for children with disabilities. CP has an impact on a child’s capacity to do activities of daily living thus affecting QOL of patients and their families. Aims and Objectives: The objective of present study was to assess the QOL in children with CP. Materials and Methods: In this study, 29 children with CP in the age group of 4–12 years were evaluated for QOL was assessed using CPQOL-Child Primary Caregiver Questionnaire (4–12 years). The questionnaire was completed by one of the parents or their caregiver. Scores for each domain of QOL were converted to a scale ranging from 0 to 100 and analyzed. Results: The scores as reported by the parents were low for each of the domains with maximum effect seen in functioning domain and least in pain domain. Girls had better QOL than boys. The QOL scores were negatively related to the severity of CP which was assessed by gross motor function classification system suggesting that severity of disability had negative impact on QOL. Conclusion: QOL of children with CP was found to be poor and was influenced by age, sex and motor functioning

Relationship between the gross motor function classification system and hip and lumbar spine development in children with spastic cerebral palsy / 中国骨伤

OBJECTIVE@#To investigate the relationship among the gross motor function classification system (GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.@*METHODS@#The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed. There were 85 males and 40 females, aged from 4 to 12 years old with an average of (8.4±2.9) years. According to GMFCS, the patients were divided into gradeⅠ, Ⅱ, Ⅲ and Ⅳ groups. There were 27 cases in gradeⅠgroup, 40 cases in gradeⅡgroup, 35 cases in grade Ⅲ group and 23 cases in grade Ⅳ group. The migration percentage(MP), central edge angle(CE), neck-shaft angle(NSA), acetabular index(AI) were measured by the radiograph of pelvis, abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development. Lumbar sagittal Cobb angle, lumbar sacral angle, lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.@*RESULTS@#①Among the 125 spastic cerebral palsy children, there were 119 cases of pelvic radiographs that met the measurement standards. In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, MP was (22.72±3.88), (26.53±4.36), (33.84±4.99), and (49.54±7.87)%, CE was(30.10±6.99) °, ( 22.92±4.19) °, ( 17.91±5.50) °, and (-0.70±17.33)°, AI was (16.41±2.77) °, (20.46±4.63) °, (23.76±5.10) °, and ( 29.15±7.35)°, respectively, there were significant differences between the two comparisons (P<0.05). And the higher GMFCS grade, the greater MP and AI, and the smaller CE.The NSA was(142.74±10.03) °, (148.66±9.09) °, (151.66±10.52) °, and (153.70±8.05)° in four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively. The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant (P<0.05). NSA of GMFCSⅠgroup was significantly lower than that of the others, there was no significant difference among other groups(P>0.05). ② Among the 125 spastic cerebral palsy children, there were 88 cases of lumbar spine radiographs that met the measurement standards. ③The lumbar sagittal Cobb angle was(32.62±11.10) °, (29.86±9.90) °, (31.70±11.84) °, and (39.69±6.80)° in the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, respectively;GMFSS of grade Ⅳ group was significantly higher than that of other three groups, there was significant difference between the two comparisons (P<0.05);there were no significant differences between other groups (P>0.05). In the four groups with gradeⅠ, Ⅱ, Ⅲ, Ⅳ, the lumbosacral angle was (31.02±9.91) °, ( 26.57±9.41) °, (28.08±8.56) °, and ( 27.31±11.50)°, the lumbar lordosis index was (4.14±12.89), (8.83±13.53), (13.00±11.78), and (10.76±9.97) mm, the arch apex distance was (9.50±6.80), (6.68±3.20), (7.16±4.94), and (6.62±4.13) mm, respectively, there were no significant differences between the two comparisons(P>0.05).@*CONCLUSION@#①In children with GMFCS gradeⅠ-Ⅳ, the higher the GMFCS grade, the worse the hip develops. ② Children with GMFCS grade Ⅲ-Ⅳ may be at greater risk for lumbar kyphosis.

A clinical cross-sectional study of resting energy expenditure in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To investigate the characteristics of resting energy expenditure (REE) in children with cerebral palsy (CP) graded with different levels of Gross Motor Function Classification System (GMFCS), and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.Methods:It was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS, children with CP were divided into grade Ⅰ-Ⅱ group (20 cases), grade Ⅲ group (6 cases) and grade Ⅳ-Ⅴ group(10 cases). During the same period, 11 age-matched healthy children were included in control group.The measured REE (MREE) between children with CP and healthy controls was compared.Predicted REE (PREE) calculated by the Harris-Benedict, WHO, Schofield-W, Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann- Whitney U test, and categorical data were analyzed using Chi- square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error. Results:The MREE in control group and children with CP were (952.18±270.56) kcal/d and (801.81±201.89) kcal/d, respectively.There was no significant difference in the MREE between grade Ⅰ-Ⅱ group versus control group[(868.30±194.81) kcal/d vs.(952.18±270.56) kcal/d, P>0.05], and grade Ⅲ group versus control group [(813.17±192.48) kcal/d vs.(952.18±270.56) kcal/d, P>0.05]. The MREE was significantly lower in grade Ⅳ-Ⅴ group than that of control group [666.00(513.50, 775.50) kcal/d vs.(952.18±270.56) kcal/d, P=0.011]. There were no significant difference between MREE and PREEs calculated by Harris-Benedict, WHO, Schofield-W, Schofield-WH, and Oxford (all P>0.05). The correct classification fraction calculated by the 5 formulas were 33.3%, 47.2%, 41.7%, 47.2%, and 41.7%, respectively.The r values of the consistency of PREE calculated by the 5 formulas were 0.585, 0.700, 0.703, 0.712, and 0.701, respectively.The Blande-Altman Limits of Agreement were (-297.77, 359.22), (-245.60, 326.94), (-250.62, 316.05), (-242.22, 177.36) and (-241.28, 325.81), respectively.The clinically acceptable range was -80.18 to 80.18 kcal/d.The root mean square error were 168.09 kcal/d, 149.64 kcal/d, 146.24 kcal/d, 144.23 kcal/d and 148.77 kcal/d, respectively. Conclusions:The MREE values decreased significantly in children with CP classified as CMFCS grade Ⅳ and Ⅴ.When REE cannot be regularly monitored by indirect calorimetry to develop nutritional support programs, children with CP may be prioritized to estimate REE using the prediction formula of Schofield-WH.

Applicability of Modified Pediatric Nutritional Risk Screening Tool in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To explore the scheme of assigning rational scores to the Modified Pediatric Nutritional Risk Screening Tool for children with cerebral palsy(CP) at different Gross Motor Function Classification System(GMFCS) levels.Methods:The clinical data of 360 children with CP hospitalized in the Department of Children′s Rehabilitation, the Third Affiliated Hospital of Zhengzhou University from January to October 2019 were analyzed retrospectively.All the CP children at different GMFCS levels who met the inclusion criteria were subject to nutrition screening and assessment by using the Modified Pediatric Nutritional Risk Screening Tool and the Subjective Global Nutritional Assessment(SGNA) scale.The distribution of malnutrition rates assessed by the SGNA scale among the children at different GMFCS levels was examined.Data between groups were compared by the χ2 test.Children at different GMFCS levels were divided into different subgroups according to the statistical difference.Then, 0 or 1 score was assigned to the Modified Pediatric Nutritional Risk Screening Tool in different subgroups, and different combinations were formed.The nutritional risk screening results of different combinations were evaluated by using the SGNA scale assessment results as a reference. Results:In children with CP, the risk detection rate and incidence rate of malnutrition were 58.1%(209/360) and 36.9%(133/360), respectively.There was no significant difference in the incidence rate of malnutrition between GMFCS Ⅱ and GMFCS Ⅲ, as well as between GMFCS Ⅳ and GMFCS Ⅴ(all P>0.05). Therefore, children with CP were divided into 3 subgroups, namely, group Ⅰ, group Ⅱ to Ⅲ, and group Ⅳ to Ⅴ.Different CP disease scores were given to the Modified Pediatric Nutritional Risk Screening Tool in 3 subgroups, forming 3 different protocols[protocol 1 (0, 0, 1 point); protocol 2(0, 1, 1 point); current protocol (1, 1, 1 point)]. Taking the SGNA scale assessment results as a reference, the sensitivity of protocol 1, protocol 2 and current protocol were 85.7%, 92.5%, and 93.2% respectively.The specificity protocol 1, protocol 2 and current protocol were 81.1%, 78.0%, and 62.6%, respectively.And the Youden indexes of above three protocols were 0.668, 0.705, and 0.558, respectively.The Youden index of protocol 2 was relatively high. Conclusions:The Modified Pediatric Nutritional Risk Screening Tool can effectively identify the risk of malnutrition in children with CP.The scheme of assigning 0 points to children with GMFCS grade Ⅰ and 1 point to children with GMFCS grade Ⅱ to Ⅴ is more reasonable.

Gross Motor Function Classification System (GMFCS) For Children With Cerebral Palsy

Objectives: The objectives were to find out the sociodemographic characteristics, comorbidities, types of CP, level of GMFCS and to determine the association between GMFCS with age, gender, types of CP and topographic distribution among children with cerebral palsy. Methods and Materials: A retrospectives study was done in children with cerebral palsy. Total 384 participants were included in this study. The study setting was Paediatric Department, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh. The samples were collected through convenient sampling. The Chi-Square was used to find out the association between GMFCS with age, gender, types of CP and others. Results: Males were affected than female among all participants. The majority participants came from rural area. The children were more in 2 to 4-year age band in GMFCS. The majority participants (81%) had visual problem, 11% hearing and 31% had convulsion. The common levels were II and III. The age bands, topographic classification was associated with GMFCS (p<0.05) but gender and types of CP were not statistically associated (p>0.05). Conclusion: The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP).

Effects of Scalp Acupuncture on Cerebral Blood Flow and Gross Motor Function in Children with Spastic Cerebral Palsy / 中国康复理论与实践

@#Objective To investigate the effect of scalp acupuncture on cerebral blood flow and gross motor function in children with spastic cerebral palsy. Methods From January to November, 2016, 79 children with spastic cerebral palsy were randomly divided into con-ventional group (n=40) and scalp acupuncture group (n=39). Both groups received conventional rehabilitation treatment, and the scalp acu-puncture group was given scalp acupuncture in addition, for five months. The systolic blood flow velocity (Vs), mean flow velocity of cere-bral artery (Vm) and vascular resistance index (RI) of anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) before and after treatment were assessed with color transcranial Doppler ultrasound (TCD). The clinical effect was evaluated with the Gross Motor Function Classification System (GMFCS). Results Five cases dropped out during the follow-up, three cases in the con-ventional group and two cases in the scalp acupuncture group. There was no significant difference in all the indexes between two groups be-fore treatment (P>0.05). After treatment, the Vs and Vm of ACA, MCA and PCA improved (t>2.051, P<0.05), no improvement was found in the RI of ACA, MCA and PCA in the conventional group (t<1.1631, P>0.05), and they decreased in the scalp acupuncture group (t>2.659, P<0.05). After treatment, the Vs and Vm of ACA, MCA and PCA were higher in the scalp acupuncture group than in the conventional group (t>2.098, P<0.05), the RI of ACA was lower in the scalp acupuncture group than in the conventional group (t=2.375, P<0.05), and no signifi-cant difference was found in the RI of MCA and PCA between two groups (t<1.637, P>0.05). The total effective rate was higher in the scalp acupuncture group than in the conventional group (χ2=6.887, P<0.05). Conclusion Scalp acupuncture facilitates to increase the cerebral blood flow, decrease the vascular resistance, and improve gross motor function in children with spastic cerebral palsy.

Effect of Interactive Scalp Acupuncture on the Temporal and Spatial Parameters of Gait in Spastic Cerebral Palsy / 上海针灸杂志

Objective To study the effect of scalp acupuncture plus facilitation technique on the temporal and spatial parameters of gait in spastic cerebral palsy. Method Thirty eligible patients with spastic cerebral palsy were randomized into a treatment group and a control group based on the inter-group balance in age, palsy type, and the Gross Motor Function Classification System (GMFCS), 15 cases in each group. The treatment group was intervened by scalp acupuncture, together with the facilitation technique during the retaining of the needles; the control group was also by scalp acupuncture and facilitation techniques but with over 1 h interval between the two methods. The treatment was given once a day, totally for 3 months. The walking, running, and jumping items (E category) of the Gross Motor Function Measure-66 (GMFM-66), temporal and spatial parameters of gait, and vertical ground reaction force during stance were compared before and after the treatment. Result There were no significant inter-group differences in comparing the rates of E category of the GMFM-66 before the treatment (P>0.05), the rates were significantly changed after the treatment in both groups (P<0.05), and there were significant differences in comparing the rates between the two groups after the intervention (P<0.05);after the intervention, the step length, walking speed, and step frequency were increased significantly in both groups (P<0.05), while the double-stance phase was decreased significantly, and swing phase was increased significantly (P<0.05); after the intervention, the step length, walking speed, and step frequency of the treatment group were significantly better than that of the control group (P<0.05). Conclusion Acupuncture plus facilitation technique can mitigate the spasticity in spastic cerebral palsy, improve the gross motor function, especially the function of standing and walking, enhance the activities, and benefit the improvement of the step length, step width, and walk speed.

Humoral Immune Function in Children with Cerebral Palsy / 中国康复理论与实践

Objective To investigate the levels of immunoglobulins and complement in children with cerebral palsy. Methods 59 chil-dren with cerebral palsy were assessed with Gross Motor Function Classification System (GMFCS), and the serum levels of immunoglobu-lin (Ig)G, IgA, lgM, complements C3 and C4 were measured in the children with cerebral palsy and other 61 children without cerebral palsy (controls). Results The serum levels of IgG, IgA, lgM, complement C3 and C4 decreased significantly in the children with cerebral palsy compared with the controls (P0.05). Conclusion There is humoral im-mune dysfunction in some children with cerebral palsy, which may associated with the severity of the disease.

Humoral Immune Function in Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To investigate the levels of immunoglobulins and complement in children with cerebral palsy. Methods 59 children with cerebral palsy were assessed with Gross Motor Function Classification System (GMFCS), and the serum levels of immunoglobulin (Ig)G, IgA, lgM, complements C3 and C4 were measured in the children with cerebral palsy and other 61 children without cerebral palsy (controls). Results The serum levels of IgG, IgA, lgM, complement C3 and C4 decreased significantly in the children with cerebral palsy compared with the controls (P<0.001). There was significant difference in the levels of IgG, IgM, and complement C4 among cerebral palsy children of different grades of GMFCS (P<0.05), but not in the levels of IgA and complement C3 (P>0.05). Conclusion There is humoral immune dysfunction in some children with cerebral palsy, which may associated with the severity of the disease.

Effect of Grade of Gross Motor Function Classification System on Outcome of Selective Posterior Rhizotomy for Children with Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the outcome of selective posterior rhizotomy (SPR) for cerebral palsy children with different gross motor function before operation. Methods 132 cases accepted SPR were grouped with their grades of Gross Motor Function Classification System (GMFCS), and their outcomes were compared. Results The muscle tension, gross motor function and activities of daily living improved in all the groups after SPR (P<0.01). The muscle tone decreased the most in grade I (P<0.01). The gross motor ability improved the most in grade II(P<0.001). The activiti es of daily living improved the most in grades I and IV (P<0.05). Conclusion The outcome of SPR for children with cerebral palsy is various with the gross motor function before operation.

Neuroimaging and its correlation with clinical aspects of cerebral palsy / 中华物理医学与康复杂志

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.

Prevalence of Obesity in Ambulatory Patients with Cerebral Palsy in the Korean Population: A Single Institution's Experience

BACKGROUND: There is a worldwide tendency of an increasing prevalence of obesity. Therefore, this study aimed at determining whether such a trend exists among cerebral palsy (CP) patients. We also tried to compare this trend with the trend in the general population. We also discuss the importance of obesity trends in CP patients. METHODS: This retrospective study was performed on 766 ambulatory patients who were diagnosed with CP since 1996 in our institution. The associations among the prevalence of obesity and the body mass index, age, gender, the type of CP, the gross motor function classification system and the time of survey were investigated. RESULTS: The overall prevalence of obesity was 5.7%, and the overall prevalence of obesity together with being overweight was 14.6% for the ambulatory patients with CP. The prevalence of obesity and of obesity together with being overweight did not show a statistically significant temporal increase. On the other hand, age and gender were found to affect the body mass index of the ambulatory CP patients (p < 0.001 and 0.003, respectively). CONCLUSIONS: The extent of obesity and being overweight in the ambulatory patients with CP in this study was far less than that reported in the United States (US). In addition, it appears that the differences of the prevalence of obesity in children and adolescents between those with and without CP are disappearing in the US, whereas the differences of the prevalence of obesity in children and adolescents between those with and without CP seem to be becoming more obvious in Korea. Accordingly, care should be taken when adopting the data originating from the US because this data might be affected by the greater prevalence of obesity and the generally higher body mass indices of the US.

Cerebral palsy in children with prematurity and its comorbidities / 中华物理医学与康复杂志

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.

Dysphagia in Cerebral Palsy and the Relationship between Levels of Gross Motor Function Classification System / 中国康复理论与实践

@#ObjectiveTo analyze the characteristics of dysphagia in children with cerebral palsy and explore the relation with the gross motor function classification.MethodsThe children with cerebral palsy in our rehabilitation center from June 2009 to June 2010 were assessed by Dysphagia Disorders Survey(DDS), Oral Motor Assessment and Gross Motor Function Classification System (GMFCS) to explore the relationship between the dysphagia disorders and different gross motor levels.ResultsOf all 105 children with cerebral palsy, 21.9% were mild dysphagia, and 34.3% were moderate to severe dysphagia, resulting in a prevalence of dysphagia of 56.2%. DDS and oral motor scores were changed by GMFCS levels. The correlation coefficient were 0.767 and -0.504 between DDS, oral motor scores and GMFCS, 0.55 and 0.27 between dysphagia, oral motor disorder and the gross motor functions, respectively(P<0.01).ConclusionDysphagia was positively related to severity of motor impairment. Children in GMFCS levels Ⅳ～Ⅴ almost with problems in the pharyngeal and esophageal phases, apparently on the DDS, should be referred for appropriate clinical evaluation of swallowing function.

Preliminary study of the Gross Motor Function Classification System(GMFCS) for children with cerebral palsy / 中国康复理论与实践

@#ObjectiveTo test the reliability of Gross Motor Function Classification System(GMFCS) among different raters.MethodsUsing the Chinese translation vision of the GMFCS,5 doctors(raters) determined the level of each cerebral palsy(CP) child(aged 0～12) independently.After finishing classification of all the 23 CP children's level,the reasons of disparities among raters were discussed and analyzed,and the supplementary classification sentences were formulated.ResultsThere was no statistic significant difference in classifications among 5 raters,the GMFCS levels were correlated well with mobility and self-care domain scores in comprehensive function assessment,and higher degree of agreement could be achieved by referring to the supplementary classification sentences while classifying.ConclusionFor classifying the level of gross motor function of CP children,Chinese translation vision of the GMFCS has high degree of reliability.