Three-dimensional reconstructions of Lenke 1A curves.

BACKGROUND: Scoliosis is a 3D deformity that can be reconstructed through 2D antero-posterior and lateral radiographs, which provide an upper view of the deformed spine as well as regional planes matching all vertebrae of elective plane for each curve. The objective of this study is to explore whether all idiopathic scoliosis classified Lenke 1A have the same 3D representation made with regional planes. METHODS: All patients treated for idiopathic thoracic scoliosis during the growth period and classified Lenke 1A were included in this study conducted in the pediatric spinal orthopedic department of Centre des Massues. A photogrammetric technique was used to obtain a 3D reconstruction, from regional planes identified on radiographs made with the EOS system. Three regional planes are usually identified in asymptomatic spines: lumbar, dorsal, and cervical-none of them presenting rotation. In the studied group, the number of planes, the rotation, and the limit vertebrae of each plane were looked for. RESULTS: Sixty-three patients were included (47 girls and 16 boys, mean age 11.3 years). The Cobb angle was meanly 36.5°. The scoliosis was reconstructed with three regional planes (57%) or four ones (43%, with the thoracic plane divided into two planes). Maximal rotation was found in the thoracic plane, especially when scoliosis was represented with four regional planes. The transition between planes 2 and 3 was mainly located between the fourth and sixth dorsal vertebrae. CONCLUSION: The use of an arbitrary regional plane representation of a 3D shape leads to conclude that there are two types of Lenke 1A scoliosis, which should be taken into account for designing the brace.

Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications.

AIM: To evaluate the inter- and intra-rater reliability of two previously developed classifications of upper limb and hand patterns. METHOD: Two hundred and twelve films of patients with CP (118 of UL postures and 94 of hand tasks; median age 14, 3-46 years) were viewed by 18 examiners from 2 different rehabilitation centers, and one expert who had participated in the design of the classifications. They classed upper limb (3 patterns with sub-types) and hand patterns (2 patterns with subtypes) twice, at 2 months' interval. Inter- and intra-rater reliability were analysed. RESULTS: Intra-rater and inter-rater reliability were very high for upper limb and hand patterns (0.87 < k < 0.92), and high for the subtypes (0.58 < k < 0.68). Examiners stated that both classifications were useful and feasible in clinical practice. INTERPRETATION: Despite the single, short training session on use of the classifications, agreement between the examiners and the expert examiner was good to high, confirming that these classifications are easy to use and reliable. The classifications proposed here provide homogenous terminology for use in both clinical practice and research, to describe, evaluate and follow-up changes in upper limb and hand patterns in patients with cerebral palsy, particularly those with dyskinesia.

Management of drooling in children with cerebral palsy: A French survey.

AIM: To characterise children with cerebral palsy (CP) and pathological drooling in France, and to describe care pathways, assessment and treatment. METHOD: A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with CP, was carried out nationally across France in 2013. RESULTS: The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (<25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine(®)) (94%) botulinum toxin injections (BT) (66%) and surgery (34%). Scopolamine was considered to be less effective than BT and to have more side effects. CONCLUSION: The rate of pathological drooling in children with CP is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that BT is more effective and has less side effects.

Relation between unimanual capacities and bimanual performance in hemiplegic cerebral-palsied children: impact of synkinesis.

OBJECTIVE: Analyze the link between unimanual capacities and bimanual performance in cerebral-palsied (CP) hemiplegic children, aged between 5 and 18 years old, studying specifically the impact of synkinesis. MATERIAL AND METHODS: 71 CP hemiplegic children (35 boys and 36 girls - with average age of 8 years and 6 months; MACS levels from I to III; GMFCS from I to IV) took part in a transversal study, assessed - Melbourne Test (MUUL) for unimanual capacities, and Assisting Hand Assessment (AHA) for bimanual performance - with a specific scale to analyze synkinesis during Box and Block test for affected and healthy hands, collecting synkinesis type, duration and intensity. RESULTS: There is a strong correlation between unimanual capacities (MUUL) and bimanual performance (AHA) (r = 0.871). Neither age nor gender contribute to bimanual performance (AHA). Multiple linear regression shows that MUUL contributes to bimanual performance variance (AHA) by 70%. Synkinesis is partly correlated to capacities (MUUL) and accounts for 10% of the variance of the gap between capacities and bimanual performance. CONCLUSION: A high relationship between unimanual capacities and bimanual performance is confirmed by this study; some authors demonstrated impact of sensory troubles, we demonstrate that synkinesis influences the use of unimanual capacities in bimanual performance.

Motor function levels and pelvic parameters in walking or ambulating children with cerebral palsy.

BACKGROUND: In children with cerebral palsy, spinal equilibrium and pelvic strategies may vary according to the functional status. OBJECTIVES: To study the relationship between motor function and pelvic and spinal parameters in a population of children and adolescents with cerebral palsy (rated from level I to level IV on Gross Motor Function Classification System [GMFCS]). A sagittal X-ray of the spine in the standing position was analyzed with Optispine(®) software. RESULTS: The study population comprised 114 children and adolescents (mean [range] age: 12.35 [4-17]). For the study population as a whole, there were significant overall correlations between the GMFCS level on one hand and pelvic incidence and pelvic tilt (PT) on the other (P=0.013 and 0.021, respectively). DISCUSSION: Pelvic parameters vary according to the GMFCS level but do not appear to affect spinal curvature. The sacrum is positioned in front of the head of the femur (i.e. negative PT) in GMFCS level I and progressively moves backwards (i.e. positive PT) in GMFCS levels II, III and IV.

Isokinetic trunk muscle performance in pre-teens and teens with and without back pain.

OBJECTIVE: To assess with an isokinetic dynamometer the force and endurance of the spinal flexor and extensor muscles in pre-teens or teens aged 11 to 13 and 14 to 16 years with and without low back pain (LBP). METHOD: The control group and the LBP group were homogeneous in terms of age, weight, height and Body Mass Index (BMI). Assessment was carried out with the isokinetic dynamometer Cybex Norm®. The spinal flexors and extensors were explored concentrically at speeds of 60°, 90° and 120°/sec. The parameters chosen were: maximal moment of force (MMF), mean power (MP), total work (TW), F/E ratios (between the flexors and the extensors for the aforesaid parameters). In the LBP groups, clinical information (pain, extensibility of the spinal and sub-pelvic muscles, sports practice) and sagittal radiological data were all measured. RESULTS: While no significant difference in isokinetic performance was found between asymptomatic and LBP children in the 11-to-13-year-old group, the isokinetic performances of the LBP children were influenced positively by BMI value, number of hours of physical activity and radiologic value of the lumbar lordosis. As regards these pre-teens, assessment with an isokinetic dynamometer does not highlight muscle characteristics that might explain LBP occurrence. As regards the 14-to-16-year-old group, muscle strength has been found to be correlated with age. LBP teens were showed to have weaker extensors and stronger flexors than the healthy teens. It is with regard to this age group that assessment with an isokinetic dynamometer clearly yields interesting results. Since we have yet to standardize our evaluation criteria (working speed, number of trials…), it is difficult to compare our results with those reported in the literature. CONCLUSION: This is a preliminary study involving a relatively low number of patients. That said, given the fact that numerous parameters are connected with the age and height of the subjects, assessment with an isokinetic dynamometer can be constructively carried out from the age of 14. In order to further enhance understanding of this phenomenon, a longitudinal and comparative study of a larger group is needed.

Sagittal X-ray parameters in walking or ambulating children with cerebral palsy.

Adolescents with cerebral palsy (CP) who walk or ambulate often have an abnormal clinical and radiological spinal profile during pubertal growth compared with adolescents of the same age without neuromotor impairments. Therefore, in the following study, we aimed to conduct a radiological assessment of static data on the lumbar-pelvic-femoral complex in ambulatory children with CP to compare these data with those of an asymptomatic population. The CP population was comprised of 119 children and the asymptomatic population was comprised of 652 children. The large format (30×90cm) sagittal X-rays were taken while subjects were in a comfortable position in which knees and hips were in maximal extension. Analyses were performed using Optispine(®) software to measure the parameters of an X-ray of the profile of the spine, pelvis and femurs. Comparing, the two populations, we found no difference in the shape parameter (pelvic incidence) but we did find significant differences in the positional parameters (pelvic tilt and sacral slope) of the pelvis. We found a difference in the curvature and orientation of lumbar lordosis as well as in the number of vertebrae involved in the kyphosis and its orientation. There was also a significant difference in the C7 plumb line. We can say that the CP population is not structurally different from the control population, but that parameters become disturbed during growth. These disturbances should be identified and monitored so that changes can be detected early and progression can be prevented.

Upper limb assessment in children with cerebral palsy: translation and reliability of the French version for the Melbourne unilateral upper limb assessment (test de Melbourne).

INTRODUCTION: The Melbourne unilateral upper limb assessment evaluates upper limb function in children with neurologic impairment aged from 5 to 15 years old. Its validity and reliability have been well demonstrated for the English version, which supports this tool as a reference tool. OBJECTIVES: To present the French version of the Melbourne, its validity and reliability in order to offer French-speaking clinicians a relevant tool. PATIENTS AND METHODS: The criterion validity was studied in a group of 46 children (mean age 10.6 years, gross motor function classification system in cerebral palsy [GMFCS] 1 to 4) in comparison with Box and Block test; the intra-rater and inter-rater reliability was studied in a group of 11 hemiplegic children (mean age 9.8 years, GMFCS 1 or 2). RESULTS: The French version of the Melbourne test has a good criterion validity, with a good correlation between the score of Melbourne and the score of Box and Block test; the intra-rater reliability is very high or excellent, the inter-rater reliability is good on the whole, from moderate to excellent depending on the items. CONCLUSION: The Melbourne test is a tool which has good psychometric properties. The French version is usable and reliable.