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.

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.

Muscle assessment in healthy teenagers, Comparison with teenagers with low back pain.

OBJECTIVES: To describe muscle parameters in healthy teenagers and compare them to teenagers with chronic low back pain. METHODS: A comparative study of 276 control teenagers and 51 teenagers with chronic low back pain (CLBP), benefiting from a specific treatment, 14.5 years average age. The control group is made up of teenagers without back pain and teenagers who reported some back pain when we asked them, but without specific treatment. The results to four static tests assessing trunk flexors, trunk extensors, hip extensors and quadriceps endurance are statistically compared. In the control group, associations between different clinical measures and possible back pain are looked for. RESULTS: The two groups are homogeneous, concerning age, weight, standing height, sitting height and BMI (p>0,05). Low back pain is more common in girls, either in the control group (n=48; 69% of girls) or in the group with CLBP (n=51; 78%). CLBP is associated with a poor endurance strength of the trunk extensors (median: 2 min 31 s in the control group to 1 min 45 s in the CLBP), with hip extensors weakness (median: 2 min 20s in the control group to 1 min 24s in the CLBP), and with quadriceps weakness (median: 2 min 39 s in the control group to 1 min 20s in the CLBP), (p=0.000). No significant difference was found between trunk flexors endurance in the two groups (median: 2 min 11s in the control group to 2 min 13s in the CLBP). In the control group, 48 teenagers reported back pain "often", "very often" or "all the time"; no links were found between pain and muscle flexibility, measured with finger-floor distance, heel-cheek distance, and popliteal angle. Only the sitting height was found statistically higher (p=0.003) in the control teenagers who reported back pain (87 cm) related to the ones who have no pain (85 cm). Sport influences global strength in lower limbs and changes the ratio of quadriceps to hip extensors, in favour of quadriceps. Neither pain nor the ratio of trunk flexors to trunk extensors are modified by sport. There is a linear relation between Shirado's and Sorensen's logarithmic values: it is consequently possible to predict the Shirado value when we have the Sorensen one. Trunk extensors, hip extensors and quadriceps endurance is lower in the CLBP group, 14.5 years of age.