Upper limb impairments, process skills, and outcome in children with unilateral cerebral palsy.

AIM: To examine the relationships between upper limb impairments and independence in self-care (ISC) in children with unilateral cerebral palsy (CP). METHOD: One hundred and eight children with unilateral CP (46 females, 62 males; mean age 8y 7mo, SD 3y 9mo) recruited from a population register were assessed for upper limb muscle power, spasticity, sensation, motor control, and process skills, and for ISC as the functional outcome using structural equation modelling. RESULTS: The model showed good fit indices and explained 90% of the variance in ISC. Direct effects were significant between manual ability and ISC (ß=0.47), and process skills and ISC (ß=0.63). Sensation had a significant positive indirect effect on ISC through manual ability (ß=0.24) and a positive but marginally non-significant indirect effect through process skills (ß=0.21, bootstrapped 95% confidence interval -0.05 to 0.55). Spasticity had a significant negative indirect effect on ISC through its effect on manual ability (ß=-0.21). Age had a significant positive indirect effect on ISC, as did intellect, through their effect on process skills (ß=0.34 and 0.21 respectively). INTERPRETATION: ISC is affected by upper limb impairments and process skill. Sensation influences ISC through its effects on manual and process skill abilities. Both sensation and process skills require further evaluation to assist ISC in children with unilateral CP. WHAT THIS PAPER ADDS: Process skills and manual ability most strongly positively influence independence in self-care (ISC) in children with unilateral cerebral palsy. Sensation influences ISC through manual ability and process skill.

COMPROMISO DE EXTREMIDADES SUPERIORES, HABILIDADES DE PROCESAMIENTO Y PRONÓSTICO DE NIÑOS CON PARÁLISIS CEREBRAL UNILATERAL: OBJETIVO: Evaluar la relación entre el daño de las extremidades superiores y la independencia en el autocuidado de niños con parálisis cerebral unilateral. METODO: Ciento ocho niños con parálisis cerebral unilateral (46 mujeres, 62 varones; media de edad 8 años y 7 meses, desviación estándar 3 años y 9 meses) fueron reclutados de un registro poblacional. Se evaluó la fuerza muscular, espasticidad, sensibilidad, control motor y habilidades de procesamiento. Como resultado funcional para la independencia en el autocuidado se usaron modelos de ecuación estructural. RESULTADOS: El modelo mostro un adecuado ajuste y explicó el 90% de la varianza en la independencia en el autocuidado. Los efectos directos entre la habilidad manual y el autocuidado (ß=0,47), y las habilidades de procesamiento y el autocuidado (ß=0,63) fueron significativos. La sensibilidad tuvo un efecto positivo indirecto sobre el autocuidado a través de la habilidad manual (ß=0,24 y un efecto positivo, pero marginalmente no significativo a través de las habilidades de procesamiento (ß=0,21, error estándar 95% con un intervalo de confianza de -0,05 a 0,55). La espasticidad tuvo un efecto indirecto negativo significativo en el autocuidado, a través de su efecto en la habilidad manual (ß=−0,21). La edad tuvo un efecto positivo significativo indirecto sobre el autocuidado, al igual que en el intelecto, a través de su efecto sobre las habilidades de procesamiento (ß=0,34 y 0,21 respectivamente). INTERPRETACIÓN: La independencia en el autocuidado depende del compromiso de las extremidades superiores y de las habilidades de procesamiento. La sensibilidad influencia el autocuidado a través del efecto sobre la habilidad manual y las habilidades de procesamiento. Ambas, la sensibilidad y las habilidades de procesamiento requieren evaluación adicional para ayudar a la independencia de autocuidado en niños con parálisis cerebral unilateral.

DEFICIÊNCIAS NO MEMBRO SUPERIOR, HABILIDADES DE PROCESSAMENTO, E DESFECHO EM CRIANÇAS COM PARALISIA CEREBRAL UNILATERAL: OBJETIVO: Examinar as relações entre deficiências no membro superior e independência no auto-cuidado (IAC) em crianças com paralisia cerebral (PC). MÉTODO: Cento e oito crianças com PC unilateral (46 do sexo feminino, 62 do sexo masculino; média de idade 8a 7m, DP 3a 9m) recrutadas a partir de um registro populacional foram avaliadas quanto a força muscular, espasticidade, sensação, controle motor, e habilidades de processamento do membro superior, e quanto a IAC como resultado funcional, usando modelamento de equação estrutural. RESULTADOS: O modelo mostrou bons índices de adequação e explicou 90% da variância na IAC. Efeitos diretos foram significativos entre a capacidade manual e IAC (ß=0,47), e habilidades de processamento e IAC (ß=0,63). A sensação teve efeito significativo positivo indireto na IAC por meio da capacidade manual (ß=0,24) e efeito positivo indireto mas marginalmente não-significativo por meio das habilidades de processamento (ß=0,21, intervalo de confiança bootstrapped a 95% - 0,05 a 0,55). A espasticidade teve efeito significativo negativo indireto na IAC por meio do seu efeito na capacidade manual (ß=−0,21). A idade teve efeito positivo significativo indireto na AAC, assim como o intelecto, por meio do seu efeito nas capacidades de processamento (ß=0,34 e 0,21 respectivamente). INTERPRETAÇÃO: A IAC é afetada pelas deficiências do membro superior e pela habilidade de processamento. A sensação infuencia a IAC por meio de seus efeitos nas habiildades manuais e de processamento. Tanto a sensação quanto as habilidades de processamento requerem maior avaliação para facilitar a IAC em crianças com PC unilateral.

Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child.

A case of spinal arterio-venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long-standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3-month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra-medullary spinal AVM compressing the mid-thoracic cord. This was successfully managed by embolisation with a non-adhesive polymer: ethylene-vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed.

Hip surveillance in Tasmanian children with cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) are at risk of hip subluxation. Over time, subluxation can lead to dislocation, deformity and pain. Hip surveillance in the form of an X-ray and clinical examination of this 'at risk group' can identify early subluxation. Early subluxation can be treated, preventing hip dislocation in many cases. Hip surveillance in CP commenced in Tasmania in 1992. AIMS: To audit the hip surveillance data to date, perform a literature review to understand the emerging evidence for prevention and management of hip subluxation in CP and update hip surveillance guidelines. METHODS: New guidelines were written and distributed, and an audit of the previous 12 years performed by review of medical files and X-rays. RESULTS: Two hundred and eighteen children had been involved in the hip surveillance programme. Fifteen cases of dislocation were recorded in this time. The incidence of subluxation and surgery, as well as the gross motor function classification system (GMFCS) level, was recorded. CONCLUSION: Data from Tasmania showed a similar incidence of hip subluxation according to GMFCS level, and frequency of different surgical interventions as other recent audits. Some children with minor subluxation improved without orthopaedic intervention once weight bearing occurred, which had not before been appreciated. Migration percentage alone is not adequate to fully describe the outcome of hip subluxation. More appropriate measures of outcome in terms of quality of life for children with CP need to be developed.

Recurrence risk in Autism Spectrum Disorder: a study of parental knowledge.

AIM: To describe recurrence risk information currently being obtained by families affected by Autism Spectrum Disorder (ASD). METHODS: Structured telephone interview of parents of 21 children who received a diagnosis of ASD at Calvary Health Care Tasmania, Hobart, Australia between May 2005 and May 2006. RESULTS: Only one of the 21 parents knew their true recurrence risk. Many overestimated their risk substantially, and in four cases this had led to a decision against increasing family size. Eleven parents said they had received no information about recurrence risk, and only one cited medical practitioners as a source of information about recurrence risk. CONCLUSION: Current provision of information about recurrence risk to families affected by ASD is inadequate.

Upper-limb botulinum toxin A injection and occupational therapy in children with hemiplegic cerebral palsy identified from a population register: a single-blind, randomized, controlled trial.

OBJECTIVES: The purpose of this work was to assess the effect of botulinum toxin A and occupational therapy compared with occupational therapy alone on body structure, activities participation, and self-perception in a sample of children (aged 3-16 years) with hemiplegic cerebral palsy recruited from a statewide register. PATIENTS AND METHODS: Participants of this single-blind, randomized, controlled trial identified from a population-based cerebral palsy register received either an individually prescribed and localized injection of botulinum toxin A with 4 sessions of occupational therapy over 4 weeks (intervention) or occupational therapy alone (control). Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability, and Health: body structure (Modified Ashworth Scale and Tardieu Scale) and activities participation (Assessment of Motor and Process Skills, Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, and Pediatric Quality of Life Inventory). Self-perception was also measured. RESULTS: All of the participants (intervention: n = 21; control: n = 22) provided data at baseline and 3 and 6 months. Mean age was 8.6 years; 23 were boys and 20 were girls. At 3 months, children allocated to receive the intervention performed significantly better in terms of body structure and activities participation. They reported improvements in self-perception for the global self-worth domain. At 6 months, the differences between the intervention and control groups persisted for the measures of body structure but not for activities participation or self-perception. CONCLUSION: Botulinum toxin A injection combined with a low-intensity occupational therapy program achieves significant improvements in body structure, activity participation, and self-perception.