Predicting Gross Motor Function in Children and Adolescents with Cerebral Palsy Applying Artificial Intelligence Using Data on Assistive Devices.

Data obtained from routine clinical care find increasing use in a scientific context. Many routine databases, e.g., from health insurance providers, include records of medical devices and therapies, but not on motor function, such as the frequently used Gross Motor Function Measure-66 (GMFM-66) score for children and adolescents with cerebral palsy (CP). However, motor function is the most common outcome of therapeutic efforts. In order to increase the usability of available records, the aim of this study was to predict the GMFM-66 score from the medical devices used by a patient with CP. For this purpose, we developed the Medical Device Score Calculator (MDSC) based on the analysis of a population of 1581 children and adolescents with CP. Several machine learning algorithms were compared for predicting the GMFM-66 score. The random forest algorithm proved to be the most accurate with a concordance correlation coefficient (Lin) of 0.75 (0.71; 0.78) with a mean absolute error of 7.74 (7.15; 8.33) and a root mean square error of 10.1 (9.51; 10.8). Our findings suggest that the MDSC is appropriate for estimating the GMFM-66 score in sufficiently large patient groups for scientific purposes, such as comparison or efficacy of different therapies. The MDSC is not suitable for the individual assessment of a child or adolescent with CP.

Association of Trunk/Leg Fat Mass Ratio with Low-Density Lipoproteins-Cholesterol and Triglycerides Concentration in Children and Adolescents: A Cross-Sectional, Retrospective Study.

Background: Increased central (or abdominal) fat mass has been associated with cardiometabolic risk factors such as high low-density lipoproteins (LDL)-cholesterol or triglycerides (TG) concentration in children. Objectives: To generate pediatric reference centiles for trunk/leg fat mass ratio (T2L) (assessed by dual-energy X-ray absorptiometry [DXA]) and to evaluate the association of LDL-cholesterol and TG concentrations with T2L in children and adolescents. Methods: Data of the National Health and Nutrition Examination Survey (1999-2004) were used to determine total and regional fat mass by DXA of the participants (aged 8-19 years) who had also an examination of LDL-cholesterol and TG concentrations. Fat mass was assessed by DXA-determined fat mass index (FMI). Central fat mass was quantified by T2L. Results: The DXA results of 6538 children and adolescents (2629 females) were used to generate reference centiles for T2L. In girls, T2L was significantly associated with high LDL-cholesterol and TG concentration (odds ratio [OR] adjusted to FMI 1.69), (95% confidence interval [CI] 1.20-2.40), and 1.45 (95% CI 1.11-1.91, p = 0.003 and p = 0.008). In boys, T2L was significantly associated only with high TG concentration (OR adjusted to FMI 1.81 [95% CI 1.52-2.19, p < 0.001]). Conclusions: A central fat distribution seemed to be an independent risk factor for high TG concentrations in children and for high LDL-cholesterol only in girls. The first ethnicity-specific, pediatric reference centiles for T2L were presented.

Accelerometric Gait Analysis Devices in Children-Will They Accept Them? Results From the AVAPed Study.

Aims: To assess children's acceptance to wear a 3D-accelerometer which is attached to the waist under real-world conditions, and also to compare gait speed during supervised testing with the non-supervised gait speed in every-day life. Methods: In a controlled observational, cross sectional study thirty subjects with cerebral palsy (CP), with level I&II of the Gross Motor Function Classification System (GMFCS) and 30 healthy control children (Ctrl), aged 3-12 years, were asked to perform a 1-min-walking test (1 mwt) under laboratory conditions, and to wear an accelerometric device for a 1-week wearing home measurement (1 WHM). Acceptance was measured via wearing time, and by a questionnaire in which subjects rated restrictions in their daily living and wearing comfort. In addition, validity of 3D-accelerometric gait speed was checked through gold standard assessment of gait speed with a mobile perambulator. Results: Wearing time amounted to 10.3 (SD 3.4) hours per day, which was comparable between groups (T = 1.10, P = 0.3). Mode for wearing comfort [CP 1, Range (1,4), Ctrl 1, Range (1,6)] and restriction of daily living [CP 1, Range (1,3), Ctrl 1, Range (1,4)] was comparable between groups. Under laboratory conditions, Ctrl walked faster in the 1 mwt than CP (Ctrl 1.72 ± 0.29 m/s, CP 1.48 ± 0.41 m/s, P = 0.018). Similarly, a statistically significant difference was found when comparing real-world walking speed and laboratory walking speed (CP: 1 mwt 1.48 ± 0.41 m/s, 1 WHM 0.89 ± 0.09 m/s, P = 0.012; Ctrl: 1mwt 1.72 ± 0.29, 1 WHM 0.97 ± 0.06, P < 0.001). Conclusion: 3D-accelerometry is well-enough accepted in a pediatric population of patients with CP and a Ctrl group to allow valid assessments. Assessment outside the laboratory environment yields information about real world activity that was not captured by routine clinical tests. This suggests that assessment of habitual activities by wearable devices reflects the functioning of children in their home environment. This novel information constitutes an important goal for rehabilitation medicine. The study is registered at the German Register of Clinical Trials with the title "Acceptance and Validity of 3D Accelerometric Gait Analysis in Pediatric Patients" (AVAPed; DRKS00011919).

Motor Function Improvement in Children with Ataxia Receiving Interval Rehabilitation, Including Vibration-Assisted Hometraining: A Retrospective Study.

BACKGROUND: Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias. PATIENTS: 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character. METHOD: Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66). RESULTS: The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia. CONCLUSION: The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms.

Murine gammaherpesvirus-68 infection of mice: A new model for human cerebral Epstein-Barr virus infection.

Epstein-Barr virus infection may cause severe neurological complications that are not mirrored by animal models. Here, we show that nasal inoculation of newborn BALB/c wild-type mice with MHV-68, a murine gammaherpesvirus, causes cerebral infection with inflammation in 50% of the animals. The inflammatory patterns are strikingly similar to those known from Epstein-Barr virus, including hydrocephalus, meningitis, cerebellitis, focal or diffuse encephalitis, and temporal lobe encephalitis. This offers a new powerful tool to study the virological and immunological characteristics of cerebral gammaherpesvirus infections.