Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis.

BACKGROUND: A group of diplegic cerebral palsied (CP) children presents six precise signs that can be easily observed during clinical examinations, physiotherapy sessions and everyday activities. These signs are: startle reaction, upper limbs in startle position, averted-eye gaze, grimaces, eye blinking and posture freezing. METHODS: In a population of 32 diplegic CP children (aged 1-8 years) perceptual signs were retrospectively identified through videos to verify their stability in the same child over time. RESULTS: Startle reaction, upper limb in startle position and posture freezing were the most frequently observed signs and the easiest to recognize with the highest agreement in both observations (P<0.001). Eye signs (eye blinking and averted-eye gaze) were more difficult to detect in our recordings. CONCLUSIONS: Signs of perceptual disorders were present in our sample of diplegic CP children from the second year of age and could still be observed after 1- to 3-year intervals, demonstrating they remain unaltered over time. Furthermore, if absent in the first observation, they did not appear later on. CP children with these perceptual signs could represent a new clinical entity, which we are currently describing and defining.

Functional reaching discloses perceptive impairment in diplegic children with cerebral palsy.

The currently accepted definition classifies Cerebral Palsy (CP) as a mere posture and movement disorder. Conversely, some authors have recently associated the presence of several motor dysfunctions exhibited by diplegic children with CP to an impairment in the perceptive system. The aim of the present study was to investigate the influence of the Perceptive Impairment (PI) on motor control and to appraise if the PI can be revealed by a reaching task. A functional reach and touch experiment was accomplished from sitting posture considering different directions and distances. Typically developing and diplegic children with CP were enrolled and, the latter, a priori divided in two subgroups considering a positive or negative diagnosis of PI. The reaching trials were quantified by means of centre of pressure analysis in terms of the overall quality of the task, and accuracy and effectiveness of postural adjustments and Anticipatory Postural Adjustments (APAs). The three groups showed statistically significant differences in terms of percentage of touched target, and of time spent and maximum distance covered to reach the target. In particular, PI caused a major difficulty in accomplishing the reaching tasks, thus a lower autonomy level in action. Overall, the PI strongly affected the anticipatory control system. Children with PI, rarely recruited APAs, each of which was characterized by small amplitude and inaccuracy in direction. The lack of effective APAs indicated how PI strongly influenced the motor control strategy. The present study demonstrates that the PI is a primary syndrome responsible for the long-term prognosis beside the motor and the postural disorders in CP.