scholarly journals Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 252
Author(s):  
H. Kerr Graham ◽  
Pam Thomason ◽  
Kate Willoughby ◽  
Tandy Hastings-Ison ◽  
Renee Van Stralen ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Classification System ◽  
Joint Deformity ◽  
Stage 4 ◽  
Analysis Laboratory ◽  
Severe Pathology ◽  
Musculoskeletal Pathology ◽  
And Function ◽  
Stage 1

This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss’ kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.

scholarly journals Impact of Lower Limb Active Movement Training in Individuals With Spastic Type Cerebral Palsy on Neuromuscular Control Outcomes: A Systematic Review

2020 ◽  
Vol 11 ◽  
Author(s):  
Shari M. O'Brien ◽  
Glen A. Lichtwark ◽  
Timothy J. Carroll ◽  
Lee A. Barber
Keyword(s):  
Cerebral Palsy ◽  
Outcome Measures ◽  
Lower Limb ◽  
Methodological Quality ◽  
Muscle Activation ◽  
Assessment Tool ◽  
Motor Impairment ◽  
Neuromuscular Control ◽  
Active Movement ◽  
And Function

Background: Cerebral Palsy (CP) is a non-progressive neurological condition that results in motor impairment which increases proximally to distally along the lower extremity (i.e., greatest impairment at the ankle). Consequently, motor impairment and reduced voluntary muscle activation results in reduced neuromuscular control of the lower limb in this population. CP rehabilitation traditionally aims to improve movement proficiency for functional activities, such as walking, by using a range of active movement modalities that require volitional effort; however, the underlying neural mechanisms of improved control and function remain unknown. The primary purpose of this study was to systematically determine the efficacy of lower limb active movement interventions to improve neuromuscular control in individuals with CP.Methodology: A search for studies involving an active lower limb intervention and neurophysiological outcome measures in individuals with CP was performed in five electronic databases. Studies were assessed for methodological quality using the Downs and Black assessment tool.Results: Nine of 6,263 articles met the inclusion criteria. Methodological quality of all studies was poor, ranging from 2 to 27 out of a possible score of 32 points on the Downs and Black assessment tool. The study interventions varied extensively in modality and prescription as well as in the outcome measures used.Conclusions: Whether active movement improves neuromuscular control of the lower limb in CP is unclear due to high variability in intervention protocols and selected outcomes measures. Future active intervention studies must carefully consider the selection of neurophysiological outcome measures.

scholarly journals Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels

2019 ◽  
Vol 121 (5) ◽  
pp. 1680-1691 ◽  
Author(s):  
Yi Yu ◽  
Xiang Chen ◽  
Shuai Cao ◽  
De Wu ◽  
Xu Zhang ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Lower Limb ◽  
Classification System ◽  
Neuromuscular Control ◽  
Muscle Synergies ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Gait Abnormalities ◽  
Semg Signals

Cerebral palsy (CP) is a neural developmental disease featured with gait abnormalities. CP gait assessment is usually performed with the Gross Motor Function Classification System (GMFCS) in clinics, which does not involve a thorough assessment of neuromuscular control. To understand how the neuromuscular control disorders lead to gait abnormalities, we explored the relationship between GMFCS levels and the gait synergetic control characteristics in this study. In total, 18 children with CP at different GMFCS levels (mean age: 4.41±1.30 yr) and 8 age-matched typically developing (TD) children (mean age: 4.43±1.36 yr) were recruited to perform a straight walking task, and the surface electromyographic (sEMG) signals from eight lower limb muscles on each side and accelerometer data were collected. A nonnegative matrix factorization method was applied to obtain the muscle synergies from the sEMG signals. Next, synergy structures were projected onto the basic gait synergies to test the completeness of those structures. Subsequently, synergy activation parameters, including total activation duration and coactivation index, were compared across the participants. This study showed that children with CP at GMFCS levels I and II and the TD children had similar synergy structures, but the synergy activations of these children with CP were different from those of TD children. In addition, similar to previous research, we also found that children with CP at GMFCS level III could not access all four basic synergies on both sides. Based on the synergy analysis results, a gait assessment paradigm was proposed to facilitate the clinical CP gait evaluation. NEW & NOTEWORTHY Understanding the mechanism of gait abnormality has important clinical significance for the diagnosis, prognosis, and possible treatment of motor dysfunction in children with cerebral palsy (CP). In this study, the comparisons of the lower limb muscle synergies among different groups of children with CP at different Gross Motor Function Classification System levels might provide some new insight into the mechanism underlying the gait disorder. In particular, the discrepancies of gait synergy structure and activation patterns across the study groups may indicate different neurophysiological and pathological attributes in different groups of patients.

Alterations in the number of motoneurons containing immunoreactive calcitonin gene-related peptide(CGRP)& choline acetyltransferase(ChAT) in the cervical spinal cord of the wobbler mouse during the development of the motoneuron disease

1995 ◽  
Vol 53 ◽  
pp. 970-971
Author(s):  
L. Vacca-Galloway ◽  
Y.Q. Zhang ◽  
P. Bose ◽  
S.H. Zhang
Keyword(s):  
Spinal Cord ◽  
Early Stage ◽  
Cervical Spinal Cord ◽  
Wild Type Mouse ◽  
Reflex Response ◽  
Mouse Strains ◽  
Behavioral Tests ◽  
Wobbler Mouse ◽  
Stage 4 ◽  
Stage 1

The Wobbler mouse (wr) has been studied as a model for inherited human motoneuron diseases (MNDs). Using behavioral tests for forelimb power, walking, climbing, and the “clasp-like reflex” response, the progress of the MND can be categorized into early (Stage 1, age 21 days) and late (Stage 4, age 3 months) stages. Age-and sex-matched normal phenotype littermates (NFR/wr) were used as controls (Stage 0), as well as mice from two related wild-type mouse strains: NFR/N and a C57BI/6N. Using behavioral tests, we also detected pre-symptomatic Wobblers at postnatal ages 7 and 14 days. The mice were anesthetized and perfusion-fixed for immunocytochemical (ICC) of CGRP and ChAT in the spinal cord (C3 to C5).Using computerized morphomety (Vidas, Zeiss), the numbers of IR-CGRP labelled motoneurons were significantly lower in 14 day old Wobbler specimens compared with the controls (Fig. 1). The same trend was observed at 21 days (Stage 1) and 3 months (Stage 4). The IR-CGRP-containing motoneurons in the Wobbler specimens declined progressively with age.

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

2019 ◽  
Vol 34 (13) ◽  
pp. 842-850
Author(s):  
Emmanuel Segnon Sogbossi ◽  
Damienne Houekpetodji ◽  
Toussaint G. Kpadonou ◽  
Yannick Bleyenheuft
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Low Income ◽  
Classification System ◽  
West African ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Common Cause ◽  
Low Income Country ◽  
Children With Cerebral Palsy

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

Novel staging classification of primary mitral regurgitation based on the presence of cardiac damage

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Van Wijngaarden ◽  
Y.L Hiemstra ◽  
P Van Der Bijl ◽  
V Delgado ◽  
N Ajmone Marsan ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Kidney Function ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Cardiac Damage ◽  
Stage 4 ◽  
All Cause Mortality ◽  
Primary Mitral Regurgitation ◽  
Stage 1 ◽  
Staging Classification

Abstract Background The indication for surgery in patients with severe primary mitral regurgitation (MR) is currently based on the presence of symptoms, left ventricular (LV) dilatation and dysfunction, atrial fibrillation and pulmonary hypertension. The aim of this study was to evaluate the prognostic impact of a new staging classification based on cardiac damage including the known risk factors but also including global longitudinal strain (GLS), severe left atrial (LA) dilatation and right ventricular (RV) dysfunction. Methods In total 614 patients who underwent surgery for severe primary MR with available baseline transthoracic echocardiograms were included. Patients were classified according to the extent of cardiac damage (Figure): Stage 0-no cardiac damage, Stage 1-LV damage, Stage 2-LA damage, Stage 3-pulmonary vasculature or tricuspid valve damage and Stage 4-RV damage. Patients were followed for all-cause mortality. Results Based on the proposed classification, 172 (28%) patients were classified as Stage 0, 102 (17%) as Stage 1, 134 (21%) as Stage 2, 135 (22%) as Stage 3 and 71 (11%) as Stage 4. The more advanced the stage, the older the patients were with worse kidney function, more symptoms and higher EuroScore. Kaplan-Meier curve analysis revealed that patients with more advanced stages of cardiac damage had a significantly worse survival (log-rank chi-square 35.2; p<0.001) (Figure). On multivariable analysis, age, male, chronic obstructive pulmonary disease, kidney function, and stage of cardiac damage were independently associated with all-cause mortality. For each stage increase, a 22% higher risk for all-cause mortality was observed (95% CI: 1.064–1.395; p=0.004). Conclusion In patients with severe primary MR, a novel staging classification based on the extent of cardiac damage, may help refining risk stratification, particularly including also GLS, LA dilatation and RV dysfunction in the assessment. Funding Acknowledgement Type of funding source: None

A Description of Middle School Male Singers’ Voice Change and Voice Part Assignment

2021 ◽  
pp. 875512332110182
Author(s):  
Ryan Austin Fisher ◽  
Nancy L. Summitt ◽  
Ellen B. Koziel
Keyword(s):  
Middle School ◽  
Sixth Grade ◽  
Eighth Grade ◽  
Voice Change ◽  
Stage 4 ◽  
Public Middle School ◽  
Middle School Choir ◽  
Choral Programs ◽  
Stage 1 ◽  
The Voice

The purpose of this study was to describe the voice change and voice part assignment of male middle school choir members. Volunteers ( N = 92) were recruited from three public middle school choral programs (Grades 6-8). Participants were audio-recorded performing simple vocal tasks in order to assess vocal range and asked to share the music they were currently singing in class. Results revealed 23.91% of participants’ voices could be categorized as unchanged, 14.13% as Stage 1, 3.26% as Stage 2, 10.87% as Stage 3, 26.09% as Stage 4, and 21.74% as Stage 5. The majority of sixth-grade participants were classified as unchanged or in Stage 1 of the voice change and the majority of eighth-grade participants were classified in Stages 4 to 5 of the voice change. Of the participants labeled “tenors” in their choir, over 60% were classified as either unchanged voices or in Stage 1 of the voice change.

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