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Cerebral Palsy (CP) is a common disorder of posture and movement caused by a non-progressive injury to the developing brain. Based on the degree of brain lesion the child can have hemiplegia , spastic diplegia or even total cerebral palsy Achilles tendon spasticity, weakness, or contracture in these conditions may lead to gait abnormalities. Achilles tendon plays an important role in performing plantar flexion and dorsiflexion of the ankle. The objective of this study was to find out the effect of structured exercises for Achilles tendon tightness prevailing in spastic cerebral palsy children. A total 34 subjects was selected for the study. Inclusion and exclusion crieteria were used to select the children for the study. Children of ages between 2 to 6 years of both sex were also considered for the study. The subjects who were not included in the study were those not willing to participate, individual’s history of acute trauma or with any congenital musculoskeletal problems, previous surgery or pain in the lower limbs, Vision and hearing problems and Cardio-respiratory problems. Demographic data, assent and consent was taken from the child and their parents, respectively and the explanation of the study was given. Pre and post assessment was taken on the basis of Tardieu scale before and after 16 sessions of the treatment respectively. Each session was of 45 mins and was started with warm exercises and then functional exercises were carried out. Later evaluation and interpretation of the data was done. The study revealed that there was significant effect of structured exercises for Achilles tendon tightness in subjects with spastic cerebral palsy. The structured exercise for Achilles tendon tightness was very effective in improving the gait and strength of the spastic cerebral palsy children.

AIM To analyze transcriptomes from muscle tissue and cells to improve our understanding of differences in gene expression and molecular function in cerebral palsy (CP) muscle. METHOD In this case-control study, eight participants with CP (five males, three females; mean [SD] age 14y 2mo [1y 8mo]) and 11 comparison individuals (eight males, three females; mean [SD] age 14y 0mo [2y 6mo]) were enrolled after informed consent/assent and skeletal muscle was obtained during surgery. RNA was extracted from tissue and from primary satellite cells grown to form myotubes in vitro. RNA sequencing data were analyzed using validated informatics pipelines. RESULTS Analysis identified expression of 6308 genes in the tissue samples and 7459 in the cultured cells. Significant differential expression between CP and control was identified in 87 genes in the tissue and 90 genes in isolated satellite cell-derived myotube cultures. INTERPRETATION Both tissue and cell analyses identified differential expression of genes associated with muscle development and multiple pathways of interest. What this paper adds Expression differences were found in muscle tissue and in isolated muscle cells. There was low variability in expression among cells isolated from different muscles. Expression differences suggest complex functional alterations in spastic cerebral palsy.

Trunk control during gait in children with cerebral palsy (CP) is known to be impaired. While differentiation of trunk movement between CP subtypes (unilateral/bilateral) has been examined, differentiation of lower lumbar spinal loading has not been considered. Furthermore, the relationship between lower lumbar loading and lower limb pathology has not been reported.How do lower lumbar spinal kinetics differ during unilateral and bilateral CP gait and what is the relationship between trunk kinematics and L5/S1 kinetics with lower limb pathology?Three-dimensional thorax kinematics and L5/S1 kinetics were measured during gait with children divided into 3 groups (unilateral CP (n = 21), bilateral CP (n = 31) and typical development (TD) (n = 26)). Differences in thorax kinematics and reactive forces and moments at L5/S1 between groups were analysed using Statistical Parametric Mapping. Correlation coefficients were calculated between Gait Profile Score (GPS) and kinematic measures of the thorax and kinetics at L5/S1.An increased ipsilateral bending moment was present for unilateral CP in the coronal plane (55-70% Gait Cycle (GC), p0.001), while children with bilateral CP demonstrated two distinct increased peaks during mid-stance (10-30 % GC, p0.001) and mid-swing (60-80% GC, p = 0.004) compared to TD. RMS and RoM thorax flexion, side flexion and L5/S1 lateral bend moment demonstrated significant moderate correlations with GPS.This study confirmed an increased involvement at the trunk and of lower lumbar spinal loading for children with bilateral CP compared to unilateral CP. It has been suggested that altered trunk movement in CP gait may be a combination of both a compensation for lower limb pathology and an underlying deficit. Our result of positive yet moderate correlations between GPS and trunk movement and lower spinal loading support this theory.

OBJECTIVE: We aimed to determine whether the posture control training in the sitting posture using virtual reality (VR) training program affects sitting balance and trunk stability in children with spastic cerebral palsy (CP). METHODS: The experiment was conducted for 4 weeks by randomly allocating 20 children with CP. The experimental group (n = 10) performed balance training in the sitting position using a VR training program, and the control group (n = 10) performed arm reach training in the sitting position. To evaluate static and dynamic sitting balance and trunk stability, the Wii Balance Board and Balancia software, the modified functional reach test, and the Korean version of the Trunk Control Measurement Scale were used. RESULTS: There were significant differences between the two groups in the changes in speed and postural swing distance before and after training (p

BackgroundCerebral palsy (CP) is a non-progressive disorder of posture and movement caused by prenatal or perinatal lesions of the brain. Children with CP are also at increased risk of other disabilities, for example, intellectual disability. Previous studies suggest the risk of intellectual disability varies in complex ways according to the type of motor impairment and perinatal factors such as gestational age.ObjectiveTo determine the patterns of risk of intellectual disability in children with spastic CP.DesignCross-sectional, population-based study using the Northern Ireland Cerebral Palsy Register.ParticipantsPersons born in 1981–2008 with congenital bilateral or unilateral spastic CP (N=1452).Outcome measureThe outcome measure was severe intellectual disability (IQ ResultsSevere intellectual disability was significantly more prevalent in children with bilateral spastic CP (BSCP) compared with children with unilateral spastic CP (χ² (2)=162.60, pConclusionsChildren with BSCP are at increased risk of intellectual disability, with those born at term at the highest risk. The findings highlight the importance of early screening, particularly for children with BSCP born at term.

To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique. This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position. The study cohort underwent intraoperative, laterally placed correction using a distractor placed between two upper ribs and the ipsilateral greater trochanter while the control cohort did not. The 24 study patients were compared to 22 control patients. Preoperative comparisons identified significant differences in Cobb angle, preoperative flexibility, and pelvic obliquity with the study group having larger, stiffer deformities with greater obliquity. There were no differences in pre-operative sagittal plane deformity. Mean post-operative upright Cobb angle correction was 67.3° ± 14.8° in the study and 55.3° ± 9.9° in the control group, representing a 66% and 60% correction, respectively. No neurological or other complications were noted from the use of this technique. The use of a laterally placed distraction device from upper ribs to ipsilateral greater trochanter allowed gradual lateral un-bending of large stiff neuromuscular spine deformities with greater correction than that of standard technique. In this small series, the technique allowed load-sharing during correction, with hips remaining in a functional sitting position, and without neurological complications. Level III—retrospective cohort study.

Background In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III–V of the Gross Motor Function Classification System (GMFCS) with minimal side effects. Methods Sixty-three SCP children aged 2–12 years, who were classified on levels III–V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment. Results We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group. Conclusion These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III–V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP. Trial registration ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953).

Aim: To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle–tendon morphology in children with spastic cerebral palsy (CP). Method: We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted. Results: Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4–32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported. Interpretation: Intervention studies reporting macroscopic muscle–tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level. What this paper adds: Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.

Constipation is a common problem in children with spastic cerebral palsy (sCP) with a prevalence that reaches 75%. We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care. Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP. A prospective, double-blinded randomized control trial was carried out involving 100 children aged 2–12 years with sCP (level III–V of the Gross Motor Functional Classification system) and chronic constipation. They were followed up in the Pediatric neurology clinic, Children’s hospital, Ain Shams University, May 2017- January 2019. The intervention group (O–Mg) received oral magnesium sulfate 1 mL/kg/day daily for 1 month compared to the placebo. Outcome measures were constipation improvement and decrease in bowel evacuation time after 1 month. Initially, weekly bowel movements, constipation scores and stool consistency were comparable in both groups. After 1 month of regular administration of oral magnesium sulfate, the constipation score, stool frequency and consistency improved compared to the placebo group (P

Objective: To evaluate the effect of positioning on gross motor function and spasticity in spastic quadriplegic cerebral palsy children with Gross Motor Function Classification System level IV and V. Methods: A quasi-experimental study was conducted at two Paediatric Physical Therapy Centres from November 2018 to July 2019. The study was comprised of seventy four children with quadriplegic cerebral palsy aged between 3 to 8 years. Data was obtained and gross motor functional abilities and spasticity were assessed by GMFM-88 and Modified Ashworth Scale respectively. Twenty four-hour positioning in specific seats, night positioning and standing frames for six months. The child was being positioned in 24 hours according to his challenges for the period of six months. Semi reclined positioning was performed to manage aspiration, oral leak and to develop retention. Prone positioning was done to develop righting reactions, functional sitting position was used in the treatment regime to attain better upright position and neutral pelvic standing using standing frames. SPSS 24 was used to analyse the data. Results: Paired t-test reported significant improvement in the test scores in lying position, rolling, sitting position, crawling, kneeling, standing, walking or running. n=59 subjects exhibited improvement in the spasticity before and after interventional procedures, while n=15 showed no improvement as the value of p

BACKGROUND: The Edinburgh Visual Gait Score (EVGS) is a comprehensive measure of gait abnormalities in children with cerebral palsy (CP) and has good psychometric properties. However, it is cumbersome to administer and requires multiple devices to record and measure its various components. We conducted this study to determine if a smartphone video protocol could be used to improve the usability and reliability of the EVGS for daily use in a clinic setting. METHODS: We used a handheld smartphone camera with slow-motion video technology and a motion analysis application to record and measure the EVGS of 30 ambulatory children with spastic CP. We tested the inter- and intra-rater reliability of various components of the EVGS between two observers. RESULTS: Average age was 7 years 3 months (range 4–14 years). The mean (range) EVGS scores for the trunk, pelvis, hip, knee, ankle, and foot were 1.18 (0–3), 0.68 (0–3), 1.1 (0–4), 3.95 (1.5–7.5), 1.87 (0–4) and 4.13 (2–6.5) respectively. Total score was 12.92 (7–21.5). The mean (SD) scores for Gross Motor Function Classification System (GMFCS) levels II and III were 10.73 (3.86) and 14.96 (4.2) (p

The lower level of salivary immunoglobulin A in children with cerebral palsy can be considered as the main cause of recurrent infections. The aim of this study was to investigate the effect of concurrent exercise training on immunoglobulin A and salivary alpha-amylase levels in children with cerebral palsy. Twenty children with spastic cerebral palsy (age 9.5 ± 1.8 years, height: 161.29 ± 4.23 cm, weight 31.5 ± 2.5 kg, fat 14.3 ± 1.2%, body mass index [BMI] 15.6 ± 1.8 kg/m2) were selected by available sampling method and assigned randomly to the experimental and control groups. The training protocol consisted of 12 weeks of resistance and endurance exercise, so that at the beginning of each session, resistance training and then aerobic training were performed. Fasting saliva samples were taken 10 min before and 48 h after the last exercise session. Independent and paired sample t-tests were used to assess the changes between and within the groups, respectively. The significance level was set at 0.05. The results of this study showed that 12 weeks of concurrent exercise training had a significant effect on salivary immunoglobulin A, salivary alpha-amylase, maximal oxygen consumption, total salivary protein, fat percentage, and BMI in children with cerebral palsy (p 0.05). It seems that 12 weeks of concurrent exercise training improves some immune factors and body composition of children with spastic cerebral palsy. So it can be beneficial to use a period of resistance and aerobic exercise training with appropriate training methodology in children.

Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO; experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.

Purpose: To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy. Methods: Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods. Results: Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength. Conclusion: Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population. This study has been funded by Mitialto Foundation, Duyvensz-Nagel Foundation, Dutch Rehabilitation Fund and Royal Dutch Society for Physical Therapy. van Vulpen, LF (corresponding author), Amsterdam Rehabil Res Ctr Reade, POB 58271, NL-1040 HG Amsterdam, Netherlands. l.v.vulpen@reade.nl; s.d.groot@reade.nl; eaa.rameckers@hetnet.nl; jg.becher@vumc.nl; a.dallmeijer@vumc.nl

BACKGROUND፡ Efficacies of community-based exercise programmes have been well reported, but there is scarce information on the expediency of community-based rehabilitation in a society where many children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. This study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP).METHODS: Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I – II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40-80% maximum heart rate. Gross motor function (GMF), walking distance and quality of life were assessed pre and post CBFAE training.RESULTS: Significant improvement was observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking + running+ jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE were observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in pain and impact of disability (67.93%, P=.049) and participation and physical health (60.00%, P=.042).CONCLUSION: CBFAE training contributes majorly to improved standing, walking, jumping and running and selfesteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.

[Purpose] Adults with cerebral palsy often use a cane as a walking aid because of their decreased gait ability. However, it is unclear whether this affects lower limb muscle activity during walking. The purpose of this study was to clarify the influence of using a cane during walking on the spatio-temporal parameters of walking, lower limb muscle activity, and lower limb muscle coactivation in adults with spastic cerebral palsy. [Participants and Methods] Eleven participants with cerebral palsy were included. The spatio-temporal parameters of walking, lower limb muscle activity, and coactivation of lower limb muscle were measured during a 10 m trial with no cane, one cane, and two canes. [Results] Walking speed was lower and the stride time longer when using two canes than when using no cane. All muscle activities significantly reduced when using two canes. No significant difference was observed between using no cane and one cane, except for walking speed. In addition, there was no significant difference in coactivation between the conditions. [Conclusion] This study revealed that when two canes were used, the walking speed was reduced, and lower limb muscle activity was reduced, reducing the burden. In contrast, the movement pattern was not suggested to have changed.

Background Pes planovalgus (PPV) deformity is common among cerebral palsy (CP) patients. There is no true consensus about the best way of treating this common deformity, especially when surgical interference is required. Treatment options range from orthotics to complex surgical procedures. The purpose of this prospective study was to evaluate and compare the effectiveness of 2 different procedures in the correction of symptomatic flexible PPV in ambulatory CP patients. Methods A total of 57 feet in 35 patients were divided into 2 groups: group 1, subtalar arthroereisis group, using the calcaneostop technique; group 2, lateral column lengthening group, using Evans osteotomy. Patients were assessed clinically by the clinical score proposed by Yoo et al and radiologically by measuring 7 weight-bearing angles, both preoperatively and 12 months postoperatively. Patients’ (or parents’) satisfaction and their tolerance to braces or shoes were assessed 12 months after surgery as secondary outcome parameters. Results There was a statistically significant improvement in both primary and secondary outcome parameters after both procedures in comparison to the preoperative parameters. No statistically significant differences were observed between the 2 groups regarding the outcomes of both procedures except for the greater power of arthroereisis in the correction of hindfoot valgus, which was statistically significant both clinically and radiographically. Conclusion Both procedures are valid options for the surgical management of PPV in ambulatory children with spastic CP. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis is appropriate for some patients, especially in the context of single-event multilevel surgery. Levels of Evidence: Level II: Prospective, comparative study.

The aim of the work is to increase the effectiveness of physical therapy of gross motor functions impairments in children with spastic cerebral palsy by using a therapeutic exercises program with partial body weight supporting and motivated walking on the device for the rehabilitation of people with impaired functions of the musculoskeletal system. The study included 30 children 6 to 11 years old with a spastic form of cerebral palsy. All patients were divided into 2 groups: in group I, in addition to the standard complex of physical therapy, walking according to the dynamic method was prescribed, in group II – according to the static method with partial body weight supporting. The duration of the program was 6 weeks. The survey was carried out before the start, at 2, 4 and 6 weeks of therapy. We studied the spatiotemporal characteristics of walking and activity of daily living indicators. The use of the developed program with the rehabilitation device positively influenced the spatiotemporal indicators of walking in both groups. The stride length, walking speed and the length of the covered distance increased statistically significantly. A significant increase in the volume of performed activities of daily living in the I group was found. At the same time, an increase in this indicator was also observed in group II, but it did not reach statistical significance. The use of the developed program of therapeutic exercises, including walking with motivated movement and partial body weight supporting on the developed rehabilitation device positively influenced the static and dynamic characteristics of walking, which improved the performance of activities important for children with cerebral palsy, especially walking and running. The optimal time for increasing the stride length is a 4-week program, for the development of general endurance and speed – a 6-week program of therapeutic training.

Cerebral ischemia is the most common pathology of the central nervous system in newborns, and its neuropsychological consequences cause child disability. The global cerebral ischemia in a newborn may be caused by a violation of fetoplacental blood flow in pregnant woman with antiphospholipid syndrome. The article considers the role of antiphospholipid antibodies in the pathogenesis of hypoxice-mia-ischemic brain damage of the fetus and newborn child. The authors present a clinical case of a patient with spastic cerebral palsy and delayed psychomotor development born from a mother with antiphospholipid syndrome.

Spastic Cerebral Palsy (CP) is the most common form of CP, comprising of 80% of all cases. Spasticity is a type of hypertonia that clinically manifests as dynamic contractures. The dynamic contracture along with the reduced level of physical activity in a child with CP leads to secondary structural and morphological changes in spastic muscle, causing real musculotendinous shortening, known as fixed contractures. When fixed muscle contractures are not treated early, progressive musculoskeletal deformities develop. As a consequence, spastic CP from a static neurological pathology becomes a progressive orthopaedic pathology which needs to be managed surgically. Orthopaedic surgical management of CP has evolved from previous "multi-event single level" procedures to a "single event multilevel" procedures, with changes in selection and execution of treatment modalities. There is increasing evidence that multilevel surgery is an integral and essential part of therapeutic management of spastic CP, but more research is needed to ensure effectiveness of this intervention on all domains of physical disability in CP.

Background: Spasticity is the most common disorder of Cerebral Palsy (CP) and has the characteristics of decreased active movement,elastic hypertonia and hyperreflexia. Because of this, one of the main purposes of treatment is to decrease hypertonia. Thus, the herbalmedicine Ziclague®, having an antispasmodic action, may offer a new possibility in addition to physiotherapy. Objective: Verify theeffects of the application of the herbal medicine Ziclague on hypertonia of the sural triceps muscle of children with spasticCP. Methods: Ten children, between one and seven years of age, received application of Ziclague® spray on the triceps sural musclebefore the physiotherapy sessions, during the period of twelve weeks. Evaluations were performed using the Modified Ashworth Scale(MAS), Durigon Protocol (DP) and goniometry, before and after application on the first day, after four weeks and at the end of twelveweeks. The four evaluations were compared. Results: After twelve weeks the results were more evident, with a decrease in hypertoniaof the right lower limb (RLL) and left lower limb (LLL) verified by MAS (p= 0.06 and p= 0.13), and by the DP (p= 0.003 and p= 0.007).Goniometry showed increased range of motion for dorsiflexion of the RLL (p= 0.002) and LLL (p= 0.111). Conclusion: The use ofZiclague® associated with physiotherapy had a positive effect in decreasing hypertonia of the sural triceps muscle and in increasing theankle dorsiflexion range of motion.

Background Spasticity in cerebral palsy is one of the most common disabilities of children in developing countries. Objectives The objective of this study was to determine the efficacy of laser acupuncture on spasticity in children with spastic cerebral palsy. Methods This clinical trial was conducted on 60 patients with spastic cerebral palsy at 2 to 10 years. The patients were categorized into two groups: the control group and treatment group. Laser acupuncture was applied on GV20, GV14, LI4, GB34, and LR3 (power 50 mW, 785 nm, 1 Joule, 40 seconds) three times a week for 12 sessions in the treatment group and placebo laser acupuncture on the same points in the control group. The spasticity was measured using the Modified Ashworth Scale before and after complete sessions. Results The results showed that there was a significant reduction in the Modified Ashworth Scale score in the treatment group compared with the control group (p = 0.003). Conclusions This study suggest that laser acupuncture on GV20, GV14, LI4, GB34, and LR3 can reduce spasticity for children with spastic cerebral palsy.

To find out functional strength training exercise on improving gross motor function among the children with spastic hemiplegic cerebral palsy children. Single group pre-experimental research design. The most common cause of movement disability in infancy is cerebral palsy. Cerebral palsy patients have impairments such as spasticity, low muscle strength and selective motor control in their body function. Such deficiencies may limit activity performance and participation in everyday life. Improving and optimising activities and involvement are crucial treatment objectives. Functional strength workouts are vital to overcoming obstacles to improving the functionality of children with neurological issues. 92 subjects of spastic hemiplegic cerebral palsied aged 4-8, male and female with spastic hemiplegic cerebral palsy were selected under purposive sampling technique and received functional strength training exercise for a period of ten weeks. To assess the gross motor function (functional independence) pre and post the exercise program, Gross motor functional measure was used. Results: The pre and post measurements shows significant changes in the gross motor function among children with spastic hemiplegic cerebral palsy. The results of the post-test mean values show improvement in gross motor functions after functional strength training program (p

Objective Children with spastic cerebral palsy (CP) have gait impairments resulting from decreased selective motor control, an inability to move the leg joints independently of one another, relying on excessive flexion or extension coupling across the 3 joints. Infants with white matter injury are at high risk of CP and have decreased selective motor control as early as 1 month corrected age. An in-home kicking-activated mobile task was developed to motivate more selective hip-knee control of infants at high risk of CP. The purposes of this study were to determine the feasibility of the in-home mobile task and to determine whether infants at high risk of CP and infants with typical development (TD) learn the association between their leg movements and mobile activation. Methods Ten infants at high risk of CP based on neuroimaging and 11 infants with TD participated in this cohort study at 3.5 to 4.5 months corrected age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Learning was assessed weekly based on an increase in the time that the infant demonstrated the reinforced leg actions when interacting with the kicking-activated mobile compared with spontaneous kicking. Results With regard to feasibility, participation averaged 92% for infants at high risk of CP and 99% for infants with TD. With regard to learning, the group at high risk of CP demonstrated learning of the task for 2 of 6 weeks, whereas the group with TD demonstrated learning for all 6 weeks. Conclusions Infants at high risk of CP demonstrated learning of the kicking-activated mobile task but at a reduced amount compared with infants with TD. Further research is necessary to determine whether the kicking-activated mobile task has potential as an intervention to motivate more selective hip-knee control and improve walking outcomes of infants at high risk of CP. Impact This study investigated the feasibility of an in-home kicking-activated mobile task, a discovery learning task designed to motivate infants at high risk of CP to engage in the intensive task practice necessary to promote their learning abilities and selective motor control. Lay Summary CP is a lifelong disorder of movement caused by abnormal development or early damage to the brain. If an in-home infant kicking-activated mobile task could be used to motivate certain types of age-appropriate leg movements of infants who are at high risk of CP, the task could help improve walking outcomes, which eventually could contribute to improving children’s ability to participate in daily life. This study showed that infants at high risk of CP did learn the infant kicking-activated mobile task but at a much reduced amount compared with infants who are developing typically; so, this is a first step in determining whether the task has potential to motivate more age-appropriate leg movements in infants at high risk of cerebral palsy.

Delayed development of the gross motor function abilities is the main manifestation of cerebral palsy (CP) in all children affected by it. Rebound therapy was introduced to help children with different disabilities such as CP. The aim of this case study was to assess the effect of the rebound therapy on the gross motor function abilities in a child with spastic CP. An eight year old girl with spastic CP of Level I on the gross motor function classification system (GMFSC) and graded 1 on the Modified Ashworth Scale (MAS) was selected to undergo the rebound therapy program using mini trampoline. Gross motor abilities were assessed pre- and post- rebound therapy program. The program was conducted for three successive months - three times / week for half an hour / session. The comparison of pre- and post- treatment results showed that rebound therapy improved the total gross motor function abilities by 3.8%, the sitting function by 5%, the kneeling and crawling functions by 3%, the standing function by 2.7% and the walking, running and jumping functions by 8% in a child with spastic CP. Rebound therapy was effective in improving gross motor function abilities in a child with spastic CP. However, further randomized control trials are recommended.

O objetivo desse estudo foi identificar as contribuições das aulas de Educação Física no desenvolvimento da autonomia de uma aluna com Paralisia Cerebral Diplégica Espástica, com idade de 17 anos, cursando o segundo ano do ensino médio na rede pública de ensino. A paralisia cerebral é resultado de desordens permanentes do desenvolvimento do movimento e postura, atribuídos a um distúrbio não progressivo que ocorre durante a formação do cérebro na fase fetal ou na infância, podendo afetar o aspecto motor, associado ou não a outros distúrbios sensoriais, cognitivos, comportamentais, dentre outros. Nesse estudo, utilizou-se o estudo de caso como método de pesquisa com caráter qualitativo. Essa investigação foi realizada no primeiro semestre do ano de 2019, levando em consideração a vivência da aluna nas aulas de Educação Física do ano anterior. Os resultados mostraram que as aulas realizadas em uma escola da rede pública de ensino, localizada no município de Colatina, ES, proporcionaram à aluna a percepção de maior autonomia e consciência corporal, além de facilitar a socialização com os sujeitos escolares daquela instituição. Apesar da sua condição física, considerar as possibilidades de participação da aluna nas diferentes propostas de exercícios pôde contribuir para que ela adquirisse mais flexibilidade e força, possibilitando avanços significativos em sua autonomia.

Introduction. Cerebral palsy (CP) is the main cause of childhood neurological disability in the world. Due to the fact that the prevalence of knee contractures in children with cerebral palsy occupies the 3rd place in the structure of orthopedic pathology of the lower extremities, this topic is least covered in the scientific periodicals. Material and methods. Findings from 40 patients of the main group, aged 7-12 and having cerebral palsy (CP), were studied retrospectively. They had knee flexion contractures with patella alta. Findings of goniometry and of Gillette FAQ were analyzed before and after surgery. The Spearman coefficient was used for the correlation analysis of goniometry parameters and surgical intervention effectiveness before surgery. 35 patients having no bilateral CP damage and other diseases leading to lower limb deformities were included into the reference group. X-ray examination and goniometry assessment of a healthy limb were made in patient’s lying position on his back with passive extension; plus goniometry in a standing position with shin active extension. Results. The median of deformation angles before and after surgery was 20° and 5°, respectively (p

Introduction: A description of Cerebral Palsy (CP) is, a group of stable disorders of the development of movement and posture, causing activity limitations that are attributed to no progressive disturbances that happened in the developing fetal or infant brain. Objective: To evaluate the role of oral Baclofen on Physiotherapy in reducing spasticity of cerebral palsy. Materials and Methods: This study was performed in the Department of Anatomy and Department of Pediatrics, University Hospital, Banaras Hindu University, Varanasi and Kiran Society, Varanasi. Patients aged between 2 years to 14 years of both sexes satisfying the inclusion and exclusion criteria were randomly enrolled into two groups; Group A included 60 patients who received only physiotherapy and Group B included 60 patients who received baclofen along with physiotherapy. Spasticity parameters were evaluated using modified Ashworth scale, physical rating scale like knee recurvatum, angle for crouch gait and foot contact. All patients were followed up at 4 weeks interval and were evaluated after of 24 weeks. Ethical clearance was obtained from the concerned authority. Data management and statistical analysis were performed using MS excel. Results: Physiotherapy was highly effective in reducing tone in spastic cerebral palsy. Similar was the observation when baclofen was added to physiotherapy regimen. However, when compared, the efficacy of baclofen along with physiotherapy was far superior as compared to physiotherapy alone. However, none of the treatment modalities has significant effect on knee recurvatum. Conclusion: Addition of baclofen to physiotherapy regimen is superior to physiotherapy alone for reducing muscle tone and improving the joint angle stiffness as well as gait. Keywords: Spastic cerebral palsy, Baclofen, Physiotherapy.

Purpose Proximal femoral osteotomy in cerebral palsy patients is a demanding procedure. The fixation of the osteotomy can fail due to the weak osteoporotic bone. The LCP pediatric hip plate with its good grip makes these procedures safe. The aims of the present study are to evaluate the radiological outcome of proximal femoral osteotomy that was fixed with the pediatric LCP in cerebral palsy patients and to raise safety issues regarding its low rate of complications. Patients and Methods Sixteen patients with cerebral palsy who were operated in our department were included in this retrospective study. Data collected from medical charts and X-ray measurements retrospectively reviewed. Results In total, 16 patients (21 hips), ie, 9 males and 7 females, were included in this analysis. The mean age at the time of the index surgery was 11.9 years (5.9-18.0). The mean follow-up period was 4.78 years (1.5-8.0). Five patients had bilateral hip involvement and 11 had unilateral involvement. All patients had spastic cerebral palsy. The mean values of varus correction and de-rotation were 25° (0°-45°) and 35° (20°-50°), respectively. Neck shaft angle and the Reimer's migration index were significantly improved postoperatively (p

Introdução: A paralisia cerebral (PC) descreve um grupo de distúrbios permanentes de movimento e postura devido a um distúrbio não progressivo que ocorre durante o cérebro fetal ou infantil, podendo contribuir para limitações na funcionalidade. Objetivo: Investigar a distribuição das pressões plantares e a postura corporal na PC espástica. Métodos: Estudo de série de casos descritivos, realizado no Setor de Reabilitação Pediátrica Ambulatorial Neurofuncional do Hospital Universitário de Santa Maria - RS. Sete crianças com PC espástica, nível I e ​​II, foram incluídas no Sistema de Classificação da Função Motora Grossa. As pressões plantares foram analisadas usando um sistema de baropodometria - Footwork - e o tipo do pé foi calculado pelo índice-ChipauxSmirak. O alinhamento postural foi avaliado subjetivamente nas vistas anteroposterior e lateral. Os dados foram analisados ​​por estatística descritiva. Resultados: A distribuição assimétrica das pressões plantares foi evidenciada nos PCs hemiparéticos, diparéticos e quadriparéticos avaliados e ocorreu a prevalência de pé plano. As alterações posturais mais frequentes foram inclinação frontal e frontal, elevação, inclinação e protrusão do ombro, lordose cervical e lombar, cifose torácica, anterversão e desnivelamento do quadril e pronação dos pés. Conclusões: Neste grupo de crianças, a pressão plantar e a postura mostraram-se alteradas. Esses achados podem influenciar o prognóstico das deformidades e os resultados da reabilitação funcional. O uso de fotometria e baropodometria pode auxiliar em uma intervenção terapêutica mais eficiente. CP diparética e quadriparética avaliada e a prevalência de pé chato ocorreu. As alterações posturais mais frequentes foram inclinação frontal e frontal, elevação, inclinação e protrusão do ombro, lordose cervical e lombar, cifose torácica, anterversão e desnivelamento do quadril e pronação dos pés. Conclusões: Neste grupo de crianças, a pressão plantar e a postura mostraram-se alteradas. Esses achados podem influenciar o prognóstico das deformidades e os resultados da reabilitação funcional. O uso de fotometria e baropodometria pode auxiliar em uma intervenção terapêutica mais eficiente. CP diparética e quadriparética avaliada e a prevalência de pé chato ocorreu. As alterações posturais mais frequentes foram inclinação frontal e frontal, elevação, inclinação e protrusão do ombro, lordose cervical e lombar, cifose torácica, anterversão e desnivelamento do quadril e pronação dos pés. Conclusões: Neste grupo de crianças, a pressão plantar e a postura mostraram-se alteradas. Esses achados podem influenciar o prognóstico das deformidades e os resultados da reabilitação funcional. O uso de fotometria e baropodometria pode auxiliar em uma intervenção terapêutica mais eficiente. anterversão e irregularidade do quadril e pronação dos pés. Conclusões: Neste grupo de crianças, a pressão plantar e a postura mostraram-se alteradas. Esses achados podem influenciar o prognóstico das deformidades e os resultados da reabilitação funcional. O uso de fotometria e baropodometria pode auxiliar em uma intervenção terapêutica mais eficiente. anterversão e irregularidade do quadril e pronação dos pés. Conclusões: Neste grupo de crianças, a pressão plantar e a postura mostraram-se alteradas. Esses achados podem influenciar o prognóstico das deformidades e os resultados da reabilitação funcional. O uso de fotometria e baropodometria pode auxiliar em uma intervenção terapêutica mais eficiente.

SEAS exercise to improve functional activities among the children with spastic hemiplegic cerebral palsy children. Single group pre- post experimental research design. Cerebral paralysis is a static encephalopathy which affects the immature brain and leads to permanent motor disability. Due to a combination of spasticity, muscle weakness and incompletion of muscle control, the spinal deformity occurs in rising patients with CP; it can lead to poor balance in the trunk and significantly limits patient function. SEAS exercise capacity to enhance the self-corrected posture by concentrating during everyday activities. Eighty eight subjects of spastic hemiplegic cerebral palsied children, aged 6-12, male and female with scoliosis were selected under purposive sampling technique and received SEAS exercise training for a period of eight weeks. pre and post outcome measures were assessed using Modified Ashworth scale and Scoliometer to measure the functional activity in the children Pediatric balance scale, functional gait assessment and Gross motor function were used. Significant changes in spasticity and scoliosis were observed, and functional parameters were increased. The results of the post-test mean values for all SEAS variables demonstrated substantial improved balance, reduced scoliosis and gross motor functions in those receiving SEAS protocol (p