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Fatigue during walking is a common complaint in cerebral palsy (CP). The primary purpose of this study is to investigate muscle fatigue from surface electromyography (sEMG) measurements after a treadmill-based fatigue protocol with increasing incline and speed in children with CP with drop foot. The secondary purpose is to investigate whether changes in sagittal kinematics of hip, knee and ankle occur after fatigue. Eighteen subjects with unilateral spastic CP performed the protocol while wearing their ankle-foot orthosis and scored their fatigue on the OMNI scale of perceived exertion. The median frequency (MF) and root mean square (RMS) were used as sEMG measures for fatigue and linear mixed effects model were applied. The MF was significantly decreased in fatigued condition, especially in the affected leg and in the tibialis anterior and peroneus longus muscle. The RMS did not change significantly in fatigued condition, while the OMNI fatigue score indicated patients felt really fatigued. No changes in sagittal kinematics of hip, knee and ankle were found using statistical non-parametric mapping. In conclusion, the current fatigue protocol seems promising in inducing fatigue in a population with CP with drop foot and it could be used to expand knowledge on muscle fatigue during walking in CP.

BACKGROUND AND AIMS: Malnutrition is common in neurologically impaired (NI) children. It is, however, ill-defined and under-diagnosed. If not recognized and treated, it increases the burden of comorbidities and affects the quality of life of these children. The aim of this study was to characterize the nutritional status of a cohort of children followed up at a reference center for cerebral palsy (CP) in Brussels, Belgium, and to investigate possible links with the occurrence of comorbidities. MATERIAL AND METHODS: We conducted a single-center retrospective study including all the children followed up at the Inter-university Reference Center for Cerebral Palsy ULB-VUB-ULg. The data were obtained by reviewing medical files. Anthropometric measurements as well as the etiology of neurological impairment, comorbidities, feeding patterns, and laboratory test results were collected. The children were assigned a nutritional diagnosis according to the World Health Organization and Waterlow definitions. RESULTS: A total of 260 children with cerebral palsy were included, 148 males and 112 females. Their mean age was 10.9±4.3 years. The gross motor function classification system (GMFCS) level was I for 79 children, II for 63 children, III for 35 children, IV for 33 children, and V for 50 children. Of the children, 54% had a normal nutritional status, 34% showed malnutrition, and 8% were obese; 38% had oropharyngeal dysphagia. The sensitivity of mean upper arm circumference of

Aim: Children with dyskinetic cerebral palsy (CP) are often severely affected and effective treatment is difficult, due to different underlying disease mechanisms. Comprehensive systematic movement disorder evaluations were carried out on patients with this disorder. Methods: Patients born from 1995 to 2007 were identified from the Danish Cerebral Palsy Register and referrals to the neuropaediatric centre, Rigshospitalet, Copenhagen. They were classified by gross motor function, manual functional ability, communication ability, dystonia and spasticity. Electromyography was carried out on the upper and lower limbs. Magnetic resonance imaging scans were revised, and aetiological searches for underlying genetic disorders were performed. Results: We investigated 25 patients with dyskinetic CP at a mean age of 11.7 years. Dystonia, spasticity and rigidity were found in the upper limbs of 21, four and six children, respectively, and in the lower limbs of 18, 18 and three children. The mean total Burke-Fahn-Marsden score for dystonia was 45.02, and the mean Disability Impairment Scale level was 38% for dystonia and 13% for choreoathetosis. Sustained electromyography activity was observed in 20/25 children. Stretching increased electromyography activity more in children with spasticity. There were 10 re-classifications. Conclusion: The children had heterogenic characteristics, and 40% were reclassified after systematic movement disorder evaluation.

Introdução: O nosso objetivo foi caracterizar os doentes com paralisia cerebral (PC) abaixo dos 18 anos, seguidos na nossa instituição, relativamente à sua caracterização clínica e funcional e à presença de deformidades da anca, bem como orientações cirúrgicas efetuadas. Material e Métodos: Estudo retrospetivo transversal baseado nos ficheiros de notificação dos doentes com PC, registos clínicos e avaliações radiológicas seriadas da bacia, de acordo com programa de vigilância da anca (PVA) australiano. Análise do grupo com classificações funcionais IV e V e caracterização de deformidades da anca: avaliação radiológica do índice de migração (IM) femoral. Subanálise dos doentes submetidos a cirurgia ortopédica e doentes não intervencionados cirurgicamente. A apresentação dos resultados foi divida em grupos etários (1-5 anos; 6-11 anos, 12-18 anos), consoante a abrangência pelo PVA implementado em 2012, na nossa instituição. Resultados: Do total de 285 crianças com PC, o grupo com níveis funcionais IV e V foi constituído por 88 crianças. Destas, mais de metade apresentaram subluxação da anca. Foram excluídas 30 crianças. O total de crianças não operadas foi de 35, a análise do IM médio foi de 31,6%. O grupo etário dos 1-5 anos foi constituído por 3 doentes, com um IM de 33,5% e a média da última radiografia da bacia há 7,1 meses. O grupo dos 6-11 anos foi constituído por 13 doentes, com IM de 32,2%, e média da última radiografia há 11,6 meses. O grupo dos 12-18 anos foi constituído por 19 doentes, com um IM de 30,9%, e média da última radiografia há 24,5 meses. Dos 23 doentes operados, 4 foram intervencionados antes do início da implementação do PVA. Dos 19 doentes operados após 2012, realizaram-se 6 tenotomias preventivas com média de idade de intervenção aos 5 anos. Conclusão: Cerca de metade dos doentes com níveis funcionais IV e V apresentaram subluxação da anca, dos quais 38% já foram operados e em que num terço foram realizadas tenotomias em idades precoces. Os doentes não intervencionados cirurgicamente estão sob vigilância da anca. Nesta população existe uma prevalência alta desta deformidade da anca. Contudo, a articulação com a Ortopedia tem permitido realizar precocemente intervenções cirúrgicas adequadas., Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação, v. 32, n. 1 (2020): Ano 28

OBJECTIVES: To investigate the operational competences screen navigation and dwell function underlying eye gaze performance, and the relation of dystonia and choreoathetosis with eye gaze performance in children with dyskinetic cerebral palsy (DCP). METHODS: During a 5-week intervention, ten participants with DCP played eye gaze video games daily for 30 minutes. Six games were used to assess task performance, fixation count, and eye movement accuracy during four measurements. Dystonia and choreoathetosis were evaluated using the Dyskinesia Impairment Scale. RESULTS: Eye gaze performance improved over time (p = .013). Moderate to strong within-subject correlations were found between eye movement accuracy and task performance, and between eye movement accuracy and fixation count. No significant correlations were found with the movement disorders. CONCLUSIONS: Eye gaze technology shows great potential to be a successful computer interface for children with severe DCP, thereby potentially improving their communication skills, participation levels, and quality of life. ispartof: Developmental Neurorehabilitation vol:23 issue:8 pages:548-556 ispartof: location:England status: Published online

Aim To determine the long-term course of difficulty in participation of individuals with cerebral palsy (CP) without intellectual disability between 16 years and 34 years of age. Method One hundred and fifty-one individuals with CP aged 16 to 20 years were included (63% male, 37% female; Gross Motor Function Classification System [GMFCS] levels I-IV; without intellectual disability). The Assessment of Life Habits questionnaire 3.0 general short form was used up to three times biennially and at 13-year follow-up (13-year follow-up: n=98). Scores (range 0-10) reflect difficulty and assistance in participation in housing, education and employment, interpersonal relationships, recreation, community life, and responsibilities. Multilevel models were used to determine the course of difficulty in participation by GMFCS level. Results Despite high average participation levels, 41% to 95% of adolescents and young adults with CP experienced difficulty. Difficulty in participation in housing and interpersonal relationships increased from age 16 years onwards and in most other life areas in the mid- and late 20s. In adolescents in GMFCS levels III and IV, participation in recreation and community life improved up to age 23 years. Interpretation Individuals with CP experience increasing difficulties in participation in their mid- and late 20s. Clinicians should systematically check for participation difficulties in young adults with CP and offer timely personalized treatment. What this paper addsMany individuals with cerebral palsy (CP) aged 16 to 34 years experience difficulty in participation. Difficulty in participation increases in the mid- and late 20s for individuals with CP. Participation in recreation/community life improves before age 23 years for those in Gross Motor Function Classification System levels III and IV.

OBJECTIVES: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. PATIENTS AND METHODS: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. RESULTS: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p

WOS: 000266374500013, PubMed: 19448355, Cerebral palsy is a common static encephalopathy and can present as multiple musculoskeletal problems. Increased peripheral muscle tone causes joint contractures and decreased functional capacity. The risk for scoliosis increases parallel with the severity of musculoskeletal involvement. Scoliosis adversely affects the functional capacity, daily care, and nutrition in disabled children. Conservative treatments including physical therapy, bracing, and botulinum toxin injections do not prevent the progression of scoliosis in most of the patients and surgical treatment becomes mandatory. With the use of pedicle screws, three-plane fixation is possible, making posterior instrumentation and fusion effective in correction of severe curves and obviating anterior surgery.

Objectives: We evaluated the results of the Grice subtalar extra-articular arthrodesis for pes planovalgus deformity in patients with cerebral palsy and its effectiveness in providing hindfoot alignment.Methods: Grice subtalar extra-articular arthrodesis was performed for pes planovalgus deformity in 14 feet of nine patients (5 males, 4 females; mean age 10.3 years; range 6 to 12 years) with cerebral palsy. Six patients were diplegic, two patients were paraplegic, and one patient was hemiplegic. Four patients had unilateral, five patients had bilateral involvement. A fibular graft taken from the distal third of the fibula above the syndesmosis was used in all the patients without any fixation material. The patients were assessed with the AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot scoring system pre- and postoperatively. The mean follow-up was 30 months (range 6 to 81 months).Results: Compared with the preoperative values, the mean AOFAS hindfoot score increased from 53 (range 41 to 81) to 68.4 (range 51 to 96), the mean talocalcaneal angle decreased from 52.6° (38°-60°) to 30.4°, and from 55.8° to 35.9° in frontal and sagittal planes, respectively (p, Amaç: Serebral felçli olgularda pes planovalgus deformitesi nedeniyle uygulanan Grice subtalar eklem dışı artrodez girişiminin sonuçları ve ayak arkası diziliminin düzelmesi üzerindeki etkinliği değerlendirildi. Çalışma planı: Pes planovalgus deformitesi nedeniyle serebral felçli dokuz hastanın (5 erkek, 4 kız; ort. yaş 10.3; dağılım 6-12 yıl) 14 ayağına Grice subtalar eklem dışı artrodez girişimi uygulandı. Hastaların altısı diplejik, ikisi paraplejik, biri hemiplejik idi. Dört hastada tek, beş hastada iki taraflı tutulum vardı. Tüm hastalarda aynı taraf fibula 1/3 distalinde sindesmoz seviyesinin üzerinden greft alındı. Greft tespiti için implant kullanılmadı. Hastalar ameliyat öncesi ve sonrasında, AOFAS (American Orthopaedic Foot and Ankle Society) ayak arkası skorlaması ile değerlendirildi. Ortalama izlem süresi 30 ay (dağılım 6-81 ay) idi. Sonuçlar: Ameliyat öncesinde ortalama 53 (dağılım 41-81) olan AOFAS skoru ameliyat sonrasında 68.4’e (dağılım 51-96) yükselirken, talokalkaneal açı ön-arka planda 52.6 dereceden 30.4 dereceye, yan planda 55.8 dereceden 35.9 dereceye geriledi (p

Objectives: We evaluated the preliminary results of distal rectus femoris transfer in patients with stiff-knee gait due to cerebral palsy.Methods: Eight knees of four patients who had stiff-knee gait due to cerebral palsy were treated by distal rectus femoris transfer. All the patients were females with a mean age of 11 years (range 9.5 to 12 years). Preoperatively and postoperatively, lower extremity examinations, the Ely test, and clinical gait analyses were performed. Satisfaction levels of the patients and their families were questioned. The mean follow-up was 17.5 months (range 3 to 23 months). Results: None of the patients manifested flexion contracture of their hips and knees postoperatively. The Ely test was negative in all patients. There were no clinical signs of stiff-knee gait. All the patients and their families but one expressed their satisfaction with clinical and functional results. Conclusion: Our clinical results suggest that distal rectus femoris transfer is effective in the treatment of stiff-knee gait due to cerebral palsy., Amaç: Serebral palsiye bağlı tutuk diz yürüyüşünün tedavisinde uyguladığımız distal rektus femoris transferi ameliyatının kısa dönem sonuçlarını değerlendirdik. Çalışma planı: Serebral palsiye bağlı tutuk diz yürüyüşü olan ve distal rektus femoris transferi uygulanan, tümü kız dört hastanın (ort. yaş 11; dağılım 9.5-12) sekiz dizi incelendi. Hastalarda ameliyat öncesi ve sonrasında alt ekstremite muayenesi, Ely testi, gözleme dayalı yürüme analizi yapıldı. Hasta ve ailelere sonuç hakkındaki görüşleri soruldu. Ortalama izlem süresi 17.5 ay (dağılım 3-23 ay) idi.Sonuçlar: Ameliyat sonrasında hiçbir hastanın kalça ve dizlerinde fleksiyon kontraktürü görülmedi; tüm olgularda Ely testi negatif bulundu. Yürüme analizlerinde tutuk diz yürüyüşünün klinik belirtileri gözlenmedi. Tüm hastalar ve biri dışında tüm aileler uygulanan ameliyatlardan memnun olduklarını belirttiler. Çıkarımlar: Elde ettiğimiz klinik sonuçlar, serebral palsiye bağlı tutuk diz yürüyüşünün tedavisinde distal rektus femoris transferinin etkin bir yöntem olduğunu gösterdi.

This study evaluated the outcome of severe cerebral palsy patients (Gross Motor Function Classification System level IV and V) treated by simultaneous percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy for hip subluxation or dislocation between 2002 and 2011. Twenty-four patients (30 hips) with an average age of 9.4 years (5-16.5) were reviewed at a mean follow-up of 35.9 months (6-96). Percutaneous pelvic osteotomy lasted on average 30 min/patient per side (25-40) and was always performed through a skin incision of 2-3 cm. The migration percentage and acetabular angle were assessed on plain radiographs. The mean Reimers' migration percentage improved from 67.1% (42-100) preoperatively to 7.7% (0-70) at the last follow-up and the mean acetabular angle improved from 31.8° (22-48) to 15.7° (5-27). Five patients presented complications: one redislocation, one bone graft dislodgement, and three with avascular necrosis of the femoral head. This study should be considered as a pilot study. These results indicate that this combined approach is an effective, reliable, and minimally invasive alternative method for the treatment of spastic dislocated hips in severe cerebral palsy patients with an outcome similar to standard techniques reported in the literature.

Patients with cerebral palsy, syndromes, myopathies, and other forms of neurological impairment can develop planovalgus foot deformity of variable degrees of severity. Several techniques have already been described to resolve the deformity with variable results. Talonavicular arthrodesis is a well-known technique in adult patients, but to our knowledge, it has not been described in children with neurological impairment.We performed a retrospective chart and radiographic review of 18 neurological patients (10 boys, 8 girls) with a mean age of 11.3 ± 2.6 years (range, 7 to 19 y) who underwent talonavicular arthrodesis for flat foot deformity between 1998 and 2009, at our center.Of a total of 29 feet, talonavicular arthrodesis was judged satisfactory in 28 feet, whereas 1 had unsatisfactory results according to the Yoo clinical outcome scoring scale. Subjective observations reported that 3 feet from 2 patients were painful preoperatively and none after last follow-up. Functionally, 2 of 13 patients were able to stop using braces after surgery. The significant improvement achieved postoperatively in radiographic measurement angles was maintained at last follow-up without any loss of angle correction.Talonavicular arthrodesis seems to achieve a reliable hind foot fixation in flat foot in patients with neurological impairment.Case series.

Pediatr Nephrol

Objective: To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. Methods: Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. Results: Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. Conclusion: The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases. RESUMO Objetivo: Descrever quadro clínico, resultados dos exames e evolução clínica de pacientes com paralisia cerebral associada ao diagnóstico de esofagite eosinofílica, monitorados em um centro terciário. Métodos: Estudo transversal, retrospectivo e descritivo, que avaliou os prontuários médicos de pacientes pediátricos com diagnóstico de paralisia cerebral e esofagite eosinofílica, atendidos em um centro terciário de gastrenterologia pediátrica, entre agosto de 2005 e agosto de 2013. Resultados: Dos 131 pacientes com paralisia cerebral, 7 tiveram o diagnóstico de esofagite eosinofílica no período estudado. A idade média no momento do diagnóstico de esofagite eosinofílica foi 52,3 meses, e o número médio de eosinófilos no esôfago foi de 35 por campo de grande aumento. Os sintomas mais frequentes associados foram vômitos recorrentes e disfagia. As alterações endoscópicas encontradas foram espessamento da mucosa, linhas verticais, opacificação da mucosa e as placas esbranquiçadas. Conclusão: A frequência de esofagite eosinofílica encontrada foi maior que na população pediátrica em geral. A investigação de esofagite eosinofílica deve ser realizada regularmente nos pacientes com paralisia cerebral, pois pode haver uma sobreposição de sintomas de outras doenças gastrintestinais.