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This study aims to analyze the prevalence and patterns of sensory processing deficits (SPD) in Indian children with spastic cerebral palsy (CP) using child sensory profile-2 (CSP-2) caregiver questionnaire. The authors surveyed 230 caregivers of children aged 3 to 14 y with spastic CP, using CSP-2. The difference in prevalence and distribution of SPDs among the CP subtypes and Gross Motor Function Classification System (GMFCS) levels was done. Overall prevalence of "Definite" (>2 SD) SPDs was 83%. Forty-seven percent had definite SPDs in more than one sensory subsection. Prevalence of definite SPDs was similar among the spastic CP subtypes. "Conduct" domain had more affection among hemiplegics and quadriplegics. "Avoiding" pattern was observed more in quadriplegics and "Seeking" pattern was observed less in diplegics. Severe GMFCS levels had more definite sensory processing deficits. SPDs are highly prevalent in children with spastic CP with unique patterns of affection among the spastic CP subtypes. [ABSTRACT FROM AUTHOR]

Children with spastic cerebral palsy (CP) have damage to the corticospinal tracts that are responsible for selective motor control (SMC). Force, velocity and timing of joint movement are related biomechanical features controlled by the corticospinal tracts (CSTs) that are important for skilled movement. Does SMC influence knee joint biomechanics in spastic CP? Methods: In this prospective study, relationships between SMC and knee biomechanics (peak torque, total work, average power) across a range of velocities (0–300 deg/s) were assessed using an isokinetic dynamometer in 23 children with spastic CP. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Logistic and linear regression models were used to evaluate relationships between SCALE and biomechanical measures. The ability to produce knee torque diminished with increasing velocity for both Low (0–4 points) and High (5–10 points) SCALE limb score groups (p < 0.01). More knees in the High group produced extension torque at 300 deg/s (p < 0.05) and flexion torque at 30, 90,180, 240 and 300 deg/s (p < 0.05). The ability to produce torque markedly decreased above 180 deg/s for Low group flexion. For knees that produced torque, significant positive correlations between SCALE limb scores and joint torque (0 and 120 deg/s), work (120 deg/s) and power (120 deg/s) were found (p < 0.05). Greater knee torque, work and power for the High group was found for the extensors at most velocities and the flexors for up to 120 deg/s (p < 0.05). Few Low group participants generated knee flexor torque above 120 deg/s limiting comparisons. Biomechanical impairments found for children with low SMC are concerning as skilled movements during gait, play and sport activities occur at high velocities. Differences in SMC should be considered when designing individualized assessments and interventions. • Selective motor control is positively related to joint torque, work and power • Reduced selective motor control limits knee torque production at high velocities • Knee flexion mechanical output is markedly less than extension across velocities [ABSTRACT FROM AUTHOR]

Objective: To observe the effect of electromyographic biofeedback therapy combined with Wenyang tongluo acupuncture on cerebral hemodynamics and serum nerve factors in children with spastic cerebral palsy. Methods: 135 children with spastic cerebral palsy admitted to Xi’an TCM Hospital of Encephalopathy from April 2021 to May 2023 were divided into control group and combined group according to the random number table method, 67 cases and 68 cases respectively. Control group received electromyographic biofeedback therapy, and combined group received Wenyang tongluo acupuncture on the basis of control group. The spasm, movement, balance function, lower limb muscle strength, cerebral hemodynamics and serum nerve factors were compared between two groups. Results: The improvement of spasm condition in combined group was better than that in control group 3 months after treatment (P＜0.05). The scores of Gross Motor Function Measure (GMFM) and Berg Balance Scale (BBS) in combined group were higher than those in control group 3 months after treatment (P＜0.05). The abductor strength of hip joint, flexor strength of knee joint and extensor strength of knee joint in combined group were higher than those in control group 3 months after treatment (P＜0.05). The arterial systolic peak flow velocity and mean blood flow velocity in combined group were higher than those in control group, and the vascular pulsatility index and vascular resistance index were lower than those in control group 3 months after treatment (P＜0.05). The nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in combined group were higher than those in control group 3 months after treatment (P＜0.05). Conclusion: The combination of wenyang tongluo acupuncture and electromyographic biofeedback therapy in the treatment of children with spastic cerebral palsy, which can effectively improve the spasm, improve the muscle strength and balance function of lower limbs, and improve the cerebral hemodynamics and serum nerve factor levels of the body. [ABSTRACT FROM AUTHOR]

Abstract Background Children with cerebral palsy (CP) may have different gross motor impairments which in sequence affecting their life occupations. The purpose of the study is to investigate the correlation between Gross Motor Function Measurement-66 (GMFM-66), the test of Bruininks-Oseretsky Motor Proficiency (BOTMP), and the Peabody Developmental Motor Scale–Second Edition (PDMS-2) in young children with CP. Methods A correlational study was applied on 50 children aged from 4 to 6 years (30 girls, 20 boys) with spastic CP. Results The Pearson correlation coefficient between the GMFM scale and PDMS-2 motor quotients, and its subscales (stationary, locomotion, and object control) and also between GMFM and BOTMP gross motor quotients and its subscales (strength, agility, and body coordination) were statistically significant. Spearman’s coefficients between the grade of the Gross Motor Classification System (GMFCS) and the PDMS-2 Gross Motor Composite, BOTS-2, and its subscale results were also statistically significant. Conclusion The three measurement scales, GMFM- 66, BOTS-2, and PDMS-2, are significantly related. Therefore, GMFCS is useful in predicting movement performance in children with CP and correlated with predictive guidance in treatment development. Trial registration ClinicalTrials.gov Identifier: NCT06124352.

Xing Wang,1,2 Fang Pang,3 Xiao-Gang Du2 1M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia; 2Famous TCM Expert Heritage Studio, Xi’an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, People’s Republic of China; 3Institute of Sports Biology, Shaanxi Normal University, Xi’an, Shaanxi, People’s Republic of ChinaCorrespondence: Xiao-Gang Du, Famous TCM Expert Heritage Studio, Xi’an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, Xi’an, Shaanxi, People’s Republic of China, Email duxg198012@163.comBackground: Cerebral palsy (CP) ranks as a major cause of motor disabilities in children, with spastic CP making up roughly 70– 80% of all CP cases. The primary objective of our study is to identify characteristics of Traditional Chinese Medicine(TCM) symptom of spastic CP, thereby establishing correlations between the TCM symptom and the disease, providing a more scientific theoretical foundation for TCM treatments on spastic CP, enabling a deeper comprehension of clinical interventions, ultimately, improving rehabilitation outcomes in TCM treatment for spastic CP.Methods: We conducted a data mining study on TCM symptom of spastic CP children aged 4– 14 years old treated at Xi’an Encephalopathy Hospital Affiliated to Shaanxi University of Chinese Medicine, from October 2021 to March 2023. The medical records of all eligible and complete spastic CP patients were extracted, processed for data cleansing, transformed, and subsequently analyzed to discern distinctive TCM symptom. K-Means Clustering Analysis and Association Rule Analysis were used for data mining.Results: Core symptoms identified for spastic CP encompassed “Motor Dysfunction”, “Impaired Speech”, “Delayed Development”, “Limb Stiffness”, “Rigidity in the limbs”, “Intellectual Impairment”, “Timidity and susceptibility to startle responses”, “Muscle Wasting”, and “Pale or Dull Complexion”. Among the top-ranking associations of symptom, patterns emerge wherein “Motor dysfunction” intertwine with “Impaired speech”, “Motor dysfunction” coexist with “Delayed development”, and “Impaired speech” are accompanied by “Delayed development”.Conclusion: This study identified the core symptom of spastic CP and tentatively suggests that the clinical manifestations of spastic CP are essentially consistent with the TCM pattern “liver exuberance and spleen weakness”. This finding has facilitated the preliminary establishment of correlations between TCM pattern differentiation and the disease in medicine. It is anticipated that this correlation will bring tangible benefits to a larger number of children with spastic CP.Keywords: spastic cerebral palsy, TCM symptom, data mining, R language

Background: Cerebral palsy (CP) is a nonprogressive developmental disorder characterized by motor deficits, such as abnormal posture, balance, and gait impairments leading to deformities, affecting activities daily and, therefore, the quality of life. The application of Kinesio taping (KT) in patients with CP has emerged as a choice of adjunct treatment. Therefore the objective of this review was to evaluate the effectiveness of KT as an addition to conventional physiotherapy (CPT) interventions on posture, balance, and gait in spastic cerebral palsy. Materials and Methods: A bibliographic search was done in various databases. Only randomized controlled trials on KT in CP were included. The risk of bias in included studies was evaluated by using the RoB 2.0 tool. Downs and Black checklist was used to determine the overall quality of studies. Results: A total of five studies were eligible, out of which two studies reported a low risk of bias and three studies reported some concerns on RoB 2.0. The overall methodological quality of the studies ranged from fair to good. Out of five studies in three studies, KT was more effective as adjunct CPT than CPT alone on sitting posture, balance, and standing balance. In one study, KT was equally effective as ankle foot orthosis on gait. Lastly, one study showed a significant improvement with KT application over CPT alone, but the effects of neuromuscular electrical stimulation were more significant than KT on postural control and sitting. Conclusion: KT is a noninvasive, inexpensive, and compliant adjunct to physiotherapy in patients with spastic CP for better outcomes regarding posture, balance, and gait. [ABSTRACT FROM AUTHOR]

Impairments of postural responses are a salient feature of children with cerebral palsy (CP). While the systems approach describes balance in seven components, the relationship between trunk control and balance in children with CP has not been previously examined with all seven of these components. In this study, we aimed to identify correlations between trunk control and all seven systems approach balance components in children with bilateral spastic CP. Our participants were 30 children (M age = 11.83, SD = 2.32 years) with CP having a Gross Motor Function Classification System level ranging from I to III. We assessed trunk control with the Trunk Control Measurement Scale, including static and dynamic balance (selective voluntary control and reaching). Balance in standing was assessed using Kids-Mini-BESTest involving four domains: anticipatory, reactive, sensory orientation and stability in gait. We used Spearman's rank correlations to correlate trunk control and balance, and we obtained a moderate correlation between the trunk control measurement scale and the Kids-Mini-BESTest in children with both bilateral spastic CP (rs =.618, p <.001) and spastic diplegic CP (rs =.52, p =.02). Analysis of the correlations between separate domains of the Kids-Mini-BESTest and the trunk control measurement scale subscales revealed moderate correlations between the static sitting balance subscale and all four domains of the Kids-Mini-BESTest. The dynamic selective motor control subscale of the trunk control measurement scale moderately correlated with the anticipatory domain of the Kids-Mini-BESTest. The dynamic reaching subscale also correlated moderately with anticipatory and stability in gait domains. This correlation was statistically significant in the 13 to 17-year-old age group and was strong among females, whereas the correlation was moderate in males. Trunk control was moderately associated with balance considering all the systems theory components of balance in children with bilateral spastic cerebral palsy. [ABSTRACT FROM AUTHOR]

Background: Children with cerebral palsy (CP) may have different gross motor impairments which in sequence affecting their life occupations. The purpose of the study is to investigate the correlation between Gross Motor Function Measurement-66 (GMFM-66), the test of Bruininks-Oseretsky Motor Proficiency (BOTMP), and the Peabody Developmental Motor Scale–Second Edition (PDMS-2) in young children with CP. Methods: A correlational study was applied on 50 children aged from 4 to 6 years (30 girls, 20 boys) with spastic CP. Results: The Pearson correlation coefficient between the GMFM scale and PDMS-2 motor quotients, and its subscales (stationary, locomotion, and object control) and also between GMFM and BOTMP gross motor quotients and its subscales (strength, agility, and body coordination) were statistically significant. Spearman's coefficients between the grade of the Gross Motor Classification System (GMFCS) and the PDMS-2 Gross Motor Composite, BOTS-2, and its subscale results were also statistically significant. Conclusion: The three measurement scales, GMFM- 66, BOTS-2, and PDMS-2, are significantly related. Therefore, GMFCS is useful in predicting movement performance in children with CP and correlated with predictive guidance in treatment development. Trial registration: ClinicalTrials.gov Identifier: NCT06124352. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to assess the effectiveness of simple and basic home-based exercise programs (HEPs), including pediatric massage (PM), executed by caregivers at their homes in the management of children with spastic cerebral palsy (CP). METHODS: Sixty-eight children with spastic CP (diplegia) aged 4–12 years were randomly assigned to PM and HEP groups for a randomized controlled trial continuing from November 01, 2021 to June 2022. Parents provided home-based exercises to both groups, five times a week for 12 weeks. However, the PM group was additionally provided with PM. Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM-88) and Gross Motor Function Classification System (GMFCS) were used for evaluation of spasticity and gross motor activity at baseline as well as after six and 12 weeks of intervention. Comparative analysis of data was carried out with SPSS-20. RESULTS: Mean age in HEP and PM groups was 6.65±2.12 and 7.09±2.22 years respectively. Data revealed homogeneity of both groups at the beginning of study. The PM group showed a statistically significant decrease in MAS scores after six and 12 weeks of intervention (p < 0.05) when compared with the HEP group, but similar changes did not happen in GMFM scores and GMFCS levels. However, comparative analysis revealed statistically significant change in GMFM scores and GMFCS levels (p < 0.05) when compared from baseline to 12 weeks of intervention in both groups. CONCLUSION: PM along with HEPs can be used effectively to reduce spasticity and to improve gross motor ability if performed for a period of at least six and 12 weeks respectively. In conjunction with HEPs, PM has better outcomes in the management of tone and movement disorders of spastic CP than HEPs alone [ABSTRACT FROM AUTHOR]

To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups. Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions. Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT. This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders. [Display omitted] • Baseline gait patterns can help identify good BoNT-responders. • Comprehensive analyses to reveal pattern-specific BoNT-effects. • Two-level improvements (ankle and knee) found for apparent equinus and jump gait. • Ankle improvements for dropfoot and true equinus subgroups. • Spasticity improvements for apparent equinus, jump gait and dropfoot. [ABSTRACT FROM AUTHOR]

Abstract Background Cerebral palsy (CP) is characterized by abnormal pronunciation, posture, and movement. Spastic CP accounts for more than 70% of all CP. To date, there has been no bibliometric analysis to summarize study on spastic CP. Here, we aim to conduct a bibliometric analysis of spastic CP to summarize this field's knowledge structure, research hotspots, and frontiers. Method Publications about spastic CP were searched utilizing the Web of Science Core Collection (WoSCC) database from 1 January 2000 to 30 November 2022, the WoSCC literature analysis wire, VOSviewer 1.6.18, CiteSpace 6.1.R4 and Online analysis platform for bibliometrics were used to conduct the analysis. Results A total of 3988 publications, consisting of 3699 articles and 289 reviews, were included in our study. The United States emerged as the most productive country, while Kathleen Univ Leuven was the most productive institution. The leading author was Desloovere K. A total of 238 journals contributed to this field, with Developmental medicine and child neurology being the leading journal. Important keywords and keyword clusters included Spastic cerebral palsy, Reliability, and Gross motor function. Keywords identified through burst detection indicated that hotspots in this field were management, randomized controlled trials, and definition. Conclusion Based on the analysis of bibliometric on spastic CP over the past 20 years, the trends and the knowledge graph of the countries, institutions, authors, references, and the keywords have been identified, providing accurate and expedited insights into critical information and potentially new directions in the study of spastic CP.

ObjectiveTo observe the effect of gait induced functional electrical stimulation (FES) combined with body-weight supported treadmill training (BWSTT) on gross motor function and walking function of children with spastic cerebral palsy (SCP).MethodsA total of 60 children with spastic cerebral palsy in the Shanghai Fourth People's Hospital Affiliated to Tongji University from March 2022 to March 2023 were randomly divided into control group, BWSTT group and combined intervention group according to a randomized sequence by SAS software, with 20 cases in each group. The control group received conventional rehabilitation therapy, once a day, 40 minutes a time, five days a week, lasting for eight weeks. The BWSTT group received body-weight supported treadmill training in addition to the training of the control group. The slope of the plate was 0°, the initial speed was 0.09 m/s, and the increment of 0.03 m/s was gradually adjusted to the appropriate speed that the child could walk with. The initial weight support was 30% of the child's body mass, and it was gradually adjusted to fully support the child's own body mass. The combined intervention group received gait induced FES in addition to the training of the BWSTT group. A low-frequency electronic pulse stimulator was used to stimulate the common peroneal nerve and anterior tibialis muscle of the children, and the stimulation intensity was set at the desirable movements of ankle dorsiflexion and valgus, and could be tolerated by the children, once a day, 20 minutes a time, five days a week, lasting for eight weeks. Before and after treatment, D (standing) and E (walking, running and jumping) zones of the 88-item gross motor function measurement 88 (GMFM-88) was used to assess the children's gross motor function; six-minute walking test (6MWT) was used to assess walking function; physiological expenditure index (PCI) was used to evaluate walking efficiency; and gait parameters of the children (such as stride length, stride width and stride speed) were analyzed.ResultsCompared with that before treatment, GMFM-D and GMFM-E scores, 6MWT, stride length and stride speed were significantly higher and PCI and stride width were significantly lower in the three groups after treatment, and the differences were statistically significant (PPP

Background: Cerebral palsy (CP) is a nonprogressive developmental disorder characterized by motor deficits, such as abnormal posture, balance, and gait impairments leading to deformities, affecting activities daily and, therefore, the quality of life. The application of Kinesio taping (KT) in patients with CP has emerged as a choice of adjunct treatment. Therefore the objective of this review was to evaluate the effectiveness of KT as an addition to conventional physiotherapy (CPT) interventions on posture, balance, and gait in spastic cerebral palsy. Materials and Methods: A bibliographic search was done in various databases. Only randomized controlled trials on KT in CP were included. The risk of bias in included studies was evaluated by using the RoB 2.0 tool. Downs and Black checklist was used to determine the overall quality of studies. Results: A total of five studies were eligible, out of which two studies reported a low risk of bias and three studies reported some concerns on RoB 2.0. The overall methodological quality of the studies ranged from fair to good. Out of five studies in three studies, KT was more effective as adjunct CPT than CPT alone on sitting posture, balance, and standing balance. In one study, KT was equally effective as ankle foot orthosis on gait. Lastly, one study showed a significant improvement with KT application over CPT alone, but the effects of neuromuscular electrical stimulation were more significant than KT on postural control and sitting. Conclusion: KT is a noninvasive, inexpensive, and compliant adjunct to physiotherapy in patients with spastic CP for better outcomes regarding posture, balance, and gait.

Objectives: Limitations in the ability to perform manual functions decrease the individual’s participation in activities of daily living (ADLs). Thus, it is required to study the relationship between manual skills and self-care activities in children. This study aims to investigate the relationship between manual ability and self-care in children with spastic cerebral palsy at the ages of 1 to 8 years. Methods: In this cross-sectional study, 125 children aged 1-8 years with spastic cerebral palsy who were chosen by the convenience sampling method from 8 occupational therapy clinics in Tehran City, Iran, in 2022 were studied. The evaluation tools were manual ability classification system (MACS), mini-manual ability classification system (Mini-MACS), pediatric evaluation of disability inventory (PEDI), and cognitive level form designed in the SPARCLE project. After collecting the data, Stata software, version 14 was used to analyze data using chi-square, Spearman correlation coefficient, Mann-Whitney, Kruskal-Wallis, and regression. Results: In this research, the mean age of the children was 54.2±15 months and 43.2% had a cognitive level >70. The mean self-care and mobility in children were 49.65±30.60 and 40.78±26.97, respectively. With increasing age, self-care and mobility of children showed a significant increase (P

Objective: This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). Methods: A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed. Results: The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension. Conclusions: SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR. [ABSTRACT FROM AUTHOR]

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12–18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability—LoS), balance, and mobility (Community Balance and Mobility Scale—CB&M; Functional Walking Test—FWT; Timed Up and Down Stair test—TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP. [ABSTRACT FROM AUTHOR]

Background: Cerebral palsy (CP) is characterized by abnormal pronunciation, posture, and movement. Spastic CP accounts for more than 70% of all CP. To date, there has been no bibliometric analysis to summarize study on spastic CP. Here, we aim to conduct a bibliometric analysis of spastic CP to summarize this field's knowledge structure, research hotspots, and frontiers. Method: Publications about spastic CP were searched utilizing the Web of Science Core Collection (WoSCC) database from 1 January 2000 to 30 November 2022, the WoSCC literature analysis wire, VOSviewer 1.6.18, CiteSpace 6.1.R4 and Online analysis platform for bibliometrics were used to conduct the analysis. Results: A total of 3988 publications, consisting of 3699 articles and 289 reviews, were included in our study. The United States emerged as the most productive country, while Kathleen Univ Leuven was the most productive institution. The leading author was Desloovere K. A total of 238 journals contributed to this field, with Developmental medicine and child neurology being the leading journal. Important keywords and keyword clusters included Spastic cerebral palsy, Reliability, and Gross motor function. Keywords identified through burst detection indicated that hotspots in this field were management, randomized controlled trials, and definition. Conclusion: Based on the analysis of bibliometric on spastic CP over the past 20 years, the trends and the knowledge graph of the countries, institutions, authors, references, and the keywords have been identified, providing accurate and expedited insights into critical information and potentially new directions in the study of spastic CP. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a result of restricted joint range of motion due to spasticity in patients with spastic cerebral palsy, the patient's ability to regain normal functioning may be hindered. PURPOSE: To evaluate the effectiveness of Myofascial Release Therapy (MFR) versus Deep Oscillation Therapy (DOT) in helping children with spastic cerebral palsy to relax and extend their hamstring range of motion. METHODOLOGY: A total of 32 individuals with spastic cerebral palsy, aged 2 to 10, were recruited for this comparative experimental study through a method of random sampling. Sixteen subjects were assigned to each group. Group 1(N=16) received two sessions of MFR with conventional exercise per day, whereas Group 2(N=16) received a single session of DOT with conventional exercise per day. Throughout the course of four weeks, both groups got therapy five days per week. A universal goniometer was used to compare the knee extension passive range of motion (PROM), active range of motion (AROM), and Popliteal angle (POP angle) measurements between the pre- and post-treatment periods. Statistical analyses were conducted using ANOVA 2x2 and Post hoc tables. RESULT: Both groups' post-mean values for each of the dependent variables (AROM, PROM, and POP angle) statistically improved (p< 0.05). Both groups' mean differences in the PROM and POP angles were statistically significant, and Group 1's spastic hamstring muscle was more improved than Group 2's, but both groups' AROM showed almost equal improvement. CONCLUSION: In children with spastic cerebral palsy, both MFR and DOT, when combined with conventional therapy, reduce spasticity and increase length (AROM & PROM) in the hamstring muscle. However, our study clearly shows that MFR is more successful than DOT. [ABSTRACT FROM AUTHOR]

This review aimed to assess the effectiveness of nonimmersive virtual reality intervention compared with traditional rehabilitation in improving the functions of the upper and lower limbs, balance, and social participation among children with spastic cerebral palsy.We used librarian-designed searches of 10 databases to identify research articles on randomized controlled trials that assessed the effectiveness of nonimmersive virtual reality in intervening spastic cerebral palsy patients up to April 15, 2023. Independent evaluation was conducted by two trained investigators using the evaluation criteria of randomized controlled trial quality indicated in the Cochrane Manual of Assessment "risk-of-bias tool." The Physical Therapy Evidence Database scale was used to evaluate the method and quality of the literature. Twenty-one research articles involving 779 patients with spastic cerebral palsy were included. Significant differences between the nonimmersive virtual reality rehabilitation and traditional rehabilitation groups were observed in all indicators, except for the Jebsen-Taylor Hand Function Test. Nonimmersive virtual reality intervention is effective in improving the function of the lower extremity, balance, and social participation in children with spastic cerebral palsy, but its effect on upper limb function is still controversial. [ABSTRACT FROM AUTHOR]

BACKGROUND: Children with spastic diplegia experience tonicity, lack of selective motor control, subnormal postural stability and delayed motor development. Selective dorsal rhizotomy followed by physical therapy is a permanent procedure aimed to alleviate hypertonicity. OBJECTIVE: To explore the efficacy of selective dorsal rhizotomy (SDR) followed by a physical training on gross motor function (GMF), functional balance, walking capacity, selective motor control (SMC) and energy cost of walking (ECW) of ambulant children with spastic diplegia. METHODS: Forty-two children with spastic diplegia aged 5 to 8 years were randomly assigned into the control or SDR-group. Both groups received a designed physical training of progressive functional strength training and standard orthotic management (SOM) 3 times a week for 6 months. GMF, functional balance, ECW, functional capacity and SMC were assessed by gross motor function measure (GMfM-88), pediatric balance scale (PBS), energy expenditure index (EEI), six-minute walking test (6MWT) and selective control assessment of lower extremity (SCALE), respectively. Assessment was carried out before the treatment (baseline), after 6 months (post I) and 1-year follow-up (post II). RESULTS: From baseline to post I and post II assessments, changes of GMF, functional balance, ECW, functional capacity and SMC within the control and SDR groups showed significant improvements (P < 0.001). Moreover, group comparison showed significant differences in favor of the SDR group. CONCLUSION: Integrated physical training followed SDR demonstrated qualitative changes and enhancement in motor function, achieved by spasticity reduction. [ABSTRACT FROM AUTHOR]

Objectives: Limitations in the ability to perform manual functions decrease the individual's participation in activities of daily living (ADLs). Thus, it is required to study the relationship between manual skills and self-care activities in children. This study aims to investigate the relationship between manual ability and self-care in children with spastic cerebral palsy at the ages of 1 to 8 years. Methods: In this cross-sectional study, 125 children aged 1-8 years with spastic cerebral palsy who were chosen by the convenience sampling method from 8 occupational therapy clinics in Tehran City, Iran, in 2022 were studied. The evaluation tools were manual ability classification system (MACS), mini-manual ability classification system (Mini-MACS), pediatric evaluation of disability inventory (PEDI), and cognitive level form designed in the SPARCLE project. After collecting the data, Stata software, version 14 was used to analyze data using chi-square, Spearman correlation coefficient, Mann-Whitney, Kruskal-Wallis, and regression. Results: In this research, the mean age of the children was 54.2±15 months and 43.2% had a cognitive level >70. The mean self-care and mobility in children were 49.65±30.60 and 40.78±26.97, respectively. With increasing age, self-care and mobility of children showed a significant increase (P<0.001). No significant difference was observed between boys and girls in self-care and mobility (P<0.05). By changing the education level of the main caregiver, no significant difference was found in self-care and mobility (P<0.05). With the increase in children's cognitive ability level and MACS level, self-care and mobility improved significantly (P<0.001). Moreover, the level of MACS and mobility with the highest beta values (-0.530 and 0.512, respectively) showed a greater contribution to the prediction of self-care. Discussion: The results showed that with increasing age, cognitive ability level, and MACS level, self-care and mobility improve significantly in children with spastic cerebral palsy. Therefore, it is suggested to pay more attention to manual ability to improve self-care and mobility in these children. [ABSTRACT FROM AUTHOR]

This article summarized the nursing measures for a pediatric patient with spastic cerebral palsy treated by lumbosacral selective posterior rhizotomy. Safety management, psychological care, nutrition care, exercise counseling and preoperative evaluation should be enhanced before operation. Key issues of postoperative nursing included observation of vital signs, maintenance of indwelling catheter, skin care, prevention of complications such as dizziness, headache, nausea and vomiting, guidance on reasonable diet to prevent postoperative abdominal distension and constipation. (总结分析腰骶段选择性脊神经后根切断术治疗1例脑性瘫痪患儿的护理经验。术前做好患者安全护理、心理护理、饮食护理、功能锻炼的指导, 完善相关检查; 术后做好生命体征的观察, 加强及管路维护和皮肤护理, 积极预防头晕、头痛、恶心呕吐、等并发症, 并指导合理饮食, 以预防术后腹胀、便秘。)

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years. Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17‑18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied. Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012). Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

This paper summarized the postoperative nursing management of a child with spastic cerebral palsy. The child received selective posterior rhizotomy followed by preoperative examination and preparation. In addition to the interventions on postoperative pain, constipation and infection, a rehabilitation exercise program was carried out to improve the comprehensive recovery of the child after surgery. (本文总结1例痉挛型脑瘫患儿的术后护理体会。患儿入院后完善相关检查和术前准备, 采用选择性脊神经后根切断术治疗, 术后做好疼痛、便秘、感染等护理干预, 根据恢复期制定康复方案, 指导患儿及家属进行康复锻炼, 促使其全面康复。)

ObjectiveTo observe the effect of Qiao meridian massage combined with modern rehabilitation therapy on adductor muscle tone and gross motor function of children with spastic cerebral palsy (SCP).MethodsA total of 60 SCP children inpatients and outpatients in the pediatric rehabilitation specialist clinic of the acupuncture and massage rehabilitation department in the First Affiliated Hospital of Hunan University of Chinese Medicine from April 2020 to September 2021 were randomly divided into control group and experimental group, with 30 cases in each group. The control group received modern rehabilitation therapy mainly including active exercise, passive exercise, physical modality therapy and occupational therapy, etc. The active exercise was 30 min a time, and the other treatment was 20 min a time, once a day, five days a week, lasting for three months. The experimental group received Qiao meridian massage on the basis of the control group, and the Qiao meridian massage was 15 min a time, active exercise was 15 min a time, and other treatments were the same as that of the control group, once a day, five days a week, lasting for three months. Before and after treatment, the modified Ashworth scale (MAS) was used to assess the muscle tone of adductor muscles; goniometry was used to measure the range of motion (ROM) of adductor muscles; the gross motor function measure scale-88 (GMFM-88) dimension D and E were used to assess the motor functions; and the clinical efficacy of both groups was evaluated.ResultsCompared with that before treatment, MAS score of both groups decreased significantly after treatment, while ROM of adductor muscles, GMFM-88 D and E scores increased significantly after treatment, and the differences were statistically significant (PPP>0.05).ConclusionQiao meridian massage combined with modern rehabilitation therapy can effectively improve spasticity of adductor muscles of children with SCP, reduce adductor muscle tone, improve ROM of hip joint and gross motor functions such as standing, walking, running and jumping, etc., which is recommended for clinical application.

Objective Methods Results Conclusion To review the effects of functional strength training (FST) on muscle strength and mobility in children with spastic cerebral palsy (CP).Eight databases were screened through March 2022 for studies assessing the impact of FST on strength, mobility, balance, and endurance in children with spastic CP. Study quality was assessed using the Downs and Black checklist and Cochrane Risk of Bias tools, followed by a meta-analysis.Twelve intervention studies of moderate-to-high-level evidence were selected. The interventions included open and closed chain exercises using free weights or body weight, administered approximately thrice a week for 12 weeks. The FST was found to have a moderate-to-large, statistically significant, positive effect on muscle strength (quadriceps, hamstrings, and plantar flexors) and mobility (GMFM D and E), with only four studies showing maintenance of gains during follow-up assessment.FST has a positive effect on muscle strength and mobility in children with spastic CP, but evidence of sustained effects following FST is limited. [ABSTRACT FROM AUTHOR]

Reduced selective voluntary motor control (SVMC) is a primary impairment due to corticospinal tract (CST) injury in spastic cerebral palsy (CP). There are few studies of brain metabolism in CP and none have examined brain metabolism during a motor task. Nine children with bilateral spastic CP [Age: 6-11 years, Gross Motor Function Classification System (GMFCS) Levels II-V] completed this study. SVMC was evaluated using Selective Control Assessment of the Lower Extremity (SCALE) ranging from 0 (absent) to 10 (normal). Brain metabolism was measured using positron emission tomography (PET) scanning in association with a selective ankle motor task. Whole brain activation maps as well as ROI averaged metabolic activity were correlated with SCALE scores. The contralateral sensorimotor and superior parietal cortex were positively correlated with SCALE scores (p < 0.0005). In contrast, a negative correlation of metabolic activity with SCALE was found in the cerebellum (p < 0.0005). Subsequent ROI analysis showed that both ipsilateral and contralateral cerebellar metabolism correlated with SCALE but the relationship for the ipsilateral cerebellum was stronger (R 2 = 0.80, p < 0.001 vs. R 2 = 0.46, p = 0.045). Decreased cortical and increased cerebellar activation in children with less SVMC may be related to task difficulty, activation of new motor learning paradigms in the cerebellum and potential engagement of alternative motor systems when CSTs are focally damaged. These results support SCALE as a clinical correlate of neurological impairment.

Reduced selective voluntary motor control (SVMC) is a primary impairment due to corticospinal tract (CST) injury in spastic cerebral palsy (CP). There are few studies of brain metabolism in CP and none have examined brain metabolism during a motor task. Nine children with bilateral spastic CP [Age: 6-11 years, Gross Motor Function Classification System (GMFCS) Levels II-V] completed this study. SVMC was evaluated using Selective Control Assessment of the Lower Extremity (SCALE) ranging from 0 (absent) to 10 (normal). Brain metabolism was measured using positron emission tomography (PET) scanning in association with a selective ankle motor task. Whole brain activation maps as well as ROI averaged metabolic activity were correlated with SCALE scores. The contralateral sensorimotor and superior parietal cortex were positively correlated with SCALE scores (p < 0.0005). In contrast, a negative correlation of metabolic activity with SCALE was found in the cerebellum (p < 0.0005). Subsequent ROI analysis showed that both ipsilateral and contralateral cerebellar metabolism correlated with SCALE but the relationship for the ipsilateral cerebellum was stronger (R 2 = 0.80, p < 0.001 vs. R 2 = 0.46, p = 0.045). Decreased cortical and increased cerebellar activation in children with less SVMC may be related to task difficulty, activation of new motor learning paradigms in the cerebellum and potential engagement of alternative motor systems when CSTs are focally damaged. These results support SCALE as a clinical correlate of neurological impairment.

ObjectiveTo investigate the rehabilitation effect of core stability training combined with all-round intensive exercise training on children with spastic cerebral palsy.MethodsA total of 144 children with spastic cerebral palsy treated in Children's Hospital of Hebei Province from September 2018 to August 2020 were divided into core stability group, intensive exercise group and combined group according to the experimental principle of 1∶1∶1 by stratified random method, with 48 cases in each group, and were provided with core stability training, all-round intensive exercise training, and core stability training + all-round intensive exercise training, respectively. The interventions for all three groups lasted for 6 months.The clinical efficacy of the three groups was statistically compared, as well as walking parameters (step length, width and speed), trunk control ability, Gross Motor Function Measure (GMFM), modified Ashworth scale (MAS) and Wee-Functional Independence Measure (WeeFIM) scores before intervention, and after 3 and 6 months of intervention.ResultsThe total effective rate of rehabilitation intervention in the combined group was higher than that in the core stability group and the intensive exercise group (PPPPPPPPPPP>0.05).ConclusionAll-round intensive exercise training combined with core stability training can be applied to children with spastic cerebral palsy, and further improve their walking function, trunk control ability and motor function, and relieve their spastic conditions.

ObjectiveTo analyze the biomechanical characteristics of equinus and crouch gait in children with spastic cerebral palsy (CP) using the foot sole model, and to compare the differences with the gait biomechanical characteristics of normal developing children.MethodsGait data of 60 children with CP collected by the Biomechanics Laboratory of University of Auckland, New Zealand were selected and divided into normal developing group, equinus gait group and crouch gait group, with 20 cases in each group. A three-dimensional motion capture system was used to collect gait data. A static trial was first completed to calibrate the computerized model to each of the physical markers. In each test, the participant walked 10 meters at a self-selected pace along a 10-metre walkway. Three successful gait trials were obtained for each participant and the mean value was taken. The anteroposterior (AP) displacement, medial-lateral (ML) displacement and displacement slope of the plantar center of pressure (COP) were calculated and compared among the three groups. The distance between the center of pressure and the origin of foot sole coordinate system, and the ankle and knee lever arms and external moments in AP and ML directions at maximal propulsion were also compared among three groups.Results(1) Characteristics of plantar center of pressure progression: compared with the normal developing group, COP-AJC0 significantly increased in the equinus gait group and the crouch gait group (P0, a greater anterioposterior displacement, and a lower center of pressure displacement slope (PPPP>0.05).ConclusionThe analysis of plantar center of pressure progression and lever arm characteristics of lower extremity joints based on the foot sole model can accurately and objectively reflect the biomechanical characteristics of gait in children with spastic cerebral palsy, which is recommended for clinical application.

Background and Study Aim. Cerebral palsy is a broad term for a variety of non-progressive, resulting in physical impairment, movement dysfunction, and poor posture. The purpose of the study was to compare the effectiveness in the Halliwick aquatic exercise versus conventional land-based therapy on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Material and Methods. In this randomized controlled trial, (n=34) children diagnosed with spastic Cerebral palsy were randomly assigned into either the Halliwick concept group (n=17) or active control (conventional exercising group) (n=17). A physiotherapist performed the sessions with participants three times a week, 45 minutes duration over 12 weeks. An independent pediatric rehabilitation specialist assessed the children’s gross motor function using the gross motor function measures (sitting, crawling and kneeling, standing, walking, running, and jumping). Results. After the intervention, both Halliwick concept group and conventional exercising group significantly improved activities of sitting, crawling & kneeling, standing and walking, running and jumping. Besides, the estimate of the effect of the Halliwick exercises on sitting, standing and walking, running & jumping activities was more clinically significant than conventional exercises, with sitting; MD = -0.06 [95%, CI; -0.19 to 0.32], standing; MD = 0.14 [95%, CI; -0.15-0.31], and walking, running & jumping activities; MD = -0.09 [95%, CI; -0.11 to 0.20]. None of the between-group differences for any remaining outcomes was significant. Conclusion. Aquatic exercises based on the Halliwick concept are better than conventional exercises to improve sitting, standing and walking, running and jumping activities in children aged 3 to 5 years with spastic cerebral palsy.

Objective: To investigate the effect of transcranial direct current stimulation (TCDC) combined with rehabilitation training on fine motor function of children with spastic cerebral palsy. Methods: 116 children with spastic cerebral palsy who were admitted to the Children’s Rehabilitation Department of our hospital from July 2020 to June 2022 were selected as the research objects. The children were randomly divided into the observation group and the control group according to the random number table, with 58 cases in each group. The control group was treated with conventional rehabilitation training, and the observation group was treated with t DCS on the basis of the control group. The degree of motion (AROM) of wrist dorsiflexion joint was measured with a goniometer, the fine motor function test scale (FMFM) for children with cerebral palsy was used to assess the fine motor ability of both upper limbs, the Peabody fine motor development scale (PDMS-FM) was used to assess the fine motor function of both hands, and the modified Ashworth muscular tension scale (MAS) was used to assess the muscular tension of the affected side of the elbow joint, The difference of each index between the two groups before and after treatment was compared. Results: After treatment, the AROM score of the two groups was significantly increased compared with that before treatment, and the AROM score of the observation group was significantly higher than that of the control group, with a statistically significant difference (P＜0.05). After treatment, the FMFM scores of the two groups were significantly increased compared with those before treatment, and the FMFM scores of the observation group were significantly higher than those of the control group, with a statistically significant difference (P＜0.05). After treatment, the FMQ scores of the two groups were significantly increased compared with those before treatment, and the FMQ scores of the observation group were significantly higher than those of the control group, with a statistically significant difference (P＜0.05). After treatment, the MAS scores of children in the two groups were significantly lower than those before treatment, and the MAS scores in the observation group were significantly lower than those in the control group, with a statistically significant difference (P＜0.05). Conclusion: Transcranial direct current stimulation intervention combined with rehabilitation training can significantly improve the range of motion of wrist dorsal extension joint, the fine manipulation ability of both upper limbs, the fine motor function of both hands, and the muscle tension of the affected upper limb elbow joint in children with spastic cerebral palsy, and can improve the fine motor function. [ABSTRACT FROM AUTHOR]

In this study, we reviewed the safety and efficacy of botulinum toxin type A (BoNT-A) injection with respect to motor development in children with spastic cerebral palsy aged <2 years. Randomized controlled trials of BoNT-A published between July 1993 and May 2021 were searched in PubMed, WANFANG, CNKI (Chinese National Knowledge Infrastructure), and Cochrane Library Central Register of Controlled Trials using keywords "Botulinum Toxin," "cerebral palsy," "nao xing tan huan," "nao tan," and "rou du du su." The 11-item PEDro Scale was used to rate the quality of all the identified studies. Twelve studies, involving 656 subjects, met the inclusion criteria, and of these, 2 involved patients aged <2 years. Treatment safety was assessed based on adverse event (AE) number and frequency, and efficacy was assessed based on spasticity, range of movement, and motor development. We observed that 3 self-limiting adverse events that were frequently reported included weakness, dysesthesia of the skin, and pain at the injection site. Moreover, there was a significant decrease in the incidence of spasticity and a notable improvement in the range of movement of BoNT-A–treated patients. Therefore, BoNT-A injection shows great safety and efficacy in the treatment of children with cerebral palsy aged <2 years. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin type A (BTX-A) is a neuromuscular blocking agent. BTX-A inhibits acetylcholine release, causes neuromuscular transmission impairment, and decreases muscle spasms. Objective: To explore the efficacy and safety of BTX-A injection in the treatment of spastic cerebral palsy through systematic evaluation and to provide a reference for the clinical use of BTX-A. Methods: We used "Cerebral palsy" and "BTX-A" as the subject terms and used a combination of subject terms and free words for the search. We searched 7 databases, including CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Web of science. Based on the inclusion and exclusion criteria, we screened the articles by reading their titles, abstracts, and full texts and finally included relevant literature for systematic evaluation. Result: A total of 93 papers were systematically evaluated, revealing that BTX-A injection treatment can effectively reduce muscle tone, increase joint mobility, improve gait and motor posture, and enhance gross motor movements in patients with spastic cerebral palsy. The benefits of BTX-A treatment can be sustained for 3-6 months, with motor ability improvement lasting up to 1 year. Combining BTX-A treatment with rehabilitation or external fixation therapy can enhance its efficacy. However, the effectiveness of BTX-A treatment is influenced by several factors, such as the dosage, number of injections, and patient age. Adverse reactions to BTX-A treatment are typically mild and can be relieved within 1-2 weeks. Conclusion: BTX-A injection is relatively safe but reversible. [ABSTRACT FROM AUTHOR]

The paradigm of comprehensive treatment approaches for children with cerebral palsy has gained traction, prompting clinicians to deliberate between independent and integrated treatment delivery. However, this decision-making process is often hindered by the dearth of empirical evidence available to inform optimal therapeutic strategies. This study, therefore, sought to compare the effects of Pilates-based core strengthening (PsCS), plyometric-based muscle loading (PlyoML), and their combination on postural control, balance, and mobility in children with unilateral cerebral palsy (ULCP). Eighty-one children with ULCP (age: 12–18 years) were randomized to PsCS (n = 27), PlyoML (n = 27), or a combined intervention (n = 27; equated for total sets/repetitions) group. The three interventions were applied twice/week over 12 successive weeks. Postural control (directional and overall limits of stability—LoS), balance, and mobility (Community Balance and Mobility Scale—CB&M; Functional Walking Test—FWT; Timed Up and Down Stair test—TUDS) were assessed pre- and post-intervention. The combined group exhibited greater increases in directional LoS compared to PsCS and PlyoML including the backward (p = 0.006 and 0.033, respectively), forward (p = 0.015 and 0.036, respectively), paretic (p = 0.017 and 0.018, respectively), and non-paretic directions (p = 0.006 and 0.004, respectively)], and this was also the case for overall LoS (p < 0.001 versus PsCS and PlyoML). In addition, the combined group displayed greater improvements compared to the PsCS and PlyoML groups regarding CB&M (p = 0.037 and p = 0.002, respectively), FWT (p = 0.012 and p = 0.038, respectively), and TUDS (p = 0.046 and p = 0.021, respectively). In conclusion, the combined PsCS and PlyoML exercise program promotes considerably greater improvements in postural control, balance, and mobility compared to unimodal training in children with ULCP.

ObjectiveThis study aimed to investigate the electro-neurophysiological characteristics of the ventral and dorsal nerves at the L2 segment in a quantitative manner.MethodsMedical records of consecutive patients who underwent single-level approach selective dorsal rhizotomy (SDR) from June 2019 to January 2022 were retrospectively reviewed. Intraoperative electro-neurophysiological data were analyzed.ResultsA total of 74 males and 27 females were included in the current study with a mean age of 6.2 years old. Quadriceps and adductors were two main muscle groups innervated by L2 nerve roots in both ventral and dorsal nerve roots. Dorsal roots have a higher threshold than that of the ventral ones, and muscles that first reached 200 µV innervated by dorsal roots have longer latency and smaller compound muscle action potential (CMAP) than those of the ventral ones. Supervised machine learning can efficiently distinguish ventral/dorsal roots using threshold + latency or threshold + CMAP as predictors.ConclusionElectro-neurophysiological parameters could be used to efficiently differentiate ventral/dorsal fibers during SDR.

Ankle-foot orthoses (AFOs) are frequently prescribed in children with cerebral palsy (CP) to improve their gait. Due to the heterogeneous nature of CP and contradictions among previous studies, it is important to evaluate the AFO-specific effects, as well as explore their effects on different gait patterns. a) What are the prevalence and specific features of AFOs in children with CP? b) How do AFOs affect gait pathology in children with CP? c) What are the pattern-specific effects of AFOs in children with CP? A group of 170 patients with CP underwent a three-dimensional gait analysis with and without AFOs (either carbon fiber, rigid, flexible or hinged). The gait profile score, the gait variable scores of the hip, knee and ankle joints, non-dimensional step length and walking speed were used as outcome measures. The AFO-specific effects on the kinematic and kinetic waveforms were investigated using statistical non-parametric mapping (SnPM). Effects were considered relevant when the minimal clinically important difference (MCID) or the standard errors of measurement, for the parameters or the waveforms respectively, were exceeded. Rigid AFOs were prescribed for more than 80 % of the children. Significant beneficial effects were observed for non-dimensional step length and walking speed. Most changes in gait indices were not considered relevant. The SnPM-analyses on the total group and specific gait patterns revealed that walking with AFOs improved the kinematic and kinetic waveforms. These effects were relevant, and were most obvious for crouch, apparent equinus and the total group. The use of AFOs improves gait, whether we inspect a total -and thus heterogeneous- group or focus on specific gait patterns. However, focussing on specific parameters (i.e. general gait indices) does not provide a full picture of the AFO-effects. • AFOs improve kinematic and kinetic gait waveforms. • AFOs improve spatiotemporal parameters. • Gait indices are not sensitive enough to capture detailed AFO-effects. • Pattern-specific AFO-effects are observed for each specific gait pattern. [ABSTRACT FROM AUTHOR]

Background: The most common kind of cerebral palsy, which affects between 70 - 80 % of those diagnosed, is spastic cerebral palsy. Treatment options include surgery, medicine, and physical therapy. This illness impairs the coordination and regulation of motor function. In turn, the spinal cord's and the nerve's responses are affected, resulting in the stiffness and spasticity of the muscles. The present study aimed to find the effectiveness of sustained slow stretch and pressure application in spastic diplegic cerebral palsy. Methodology: Based on inclusion and exclusion criteria, a comparative experimental study was carried on. 20 samples were divided into interventional (n=10) and conventional groups (n=10) and the samples were sampled according to convenient sampling. Interventional group received an inhibitory pressure application of about 35 to 50mmHg for 20 minutes with the help of sphygmomanometer over the hamstring muscle for 4 weeks. Conventional group received sustained slow stretch over the hamstring muscle for about 20 minutes per session for 4 weeks and the results will be interpreted. Results: There was only minor difference between the groups when compared statistically and was clinically significant. Conclusion: The result of this investigation allows us to draw the conclusion that both types of therapies, gradual continuous stretching and application of pressure, is effective. [ABSTRACT FROM AUTHOR]

One of the most common diseases that is the reason of severe neurological disability is Cerebral Palsy (CP). CP worldwide prevalence is average 1-4 per 1000 live births. The purpose of study was to confirm the impact of laser acupuncture therapy in improvement of immunity indices in children with spastic CP by rising NK cells count. From the pediatric outpatient clinic of the National Institute of Laser Enhanced Sciences (NILES) and the physical therapy outpatient clinic at Benha Fever Hospital, 40 children with spastic CP aged 1 to 3 years of both genders were recruited. They were split into two groups of equal number at random: The physical therapy sessions for Group A (the control group) consisted of one hour each session, three times each week, for a total of 12 weeks. In addition to their regular physical treatment, participants in Group B (the study group) also underwent 780 nm Diode laser acupuncture with an output power of 50 mw three times weekly for a total of 12 sessions. All children in both groups had their NK cells (CD16 CD56) measured by flow cytometry using “BD Facscalibur” with two different colors before and after treatment. Statistical tests were performed on the data. Counts of NK cells (CD16, CD56) differed significantly between group A and group B after treatment, with group B having a higher total. The results of this study showed that the number of NK cells in the children with spastic CP increased after they had laser acupuncture treatment. [ABSTRACT FROM AUTHOR]

PURPOSE: In children with cerebral palsy (CP), gastrocnemius muscle spasticity may lead to pes equinus posture which causes insufficient ankle joint dorsiflexion for normal gait. The aim of this study was to analyze the stiffness of gastrocnemius and tibialis anterior muscles by shear wave elastography (SWE) in children with pes equinus deformity due to spastic CP. METHODS: 24 legs of 12 children (6 females and 6 males, mean age 45.8 months) with CP were prospectively included in the study. Tissue stiffness quantification with shear-wave velocity (SWV) was analyzed. RESULTS: The mean SWVs of the gastrocnemius and tibialis anterior muscles were 3.91±0.26 m/s and 2.67±0.18 m/s, respectively. The stiffness of the gastrocnemius muscle was significantly higher than the stiffness of the tibialis anterior muscle (p < 0.0001). There was no correlation between the stiffness of these muscles (r = 0.129, p > 0.05). CONCLUSION: Gastrocnemius muscles were stiffer than tibialis anterior muscles in patients with spastic CP. But stiffness between these muscles was not correlated with each other. Pes equinus may be related to stiff gastrocnemius in these patients. This study demonstrates the clinical potential for SWE as a non-invasive tool for analyzing calf muscle stiffness. [ABSTRACT FROM AUTHOR]

ObjectiveSelective dorsal rhizotomy (SDR) can decrease spasticity in children suffering from spastic cerebral palsy (SCP) and thus improve their moving ability when supplemented with the post-operational rehabilitation program. In this case, the study aims to investigate the gait changes in children with mild SCP after SDR in short-term follow-up.MethodsThe information of ambulatory SCP cases who underwent SDR in our center was retrospectively reviewed, and comparisons of changes in spasticity, motor function and data of gait analysis before and after SDR were analyzed.ResultsIn total, 32 cases were included in this study, with a mean age of 5.9 ± 2.1 years old. Noticeable decrease was found in the median value of the pre-operational MAS score after SDR at last follow-up in both sides of adductors, gastrocnemius, soleus, and left hamstrings. The Gross Motor Function Measure-66 score increased from 70.6 ± 9.2 to 73.4 ± 8.2, and the gait deviation index increased after SDR compared with the pre-operational data (right side: 65.8 ± 8.8 vs. 60.1 ± 10.7; left side: 63.5 ± 10.1 vs. 57.0 ± 9.9). Noticeable changes were found that the maximum angle of affected ankles in the sagittal plane (the dorsal-flexion angle) increased from 2.5° to 8.2°, the angles at initial contact (1% gait cycle) of affected knees in the sagittal plane decreased from 34.0° to 27.8°, and the angles at the end of swing phase (100% gait cycle) of affected knees in the sagittal plane decreased from 35.8° to 28.3°.ConclusionIn short-term follow-up, SDR can lower spasticity in children with SCP. Post-operational gait analysis showed improvements in gross motor function and gait, which derived from the changes in the sagittal plane (ankle and knee). A longer follow-up duration is thus needed to clarify the long-term outcome.

Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morphology and gross motor function. Forty-nine children with spastic cerebral palsy were randomized by minimization. The intervention group (nparticipants = 26, age: 8.3 ± 2.0 years, Gross Motor Function Classification System [GMFCS] level I/II/III: 17/5/4, nlegs = 41) received a 12-week PRT program, consisting of 3-4 sessions per week, with exercises performed in 3 sets of 10 repetitions, aiming at 60%–80% of the 1-repetition maximum. Training sessions were performed under supervision with the physiotherapist and at home. The control group (nparticipants = 22, age: 8.5 ± 2.1 year, GMFCS level I/II/III: 14/5/3, nlegs = 36) continued usual care including regular physiotherapy and use of orthotics. We assessed pre- and post-training knee extension, knee flexion and plantar flexion isometric strength, rectus femoris, semitendinosus and medial gastrocnemius muscle morphology, as well as functional strength, gross motor function and walking capacity. Data processing was performed blinded. Linear mixed models were applied to evaluate the difference in evolution over time between the control and intervention group (interaction-effect) and within each group (time-effect). The α-level was set at p = 0.01. Knee flexion strength and unilateral heel raises showed a significant interaction-effect (p ≤ 0.008), with improvements in the intervention group (p ≤ 0.001). Moreover, significant time-effects were seen for knee extension and plantar flexion isometric strength, rectus femoris and medial gastrocnemius MV, sit-to-stand and lateral step-up in the intervention group (p ≤ 0.004). Echo-intensity, muscle lengths and gross motor function showed limited to no changes. PRT improved strength and MV in the intervention group, whereby strength parameters significantly or close to significantly differed from the control group. Although, relative improvements in strength were larger than improvements in MV, important effects were seen on the maintenance of muscle size relative to skeletal growth. In conclusion, this study proved the effectiveness of a home-based, physiotherapy supervised, PRT program to improve isometric and functional muscle strength in children with SCP without negative effects on muscle properties or any serious adverse events. [ABSTRACT FROM AUTHOR]

Children with spastic cerebral palsy (SCP) are often treated with intramuscular Botulinum Neurotoxin type-A (BoNT-A). Recent studies demonstrated BoNT-A-induced muscle atrophy and variable effects on gait pathology. This group-matched controlled study in children with SCP compared changes in muscle morphology 8–10 weeks post-BoNT-A treatment (n = 25, median age 6.4 years, GMFCS level I/II/III (14/9/2)) to morphological changes of an untreated control group (n = 20, median age 7.6 years, GMFCS level I/II/III (14/5/1)). Additionally, the effects on gait and spasticity were assessed in all treated children and a subgroup (n = 14), respectively. BoNT-A treatment was applied following an established integrated approach. Gastrocnemius and semitendinosus volume and echogenicity intensity were assessed by 3D-freehand ultrasound, spasticity was quantified through electromyography during passive muscle stretches at different velocities. Ankle and knee kinematics were evaluated by 3D-gait analysis. Medial gastrocnemius (p = 0.018, −5.2%) and semitendinosus muscle volume (p = 0.030, −16.2%) reduced post-BoNT-A, but not in the untreated control group, while echogenicity intensity did not change. Spasticity reduced and ankle gait kinematics significantly improved, combined with limited effects on knee kinematics. This study demonstrated that BoNT-A reduces spasticity and partly improves pathological gait but reduces muscle volume 8–10 weeks post-injections. Close post-BoNT-A follow-up and well-considered treatment selection is advised before BoNT-A application in SCP. [ABSTRACT FROM AUTHOR]

Objective: Several studies have shown the significance of neuroinflammation in the pathological progress of cerebral palsy (CP). However, the etiology of CP remains poorly understood. Spastic CP is the most common form of CP, comprising 80% of all cases. Therefore, identifying the specific factors may serve to understand the etiology of spastic CP. Our research aimed to find some relevant factors through protein profiling, screening, and validation to help understand the pathogenesis of cerebral palsy. Materials and methods: In the current study, related clinical parameters were assessed in 18 children with spastic CP along with 20 healthy individuals of the same age. Blood samples of the spastic CP children and controls were analyzed with proteomics profiling to detect differentially expressed proteins. On the other hand, after hypoxic-ischemic encephalopathy (HIE) was induced in the postnatal day 7 rat pups, behavioral tests were performed followed by detection of the differentially expressed markers and inflammatory cytokines in the peripheral blood and cerebral cortex of the CP model rats by Elisa and Western blot. Independent samplet-tests, one-way analysis of variance, and the Pearson correlation were used for statistical analysis. Results: Through proteomic analysis, differentially expressed proteins were identified. Among them, tissue-nonspecific alkaline phosphatase (TNAP), the gene expression product of alkaline phosphatase (ALPL), was downregulated in spastic CP. In addition, significantly lower TNAP levels were found in the children with CP and model rats. In contrast, compared with the sham rats, the model rats demonstrated a significant increase in osteopontin and proinflammatory biomarkers in both the plasma and cerebral cortex on the ischemic side whereas serum 25 hydroxyvitamin D and IL-10 were significantly decreased. Moreover, serum TNAP level was positively correlated with serum CRP and IL-10 in model rats. Conclusion: These results suggest that TNAP is the potential molecule playing a specific and critical role in the neuroinflammation in spastic CP, which may provide a promising target for the diagnosis and treatment of spastic CP. [ABSTRACT FROM AUTHOR]

Spastic cerebral palsy (CP) is a common pediatric-onset disability with an estimated prevalence of 0.2%. It is a complex condition characterized by muscle stiffness, contractures, and abnormal movement. Spastic CP is difficult to diagnose. Although nearly all affected children are born with it or acquire it immediately after birth, many are not identified until after 19 months of age with the diagnosis often not confirmed until 5 years of age. In addition, CP frequently co-occurs with other complex conditions that can complicate diagnosis and treatment. For example, an estimated 42% of spastic CP cases have co-occurring epilepsy. Recent studies indicate that altered DNA methylation patterns in peripheral blood cells are associated with CP and may have diagnostic value.Accordingly, the purpose of this study is to assess the diagnostic value of methylation in CP with more complex disease states. We evaluated machine learning classification for detecting CP based on DNA methylation pattern analysis in the context of co-occurrent epilepsy. Blood samples from 30 study participants diagnosed with epilepsy (n=4), spastic CP (n=10), both (n=8), or neither (n=8) were analyzed by Illumina MethylationEpic arrays. A novel machine learning algorithm using a Support Vector Machine (SVM) or Linear Discriminant Analysis (LDA) was developed to identify methylation loci that classified CP from controls and to measure the classification ability of identified methylation loci. The isolation of informative methylation loci was performed in a binary comparison between CP and controls, as well as in a 4-way comparison that included epilepsy. Median F1 scores for SVM-based analysis were 0.67 in 4-class comparison, and 1.0 in the binary classification. SVM outperformed LDA (median F1 0.57 and 0.86, respectively). Overall, the novel machine learning based algorithm was able to classify study participants with spastic CP and/or epilepsy from controls with significant performance., Competing Interests: Declaration of interests Karyn Robinson, Adam Marsh, and Robert Akins are inventors on pending patent US20200165675A1. Additional Declarations: The authors declare no competing interests.

Children with spastic cerebral palsy often present with muscle weakness, resulting from neural impairments and muscular alterations. While progressive resistance training (PRT) improves muscle weakness, the effects on muscle morphology remain inconclusive. This investigation evaluated the effects of a PRT program on lower limb muscle strength, morphology and gross motor function. Forty-nine children with spastic cerebral palsy were randomized by minimization. The intervention group (nparticipants = 26, age: 8.3 ± 2.0 years, Gross Motor Function Classification System [GMFCS] level I/II/III: 17/5/4, nlegs = 41) received a 12-week PRT program, consisting of 3-4 sessions per week, with exercises performed in 3 sets of 10 repetitions, aiming at 60%–80% of the 1-repetition maximum. Training sessions were performed under supervision with the physiotherapist and at home. The control group (nparticipants = 22, age: 8.5 ± 2.1 year, GMFCS level I/II/III: 14/5/3, nlegs = 36) continued usual care including regular physiotherapy and use of orthotics. We assessed pre- and post-training knee extension, knee flexion and plantar flexion isometric strength, rectus femoris, semitendinosus and medial gastrocnemius muscle morphology, as well as functional strength, gross motor function and walking capacity. Data processing was performed blinded. Linear mixed models were applied to evaluate the difference in evolution over time between the control and intervention group (interaction-effect) and within each group (time-effect). The α-level was set at p = 0.01. Knee flexion strength and unilateral heel raises showed a significant interaction-effect (p ≤ 0.008), with improvements in the intervention group (p ≤ 0.001). Moreover, significant time-effects were seen for knee extension and plantar flexion isometric strength, rectus femoris and medial gastrocnemius MV, sit-to-stand and lateral step-up in the intervention group (p ≤ 0.004). Echo-intensity, muscle lengths and gross motor function showed limited to no changes. PRT improved strength and MV in the intervention group, whereby strength parameters significantly or close to significantly differed from the control group. Although, relative improvements in strength were larger than improvements in MV, important effects were seen on the maintenance of muscle size relative to skeletal growth. In conclusion, this study proved the effectiveness of a home-based, physiotherapy supervised, PRT program to improve isometric and functional muscle strength in children with SCP without negative effects on muscle properties or any serious adverse events.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03863197.

Cerebral palsy was a primary neuromotor disorder that affects the development of movement, muscular tone and posture due to injury to the developing brain in prenatal, natal, or post-natal period. cp is non progressive disease but it is changeable features with period. The objective of this study is to identify clinical types of cerebral palsy and neuro-disabilities associated with cerebral palsy patient. Data (2019-2020) on 100 children of cerebral palsy in central teaching hospital in Baghdad analysis include clinical patterns of cerebral palsy and topographic classification of spastic cerebral palsy. also, the complication and neurological disabilities associated with cerebral palsy. In this analysis found most of cerebral palsy patients (84%) were spastic according to topographic classification, (47%) of spastic cerebral palsy was diplegic type. (29%) quadriplegic cerebral palsy and (8%) of hemiplegic cerebral palsy. About neurological complication and disabilities associated with cerebral palsy, (79%) of cerebral palsy patients had speech disturbance. (53%) had epilepsy, (43%) Micro acephaly, (32%) of patients had growth retardation, (29 %) had ocular problems, and (15%) of cerebral palsy patients had mental retardation. In conclusions; the most common type of cerebral palsy was spastic cerebral palsy & according to a topographic classification diplegic spastic cerebral palsy was the most common type of Spastic cerebral palsy. About neurodisabilities associated with cerebral palsy, the most common disabilities were speech disturbance and epilepsy.

Objective:To observe the effect of core stability training based on Bobath concept on motor function of children with spastic cerebral palsy (SCP). Methods: A total of 124 children with SCP were treated in the department of rehabilitation medicine of Children's Hospital of Nanjing Medical University from January 2018 to September 2019, which were divided into the control group and the observation group according to the random number table, with 62 cases in each group. The control group was given conventional rehabilitation treatment, which mainly included anti-spasm (joint movement, passive traction), homework, language, massage, sports training (trunk rotation, hip adduction, pelvic pronation and control, limb movement, standing and balance, walking with legs raised, knee bending), one time a day, 40 min a time, six days a week, continuous treatment for three months. The observation group was given core stability training based on Bobath's concept on the basis of the control group, which mainly included static training (hip extension, hip, knee and ankle flexion, point support, bridge training, etc.) and dynamic training (paddling, trunk support, trunk rotation, chase toy etc.), one time a day, 80 min a time, six days a week, continuous treatment for three months. After treatment for three months, the modified Ashworth scale (MAS) was used to assess spasticity; Before treatment and after treatment for one month and three months, the Peabody development motor scale-fine motor (PDMS-FM) was used to assess fine motor function, and the gross motor function measure-88(GMFM-88) was used to assess gross motor function, the Berg balance scale (BBS) was used to assess balance ability, and the activity of daily living scale (ADL) was used to assess the ability of daily living.Results:There was no significant difference in the PDMS-FM, GMFM-88, BBS and ADL scores of the control group and the observation group before treatment (P> 0.05). After treatment for three months, the effective rate of spasticity improvement in the observation group was higher than that in the control group, the difference was statistically significant (P< 0.05). Compared with before treatment, the PDMS-FM, GMFM-88, BBS and ADL scores in the control group and the observation group after treatment for one month and three months were higher; compared with the treatment after one month, the PDMS-FM, GMFM-88, BBS and ADL scores in the control group and the observation group after treatment for three months were higher, the difference was statistically significant (P< 0.05). Compared with the control group at the same time, the PDMS-FM, GMFM-88, BBS and ADL scores in the observation group were higher, the difference was statistically significant (P< 0.05).Conclusion:The core stability training based on Bobath concept can effectively improve the spasticity symptoms, motor function, balance function and activities of daily living of children with SCP, it's worthy of further clinical promotion.

Abstract 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