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Query: UMLS:C0018991 (hemiplegia)
 3,997 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.
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PMID:Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools. 1735 69

Cerebral palsy is the commonest cause of severe childhood disability, the aetiology of which is largely unknown. Data on familial aggregation of cerebral palsy are very limited. We defined familial risks for siblings who were hospitalised because of cerebral palsy in Sweden. A nationwide database for neurological diseases was constructed by linking the Multigeneration Register to the Hospital Discharge Register for the years 1987-2001. Standardised hospitalisation ratios (SHRs) were calculated for affected singletons and twins by comparing them with siblings who had no cerebral palsy. A total of 3997 patients were recorded with cerebral palsy. Familial cerebral palsy was uncommon, and it accounted for 1.6% of all cerebral palsy cases. However, for parents who had had one affected child the risk of recurrence in another child was considerably increased. Parents of one affected child had a 4.8-fold risk of having a second affected child, and where the siblings were twins, the risk was 29-fold. These familial risks were particularly high in some clinical subgroups: 17-25 in singletons and 37-155 in twins, including hemiplegia, diplegia and quadriplegia. The remarkably high familial risks are difficult to explain without some contribution of heritable factors. The lack of discordant pairs may suggest that heritable factors are disorder type-specific. Affected concordant sibling pairs should be subjected to molecular studies aiming at identifying the susceptibility gene.
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PMID:High familial risks for cerebral palsy implicate partial heritable aetiology. 1743 32

Equinovarus deformity of the foot is a result of the muscles imbalance in which inventors of the foot, mostly posterior and anterior tibialis muscle, overpower evertors. In children with cerebral palsy untreated spastic equinovarus deformity may cause severe fixed foot deformity and painful callosities under metatarsal heads and on the lateral side of the foot. The gait pattern becomes less effective and needs more energy. The study group consisted of 154 children with cerebral palsy treated in our Clinic by the multilevel soft tissue surgery. For foot problems 136 children needed surgical intervention. In 19 ambulatory patients, with hemiplegia or diplegia, split tibialis posterior tendon transfer together with tendo Achilles lengthening and plantar aponeurectomy were performed. The study was based on clinical examination, parents' questionnaire, radiology and gait analysis at least one year after surgery. The mean follow up was 4.6 years. The functional improvement was observed in 17 (89%) children with tendon transfer. At the last follow up those patients were brace free, with plantigrade foot while walking (without DAFO orthesis) and normal shoes were used. All painful callosities disappeared. On a standing AP X-ray adequate correction of the hindfoot-forefoot relation was achieved in 14 (74%) cases. Persistent equinovarus deformity over 10 degrees was observed in 2 cases. Those patients underwent additional bone surgery. With a properly planned approach the split tibialis posterior tendon transfer can bring good clinical and functional results in CP children with equinovarus deformation. We recommend this procedure in early stage of the deformity what can eliminate more harmful triple arthrodesis in severe deformities.
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PMID:[Split tibialis posterior tendon transfer on peroneus brevis for equinovarus foot in CP children]. 1763 52

This paper proposes a simple method of hand skill assessment in children that can be useful in clinical practice. A reduced 5-hole version of Annett's Peg Moving Task was used to quantify hand skill bilaterally in 435 normally developing preschool and school-children, and adolescents aged 3-18 years from Brazil. The cross-cultural validity of the normative data obtained in Brazil was verified in 157 school-children aged 6-11 years from France. An application in 76 children with cerebral palsy (hemiplegia 21, diplegia 34, triplegia 6, mixed type 15) showed very important variability of the deficits in hand function within each subtype of cerebral palsy (CP). Hand deficits were more severe in children in special schools than in children in regular schools within each CP subtype. A qualitative analysis showed which difficulties during the execution of the task were specific to children with CP and which were also observed in normally developing children.
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PMID:Hand skill assessment with a reduced version of the Peg Moving Task (PMT-5) in children: normative data and application in children with cerebral palsy. 1791 51

Background. Contracture of the triceps in the calf occurs in most CP children especially those with diplegia and spastic hemiplegia. The purpose of our research was to evaluate the effective of TB-A in the treatment of these contractures and the associated disturbances of the dynamic position of the foot in CP children.<br /> Material and methods. Thirty five CP children (19 with diplegia and 16 with hemiplegia) received botulinum toxin A (TBX-A-Dysport) for the dynamic contracture of the triceps surae muscle and secondary equinovarus foot deformity. These children ranged in age from 2-11 years (mean 4.6). Previous conservative treatment had failed to alleviate these conditions. Goniometric measurements of the passive range of motion and the evaluation of dynamie equinovarus foot were performed prior to injection of BTX-A to 54 gastrocnemius muscles, and again at 2, 6, and 12 weeks post injection.<br /> Results. The results showed high effectiveness for TBX-A, e.g. marked reduction in equinovarity in 47 and 49 ankle joints (68%- 78%) at 2 and 6 weeks respectively, and in 19 joints (35%) at 12 weeks post-treatment, and moderate reduction in 12 (22%), 8 (15%) and 14 (26%) joints respectively. These improvements were statistically significant. In some children the positive effect was present up to 16 and 20 weeks post injection. No change was found on follow-up in 5 ankle joints (9%) at 2 weeks and in 7 (13%) at 6 and 12 weeks. Reversion to baseline scores was observed in 14 ankle joints (26%). The TB-A therapy was cllosely integrated with physiotherapy and the use of AFO orthosis when necessary.<br /> Conclusions. Botulin toxin therapy is effective in the treatment contractures of the triceps of the calf and equinovarus foot in children with cerebral palsy.
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PMID:Botulin toxin A in the treatment of dynamic equinovarus foot in cerebral palsied children. 1803 86

The effect of spastic cerebral palsy on in vivo gastrocnemius muscle fascicle length is not clear. Similarity of fascicle lengths in children with diplegia and typically developing children, but shortening of fascicle lengths in the paretic legs of children with hemiplegia compared with the non-paretic legs, are both reported. In the former case, comparisons were made between fascicle lengths normalized to leg length, whereas in the latter case, absolute fascicle lengths were compared. The inherent assumptions when normalizing fascicle length (measured via ultrasonography) were not validated, raising the possibility that inappropriate normalization contributed to the controversy. We used statistical methods to control the potential confounding effect of leg length on fascicle length, and tested the feasibility of the normalization method for a group of 18 children with diplegia (nine males, nine females; mean age 8y 7mo [SD 3y 11mo], range 2-15y; Gross Motor Function Classification System levels II and III) and 50 typically developing children (20 males, 30 females; mean age 9y 1mo [SD 2y 4mo], range 4-14y). Children with diplegia, as a group, had shorter absolute and normalized fascicle lengths (p<0.05) but we could not refute the appropriateness of the normalization method. Other methodological issues (such as sample characteristics) might have contributed to the apparent controversy between the studies.
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PMID:In vivo gastrocnemius muscle fascicle length in children with and without diplegic cerebral palsy. 1848 73

The aim of this study was to investigate the relation between muscle thickness of the quadriceps femoris muscle, knee joint function (spasticity and range of motion), and activity and participation measures in children and adolescents with cerebral palsy (CP). Thirty-eight children and adolescents with mild to severe CP (20 males, 18 females; mean age 12y 8mo [SD 3y 7mo], range 6-18y) participated. The severity and type of CP of participants covered all five levels of the Gross Motor Function Classification System and three types: spastic (quadriplegia, hemiplegia, and diplegia), athetotic, and hypotonic. The thickness of the quadriceps femoris muscle (MTQ) was measured from B-mode ultrasound images. Activity limitations were evaluated by the Gross Motor Function Measurement-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI). Spasticity was assessed with the modified Ashworth scale (MAS). After adjustment for age and body mass index, the MTQ showed significant positive correlations with GMFM-66 and PEDI scores; however, there was no significant correlation with MAS ratings. The degree of knee flexion contracture correlated positively with the MAS rating of the knee flexor muscles and negatively with the MTQ. These results established the clinical relevance of assessment of muscle thickness across a broad spectrum of individuals with CP.
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PMID:Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy. 1820 Dec 98

Modelling the effect of soleus and gastrocnemius contractions against the floor resistance in a forward dynamics simulation revealed that hip flexion, internal rotation and adduction together with external pelvic rotation could be attributed to a direct, but distant effect of triceps surae contraction. Knee flexion smoothed out the effect. To validate this clinically relevant biomechanical observation, ankle plantar flexion was correlated with hip and pelvic rotation retrospectively in children with spastic cerebral palsy. In 49 children with spastic hemiplegia, plantar flexion showed a significant correlation with increased pelvic retraction and hip internal rotation. In contrast, in 47 children with spastic diplegia no significant effect of the triceps surae on hip and pelvis kinematics was found. Bilateral hip and knee flexion in diplegia appeared to prevent the proximal effect of the triceps surae seen in the hemiplegics. In diplegia triceps surae overactivity did not appear to be a significant cause of internal rotation gait.
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PMID:Effects of plantarflexion on pelvis and lower limb kinematics. 1825 30

The aim of this study was to investigate the participation of children with cerebral palsy (CP) in activities outside school and to compare their participation with a large representative sample of children. A population-based survey was conducted of children with CP born in Victoria, Australia in 1994 and 1995. Of 219 living children identified, 114 (52.1%) returned completed surveys. The children (65 males, 49 females) were aged between 10 years 9 months and 12 years 9 months (mean age 11y 9mo, SD 6mo). Thirty-eight per cent had hemiplegia, 23% diplegia, 4% triplegia, 34% quadriplegia, and 1% was of unknown topography. Distribution according to the Gross Motor Function Classification System (GMFCS) was 22.8% Level I, 36% Level II, 10.5% Level III, 8.8% Level IV, and 21.9% Level V. Distribution according to the Manual Ability Classification System (MACS) was: 19.3% Level I, 38.6% Level II, 14.0% Level III, 8.8% Level IV, and 19.3% Level V. Participation was measured using the Children's Assessment of Participation and Enjoyment. Participation in selected sport, cultural, and quiet leisure activities was compared with population-based data for 11-year-olds from the Australian Bureau of Statistics. Children with CP undertook a median of 26.5 activities (interquartile range 10) in 4 months which were commonly informal rather than formal. Intensity of participation was low. Diversity and intensity of participation was similar for children in each level of the MACS and the GMFCS, except for participants in Level V. More children with CP participated in organized sports (p<0.001) compared with other Australian children, although with lower frequency (p<0.001). Participation diversity and level of intensity of Australian children with CP were similar to those reported in a Canadian study.
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PMID:Diversity of participation in children with cerebral palsy. 1835 37

The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD 2y 2mo] range 2-9y) with and without cerebral palsy (CP) and compared with those in 75 healthy children of similar age, sex, and fat free mass (FFM; 43 males, 32 females; mean age 6y 4mo [SD 1y 8mo], range 2-9y). Of the 25 children with IE, 12 had generalized and 13 partial seizures; 10 children had CP (four hemiplegia, one diplegia, and five tetraplegia); 18 were ambulators. REE (kcal/d), determined by indirect calorimetry, was expressed as a percentage of that predicted using Schofield equations. Energy intake from 3-day weighed food records was assessed for children with IE only and expressed as a percentage of estimated energy requirement. Compared with healthy children, children with IE had significantly lower percentage (Student's t-test, p<0.05) of predicted REE (111 [SD 13] vs 104 [SD 4]), weight z-score, body mass index z-score, and FFM. Using multiple regression, REE adjusted for FFM, fat mass, and sex were significantly lower in children with IE and CP (-110 kcal/d, 95% confidence interval -199 to -21, p=0.016). In children with IE, energy intake was also a statistically significant predictor of REE. CP largely explained the suboptimal growth status and lower REE of children with IE compared with healthy children.
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PMID:Growth failure in children with intractable epilepsy is not due to increased resting energy expenditure. 1848 56


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