Purpose: Dysphagia is a significant health problem in children with infantile cerebral palsy (ICP), but not frequently discussed in the literature. The study objective was to analyse dysphagia symptoms in children with a pyramidal form of ICP, including the oral and pharyngeal phases of deglutition and dysarthria severity. We searched for a correlation between dysphagia severity and ICP type, mental development and occurrence of epilepsy.Material and Methods: A total of 67 children with a pyramidal form of infantile cerebral palsy were studied. Data were obtained based on case history elicited from the mothers, analysis of medical and psychological documentation, and logopaedic examination, including an examination of the action of swallowing.Results: Dysphagia symptoms were found in 41 (61%) studied children, most frequently referring only to the oral phase (25 children), with concomitant mild and moderate dysarthria. Oral and pharyngeal dysfunctions were observed in 14 children and coexisted with more pronounced dysarthria symptoms. The most severe disorders were mainly found in the pharyngeal phase in 2 children. A statistically significant correlation was noted between the severity of dysphagia symptoms and the ICP type (p<0.044) and mental development (p<0.00002)'Conclusions: Swallowing dysfunctions occur in the majority of children (>50%) with ICP. More serious disorders involving the oral and pharyngeal phases mainly affect children with tetraplegia and profound mental impairment. These disorders continue from early infancy through childhood and adolescence and improvement has been mainly observed when only the oral phase of swallowing is affected. These are always accompanied by dysarthria symptoms, which are especially severe when dysphagia involves the oral and pharyngeal phases. Early assessment and stimulation of the swallowing function should be a common element in the rehabilitation and care of children with ICP.

We present the case of an 11-year-old obese girl who presented with idiopathic intracranial hypertension affecting first the lateral abducens nerve. She received acetazolamide, but 5 days later she developed lateral, peripheral facial palsy. Imaging evaluation was normal, which primarily excluded cerebral venous thrombosis and sustained the initial diagnosis. Despite some complicating factors (obesity, elevated intracranial pressure), prednisolone was administered for a short-term period to counteract the facial palsy. Ophthalmological residuals resolved within almost 1.5 months, while facial palsy receded after 4 months. Peripheral facial palsy is an extremely rare, but not unknown condition in idiopathic intracranial hypertension. As a symptom, it should be investigated thoroughly, primarily to exclude cerebral venous sinus thrombosis, before it can be attributed to idiopathic intracranial hypertension. As far as treatment is concerned, corticosteroids can be added to the initial treatment with acetazolamide, without worsening already elevated intracranial hypertension or ophthalmologic findings.

INTRODUCTION: Our aims in this study were to compare the biopsychosocial aspects of patients with cerebral palsy and subjects in a control group, establish the severity of malocclusion, and identify determinant factors.

METHODS: The group with cerebral palsy included 60 patients diagnosed with the spastic form of the disease. The control group included 60 randomly selected healthy subjects with various malocclusions. Data were collected through questionnaires, medical charts, and clinical evaluations. The criteria of the dental aesthetic index were used for the diagnosis of malocclusion. Comparisons between groups and between the independent variables and dependent variable (severity of malocclusion) were performed by using the chi-square test (P ? 0.05) and multivariate logistic regression (forward stepwise procedure).

RESULTS: Significant differences between the groups were found for these variables: tooth loss, overjet, anterior open bite, facial type, breathing pattern, drooling, difficulty in swallowing, and lip incompetence.

CONCLUSIONS: The main risk factors associated with the severity of malocclusion were cerebral palsy, mouth breathing, lip incompetence, and long face.

Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

INTRODUCTION: Our aims in this study were to compare the biopsychosocial aspects of patients with cerebral palsy and subjects in a control group, establish the severity of malocclusion, and identify determinant factors.

METHODS: The group with cerebral palsy included 60 patients diagnosed with the spastic form of the disease. The control group included 60 randomly selected healthy subjects with various malocclusions. Data were collected through questionnaires, medical charts, and clinical evaluations. The criteria of the dental aesthetic index were used for the diagnosis of malocclusion. Comparisons between groups and between the independent variables and dependent variable (severity of malocclusion) were performed by using the chi-square test (P ?0.05) and multivariate logistic regression (forward stepwise procedure).

RESULTS: Significant differences between the groups were found for these variables: tooth loss, overjet, anterior open bite, facial type, breathing pattern, drooling, difficulty in swallowing, and lip incompetence.

CONCLUSIONS: The main risk factors associated with the severity of malocclusion were cerebral palsy, mouth breathing, lip incompetence, and long face.

Summary<br /> Background<br /> The variety of symptoms in cerebral palsy (CP) points to the advisability of using the term 'cerebral palsies' to underline the complex nature of the associated musculoskeletal dysfunctions. The incidence of CP is estimated at 1 to 5 in 1000 live born infants. This makes CP one of the main causes of hospitalization in paediatric orthopaedic wards.<br /> The complicated nature of the musculoskeletal dysfunctions entails the necessity of employing multiple surgical procedures: starting from multilevel soft tissue operations, to multiple corrective osteotomies, to spinal surgery with implantation of baclofen pumps for subarachnoid administration. The aim of the study was to evaluate the level of satisfaction following surgery in CP children.<br /> Material and Methods <br /> The study group was composed of 52 children (27 males and 25 females) surgically treated between 1988 and 2001. There were 18 children with hemiparesis, 19 with diparesis and 15 with tetraparesis. A subjective evaluation of the level of the satisfaction of the patient and the parent/guardian after the surgical treatment was carried out during a follow-up examination.<br /> Results<br /> Forty-three parents (82.6%) reported improvement after the surgery and declared that they would take the same decision again. Five parents reported no significant change in the quality of life of their children (9.6%), and two (3.8%) reported a deterioration.<br /> Conclusion<br /> 1. Multilevel soft tissue release in children with CP significantly improved their quality of life and was associated with a high level of parents'/guardians' satisfaction.<br /> <br /> <br />

In this paper a mathematical modeling of the swallowing sound generation is presented. To evaluate the model, its application on swallowing disorder (dysphagia) diagnosis is discussed. As a starting point, a simple linear time invariant model is assumed to represent the pharyngeal wall and tissue excited by a train of impulses. The modeling is approached by two different assumptions. In one approach it is assumed the impulse train, representing the neural activities to trigger swallow, is the same for both groups of control and dysphagic and it is the pharyngeal model that accounts for the difference between the two groups. On the other hand, in the second approach, it is assumed the pharyngeal response is the same for both groups but the neural activities to initiate the swallow are different between the two groups. The results show the second approach complies better with the physiological characteristics of swallowing mechanism as it provides a much better discrimination between the swallowing sounds of control and dysphagic groups of this study. Though, it should be noted that our dysphagic group subjects were cerebral palsy and stroke patients. Hence, the model accounting for initiation of neural activities is reasonable to show better results.

This study aimed to determine the influence of flexibility of the chair seat surface on the pressure peak and on the contact area during the execution of a task of handling an object on the seated position by individuals with spastic cerebral palsy. Ten individuals of both genders with diagnosis of spastic cerebral palsy, who had some control to voluntarily move the body and the upper limbs, participated in this study. Quantification of data was carried out in two experimental situations: (1) execution of a task of fitting with upper limbs, and with the individual placed on an adapted canvas seat; (2) execution of a task of fitting with the participant positioned on an adapted wooden seat. Data obtained were submitted to a non-parametric and descriptive statistical analysis using the Wilcoxon test. Results indicated that the use of canvas seat increased the contact area and decreased the pressure peak and the medio-lateral displacement of centre pressure on the seated posture.

Cerebral palsy (CP) is one of the major forms of developmental disorders. There are different approaches and controversies in rehabilitation treatment. The Neuronal Group Selection theory could provide theoretical explanation for Stojcevi? Polovina rehabilitation method. The aim of the study was to evaluate long-term impact of intensive and continuously performed rehabilitation on the motor autonomy level children with CR Motor autonomy levels, defined according to the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM), were analyzed in 24 children with CP at the beginning of the study and at the last visit. During rehabilitation, GMFM scores increased above the expected value of initial GMFCS level in the majority of patients. Intensive rehabilitation had significant influence on motor improvement in children with CP.

Background. Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. SCURVY, a disease of dietary ascorbic acid deficiency, is uncommon today. It still exists in high risk groups including economically disadvantaged populations with poor nutrition. The incidence of SCURVY in the pediatric population is very low. Cases Report. Here we report two cases of SCURVY revealed by subperiosteal hematoma in children with cerebral palsy and developmental delay. Conclusion. SCURVY is extremely rare in children. Musculoskeletal manifestations are prominent in pediatric SCURVY. Multiple subperiosteal hematomas are an important indicator for diagnosis.

Yabunaka Y, Kondo I, Sonoda S, Saitoh E, Tsuruta Y, Konaka M, Konaka T, Kawarada S: Evaluating the effect of intensive intervention in children with cerebral palsy using a hypothetical matched control group: A preliminary study.

OBJECTIVE: To evaluate the effect of intensive intervention in children with cerebral palsy using a hypothetical matched control group based on motor growth curves.

DESIGN: For pretest-posttest design using a hypothetical control group, a convenient sample of 39 children with cerebral palsy who received intensive intervention without surgical treatment was assigned to the experimental group. The hypothetical matched control group was created based on motor growth curves. Gains in Gross Motor Function Measure-66 score after intensive treatment in the experimental group were compared with those in the hypothetical matched control group using a mixed design for repeated-measures two-way analysis of variance.

RESULTS: Gross motor function development in the experimental group was significantly accelerated compared with the hypothetical matched control group.

CONCLUSIONS: In this preliminary study, using a hypothetical control group, the effectiveness of intensive intervention in children with cerebral palsy has been demonstrated. Although it is desirable to have a baseline phase to make sure whether gross motor function in the hypothetical control group changes in a similar way to that in the experimental group before an intervention phase, the hypothetical control group design is well worth considering as a research design option in the field of cerebral palsy research.