Purpose. The aim of this study was to compare self-concept in four groups of children distinguished by the presence/absence of either a motor impairment (with and without cerebral palsy, CP) or social adjustment problems (victimisation). Method. Four groups were formed: a victimised CP group (n = 17), a non-victimised CP group (n = 41), a victimised comparison group (n = 10) and a non-victimised comparison group (n = 46). Self-concept was measured using the Self-Perception Profile for Children (SPPC, Harter The Self-Perception Profile for Children. Unpublished manual. Denver, CO: University of Denver; 1985) during the school visit. Victimisation was obtained by conducting a classwide sociometric interview in the class of the target child. Results. The results indicate that the groups differ depending on the domain measured. Conclusions: By identifying factors that may influence self-concept in children with CP, this study contributes new information to this subject.

Background/Methods: Sensory processing capacities of 8-12-year-old internationally adopted (IA) children who experienced prolonged institutional care (> 12 months with 75% of pre-adoption lives in institutional care) prior to adoption into family environments (PI) were compared to a group of IA children who were adopted early (< 8 months) predominantly from foster care with little or no institutional experience (EA/FC) and another group of non-adopted (NA) children raised by their birth parents in the United States. All children had estimated IQs within the normal range and did not evidence major neurodevelopmental disorders (e.g., cerebral palsy, fetal alcohol syndrome, Down's syndrome). Sensory processing was evaluated with a commonly used parent-report measure and a laboratory assessment. Results: Children who had experienced prolonged institutionalization showed higher levels of reactivity to sensation and displayed both more aversion and approach to sensory stimuli than the other groups. The comparison groups (EA/FC & NA) did not differ on any of the sensory processing measures. Conclusions: These results suggest that early institutional rearing which typically involves both sensory and social deprivation is associated with problems in sensory modulation capacities.

J Oral Pathol Med (2010) Background: Previous studies reported alterations in salivary flow rate and biochemical parameters of saliva in cerebral palsy (CP) individuals; however, none of these considered the type of neuromotor abnormality among CP individuals, thus it remains unclear whether the different anatomical and extended regions of the brain lesions responsible for the neurological damage in CP might include disruption of the regulatory mechanism of saliva secretion as part of the encephalopathy. The aim of this study was to evaluate salivary flow rate, pH and buffer capacity in saliva of individuals with CP, aged 3-16 years, with spastic neuromotor abnormality type and clinical patterns of involvement. Methods: Sixty-seven individuals with CP spasticity movement disorder, were divided in two groups according to age (3-8- and 9-16-years-old) and compared with 35 sibling volunteers with no neurological damage, divided in two groups according to age (3-8- and 9-16-years-old). Whole saliva was collected under slight suction and pH and buffer capacity were determined using a digital pHmeter. Buffer capacity was measured by titration using 0.01N HCL, and flow rate was calculated in ml/min. Results: In both age groups studied, whole saliva flow rate, pH and buffer capacity were significantly lower in the spastic CP group (P < 0.05). The clinical patterns of involvement did not influence the studied parameters. Conclusion: These findings show that individuals with spastic cerebral palsy present lower salivary flow rate, pH and buffer capacity that can increase the risk of oral disease in this population.

Aim: To pilot the use of the Craig Hospital Inventory of Environmental Factors (CHIEF) questionnaire to ascertain information regarding barriers to participation experienced by a sample of New Zealand children with cerebral palsy. Methods: The CHIEF questionnaire was administered to parents/caregivers of a consecutive sample of 32 children with cerebral palsy attending a paediatric tertiary clinic in Auckland. Twenty-three children walked independently, 5 used walking aides and four used a wheelchair. Twenty-four of the 32 parent-respondents provided contextual feedback for their responses and wider issues relating to the topic. Results: The barriers to participation most commonly reported by parents were attitudes at school (72%) and in the community (56%), difficulties accessing personal equipment (59%), and the natural environment and built surroundings (56%). Contextual information from families generally supported their answers to the questionnaire but highlighted that some parents had confused the ‘not applicable’ and ‘never’ options. Discrepancy between scores on the policy-related questions and later contextual feedback suggested that the policy subscale did not fully capture family concerns about limited availability of public funding for equipment, therapy, and educational support. Conclusions: The CHIEF instrument proved easy to use in a clinic setting. However, parent-respondent feedback highlighted the difficulties in interpreting responses to some items when the instrument is used in isolation to quantify environmental barriers to participation. The results highlight the need to develop research approaches and tools that can explore barriers to participation by children with cerebral palsy taking account of socio-economic and other relevant contextual information.

Cerebral palsy (CP) is the most frequent cause of motor handicap among children. The present door to door (every door) study was conducted in El-Kharga District-New Valley to estimate the epidemiology of CP among children. Each child was subjected to complete medical and neurological examination to detect cases with CP. These diseased children were subjected to meticulous neurological and medical assessment, brain MRI, EEG and Stanford Binet (4th edition). It was found that 52 out of 25,540 children had CP yielding prevalence rate of 2.04/1000 (95% CI: 1.48-2.59) of living births. Mean age of children with CP, was 7.17+/-4.38years. The order of frequency of different subtypes of CP was as follows, 65.4% had spastic type, 26.9% mixed type and 3.8% for each ataxic and dyskinetic types of CP. The frequency of risk factors of CP in our study is prenatal complications (cyanosis, preterm, jaundice, birth weight and obstructed labor of mothers), first baby, similar condition and recurrent abortions.

Use of the coping strategy positive reinterpretation was examined among parents of children with cerebral palsy (CP). Survey data (n = 66) were used to gain a general picture of positive reinterpretation use, which was then explored in greater depth using semistructured interviews (n = 13). Positive reinterpretation was positively correlated with self-efficacy and negatively correlated with depression and stress. Interviews identified two types of positive reinterpretation: focusing on the positive aspects of the situation and finding meaning (in caring for a child with CP). Positive reinterpretation appeared to be an adaptive coping strategy used to deal with emotional stresses experienced by parents.

Objective: To compare the prevalence and types of epilepsy and other central nervous system (CNS) diseases in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. Methods: All participants were screened through the nationwide Danish National Hospital Register (DNHR). The average observation time was 30.3years (range 27-30years), and mean age at follow-up was 42.7years (range 27-57years). Results: Of the 118 individuals with IA, 29 (24.6%) were registered with at least one epilepsy diagnosis against 5 (1.5%) in the comparison group (p<0.0001; OR=21.6; 95% CI 8.1-57.3). Other CNS diseases occurred with low frequency in both groups and only cerebral palsy, unspecified (p=0.02) was significantly more frequent among participants with a history of IA. Conclusions: Our study lends further support to the notion that epilepsy, but not other CNS diseases, is a common comorbid condition in IA. Low intelligence, but not gender, was a risk factor for epilepsy in IA. Copyright © 2010 Elsevier B.V. All rights reserved.

BACKGROUND: Gait in young people with cerebral palsy is inefficient and there is a lack of relevant indicators for monitoring the problem. In particular, the impact of gait kinematics on gait efficiency is not well documented. The aim of this study is to examine the relationship between gait efficiency, gait kinematics, lower limb muscle strength, and muscular spasticity in adolescents with cerebral palsy. METHODS: Ten ambulatory adolescents with spastic cerebral palsy were recruited. The energy expenditure index during gait, gait kinematics, flexion and extension knee isometric muscle strength, and quadriceps spasticity were assessed. FINDINGS: Energy expenditure index (1.5 (0.7) beats/m) was strongly correlated with the ankle and knee flexion/extension ranges of motion (r= -0.82, P<0.01 and r= -0.70, P<0.02, respectively) and also with maximal plantar flexion (r=0.74, P<0.05) during gait. Knee flexion strength was the only strength measurement correlated with energy expenditure index (r= -0.85; P<0.01). INTERPRETATION: This study suggests that ankle and knee flexion/extension ranges of motion during gait are key kinematics factors in gait efficiency in adolescents with cerebral palsy. Copyright © 2010 Elsevier Ltd. All rights reserved.

Measurements of femoral and tibial torsion obtained from radiographs or computed tomographic scans have been used to describe rotational malalignment of the lower extremities and to clarify indications for surgery. A weak relationship between anatomic torsion deformity and the resulting transverse plane gait pattern in patients with cerebral palsy has been described, but the observations have not yet been tested in an able-bodied patient population. We conducted a prospective study to investigate the correlation of femoral torsion and tibial torsion as measured by using computed tomography with transverse plane gait data for patients with rotational malalignment. Twenty-six lower limbs from 26 patients selected for surgery based on gait analysis were evaluated. Calculation of Pearson correlations showed that increase of femoral anteversion resulted in increase of pelvic range of motion. A very weak correlation between femoral torsion and hip rotation (determination coefficient, R(2)=0.22) was found in a linear regression model, whereas tibial torsion and knee rotation showed a strong correlation (determination coefficient, R(2)=0.71). The correlation between the foot progression angle and tibial torsion was higher than between the foot progression angle and femoral torsion. We conclude that there is a considerable dynamic influence of mechanisms of compensation, especially in the hip, that should be considered when evaluating the torsional profile. We therefore recommend conducting three-dimensional instrumented gait analysis for patients undergoing surgical correction of rotational malalignment. Copyright © 2010 Elsevier B.V. All rights reserved.

PURPOSE: To correlate motor function, as measured by the Jebsen-Taylor test, and sensory function, as measured by the 12-object stereognosis testing, in the hands of children with spastic hemiplegia due to cerebral palsy. METHODS: A chart review identified children with hemiplegic and triplegic cerebral palsy with stereognosis and Jebsen-Taylor testing between 1997 and 2008. Forty-one children were included in the study, including 22 girls and 19 boys, with an average age of 8.7 years (range, 6-16 years). The right side is affected in 23 children; 34 children have hemiplegic cerebral palsy, and 7 have triplegic cerebral palsy. The initial Jebsen-Taylor and stereognosis test results were recorded for each subject, as well as age, diagnosis, affected side, and prior treatment with hand therapy, botulinum toxin injection, or surgery. Descriptive statistics, chi-square analysis, paired t-tests, and correlation measurements were used for analysis of the data. RESULTS: Statistically significant inverse correlations exist between the cards, small objects, checkers, light objects, and heavy objects on the Jebsen-Taylor subtests, as correlated with the stereognosis scores in the affected hand (p </= 0.04). The stereognosis scores for the patients who were not able to complete the Jebsen-Taylor test with the affected hand were significantly lower than those who were able to complete the Jebsen-Taylor test with the affected hand (p = .04). The stereognosis scores were significantly lower for the affected side as compared with the contralateral side. The Jebsen-Taylor total test times were significantly longer for the affected side as compared with the contralateral side (p < .001). CONCLUSIONS: In children with hemiplegic and triplegic cerebral palsy, the impairment of stereognosis is correlated with impairment in motor function, and the inability to complete the Jebsen-Taylor test with the affected hand is associated with impaired stereognosis function. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV. Copyright © 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.