OBJECTIVE: To analyze the comorbidities in patients with cerebral palsy (CP) from two perspectives as neurologic subtype and gross motor functions, and find their correlations. METHODS: Children with cerebral palsy treated in the rehabilitation center from January 2007 to June 2009 received the following examinations: intelligence capacity test, ophthalmologic consultation, language-speech test, brainstem auditory evoked potential and electroencephalogram. They were stratified according to both neurologic subtype and gross motor functions to detect the occurrence of comorbidities. RESULTS: Of all the 354 cases, 166 (46.89%) had mental retardation, 15 (4.24%) auditory limitations, 138 (38.98%) visual disorder, 216 (61.02%) language-speech disorder and 82 (23.16%) epilepsy. The frequency of individual comorbidities were distributed disproportionately between the different neurologic subtypes. Correlation analysis showed that there was a significant correlation between the spastic diplegia and the visual disorder (correlation coefficient = 0.26), between spastic hemiplegia and epilepsy (correlation coefficient = 0.17), between spastic quadriplegia and epilepsy and mental retardation (the correlation coefficient was 0.38 and 0.11, respectively) and between both dyskinetic and mixed children and language-speech disorder (the correlation coefficient was 0.24 and 0.27, respectively). The frequency of individual comorbidities was distributed disproportionately between the different neurologic subtypes and between the different GMFCS levels (P < 0.05), except for the frequency of visual disorders (chi(2) = 1.90, P > 0.05); and with the increase of the GMFCS levels, the burden of the comorbidities were more heavy and the incidence of the comorbidities was higher. Multi-comorbidities were relatively infrequently encountered in those with spastic hemiplegic or spastic diplegic children or patients whose GMFCS levels were I-III, while these entities occurred at a frequent level for those with spastic quadriplegic, dyskinetic, or mixed or children whose GMFCS levels were IV and V, and the differences were significant (P < 0.05). The mean GMFCS levels of children with spastic quadriplegic, dyskinetic or mixed CP were higher than level III, most of them had no ability of ambulation;while the mean GMFCS levels of spastic hemiplegic or spastic diplegic children were below level III, most of them could walk independently. CONCLUSIONS: There are correlations between the occurrence of the comorbidities such as mental retardation, auditory or visual impairments, language-speech disorders, epilepsy and the cerebral palsy subtype and the gross motor function levels. Clinicians should have a full recognition of these comorbidities, and we should have a cooperation between the different subjects to have an overall evaluation and rehabilitation and to improve the prognosis.

Purposes. To investigate the relationship between associated reactions and a) spasticity, b) contracture and c) coordination. Methods. Associated reactions were measured as magnitude of muscle activity in the affected limb during a 50% maximum voluntary contraction of muscles in the unaffected limb. Spasticity was measured as hyper-reflexia during passive muscle stretch, coordination as performance during a tracking task, and contracture as loss of range of motion. Chi-square analysis was used to examine the association between associated reactions and spasticity, and linear regression to examine the relationship between associated reactions and spasticity, coordination and contracture. Results. Twenty-three people with hemiplegic cerebral palsy aged from 15 to 47 years (mean [SD]: 29 years [9]) participated. Thirteen participants exhibited spasticity, and six participants exhibited associated reactions. Five of the six participants with associated reactions also had spasticity (chi(2) = 2.37, p = 0.12). Associated reactions were highly correlated with spasticity (r = 0.77, p = 0.001), but not with contracture (r = 0.35, p = 0.29) or coordination (r = -0.31, p = 0.30). Conclusions. Although 27% of participants exhibited associated reactions, and these were mostly small, associated reactions appear to be an expression of spasticity in hemiplegic cerebral palsy. Copyright (c) 2010 John Wiley & Sons, Ltd.

ABSTRACT: A 12 year old boy presented with an acute onset of anisocoria and blurred vision. Ocular motility was normal but his right pupil was dilated, round but sluggishly reactive to light. There was no history of trauma, eye drops’ instillation, nebulised drugs or local ointments. His past medical history was negative. A third nerve palsy was considered but the performed cerebral MRI was normal. On further anamnestic investigation the boy revealed that he had spent the morning doing gardening, and especially working on a “trumpet plant”. Datura and Brugmansia are well known toxic plant; all Datura and Brugmasia plants contain, primarily in their seeds and flowers, tropane alkaloids such as scopolamine, hyoscyamine and atropine. Systemic and local intoxications have already been described. The day after anisocoria was much less evident and completely resolved in three days. We present this case of an unusual cause of mydriasis to underline once more the importance of a well and deeply conducted medical hystory.

Aim The objective of this study was to assess the validity of a mobility questionnaire (MobQues) that was developed to measure parent-reported mobility limitations in children with cerebral palsy (CP). Method The parents of 439 children with CP (256 males and 183 females; age range 2-18y; Gross Motor Function Classification System [GMFCS] levels I-IV) completed the mobility questionnaire (MobQues). To assess content validity, we linked all meaningful concepts of the MobQues items to the International Classification of Functioning, Disability and Health (ICF). To assess construct validity, we compared the total scores of the two versions of the MobQues (MobQues47 and MobQues28) according to GMFCS level, and determined Pearson's correlation coefficient (r) with the Gross Motor Function Measure-66 (GMFM-66). Results Content validity was demonstrated by the fact that 46 of the 47 MobQues items were linked to categories in the 'Mobility' chapter of the ICF. Construct validity was demonstrated by the finding that MobQues scores decreased with increasing GMFCS levels (p<0.001). In a subgroup of 162 children, positive correlations were found between total scores and the GMFM-66 (MobQues47, r=0.75; MobQues28, r=0.67, p<0.001). Interpretation The results of this study provide evidence supporting the content and construct validity of the MobQues as a measure of mobility limitation in children with CP.

Aim The aim of this study was to describe and identify factors associated with motivation in children with cerebral palsy (CP). Method Children with CP were recruited for this cross-sectional study. Children were assessed using the Leiter Intelligence Test, the Gross Motor Function Measure, and the Vineland Adaptive Behavior Scale. Parents completed the Dimensions of Mastery Questionnaire (DMQ) and questionnaires on demographics, child behaviour, and family functioning. Results The parents of 74 children (46 males, 28 females; mean age 9y 2mo, SD 2y 1mo, range 5y 10mo-12y 11mo) completed the DMQ. Just over half of the children (39/74) were classified at Gross Motor Function Classification System (GMFCS) level I, with 13 classified at GMFCS level II, one at level III, six at level IV, and 14 at level V; one child was not classified. The most common diagnoses were spastic hemiplegia and quadriplegia (23 each), followed by diplegia (14). The highest motivation scores were obtained for the dimensions of mastery pleasure and social persistence and the lowest for persistence with motor or cognitive tasks. Age and sex were not predictive of scores on the DMQ. Higher IQ (r=0.41), better motor ability (r=0.43), and fewer limitations in self-care, communication, and socialization (r=0.44-0.53) were positively associated with motivation total score. A negative impact of the child’s disability on the family was associated with lower motivation (r=-0.44). Positive social behaviours were positively correlated with motivation (r=0.38-0.66), whereas hyperactivity and peer problems were negatively associated. Interpretation High motivation was associated with fewer activity limitations and behavioural problems and reduced family burden. Low motivation may adversely influence a child’s functional potential and the effectiveness of interventions. Strategies focusing on the child, peers, adults, or activities are proposed to enhance the children’s motivation to engage in more challenging activities.

Aim This paper is a systematic review of physical activity measurement instruments for field-based studies involving children with cerebral palsy (CP). Method Database searches using PubMed Central, MEDLINE, CINAHL Plus, PsycINFO, EMBASE, Cochrane Library, and PEDro located 12 research papers, identifying seven instruments that met the inclusion criteria of (1) having been developed for children aged 0 to 18 years, (2) having been used to evaluate a physical activity dimension, and (3) having been used in a field-based study involving children with CP. The instruments reviewed were the Activities Scale for Kids – Performance version (ASKp), the Canada Fitness Survey, the Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the Compendium of Physical Activities, the Physical Activity Questionnaire – Adolescents (PAQ-A), StepWatch, and the Uptimer. Second-round searches yielded 11 more papers, providing reliability and validity evidence for the instruments. Results The instruments measure physical activity frequency, mode, domain, and duration. Although most instruments demonstrated adequate reliability and validity, only the ASKp and CAPE/PAC have established reliability and validity for children with physical disabilities; the Uptimer has established concurrent validity. No instrument measuring intensity in free-living has been validated or found reliable for children with CP. Interpretation The findings suggest that further studies are needed to examine the methodological properties of physical activity measurement in children with CP. Combining subjective and objective instruments is recommended to achieve better understanding of physical activity participation.

INTRODUCTION. The limitations of gait in children with cerebral palsy are common. In fact, the training of locomotion is an essential therapeutic goal. There are various treatment approaches, but in recent years, the treadmill training, framed within the motor learning task-oriented, has increased its presence at the clinical level. AIM. To determine whether treadmill training with or without partial body weight support, improves the ability to walk, the motor function of the lower limb, the disability and the quality of life in children with cerebral palsy. MATERIALS AND METHODS. We selected only those articles with the highest level of evidence for each type of intervention. We searched in the National Guideline Clearinghouse, Trip Database, SUMsearch, Medline, CINHAL, Embase, Amed, Cochrane Library Plus and PEDro. Data were extracted from these six studies, which recruited 127 participants. Only a meta-analysis was given. We used a fixed effects model, data were not significant between increased of speed and treadmill training. RESULTS. According to the individual studies, the intervention improved lower extremity function and spatiotemporal parameters during gait. However, the differences between groups in favor of the experimental condition, were mostly not significant. CONCLUSIONS. The systematic review shows some limitations. Firstly, it includes a small number of studies, which is also a small sample of participants. In addition, among the studies, there is a great clinical diversity and many articles did not described relevant data exactly for critical reading.

PURPOSE: Little is known about the speech and language abilities of children with cerebral palsy (CP) and there is currently no system for classifying speech and language profiles. Such a system would have epidemiological value and would have the potential to advance the development of interventions that improve outcomes. In this study, we propose and test a preliminary speech and language classification system by quantifying how well speech and language data differentiate among children classified into different hypothesized profile groups. METHOD: Speech and language assessment data were collected in a laboratory setting from 34 children with CP (18 males; 16 females) who were a mean age of 54 months (SD 1.8 months). Measures of interest were vowel area, speech rate, language comprehension scores, and speech intelligibility ratings. RESULTS: Canonical discriminant function analysis showed that three functions accounted for 100% of the variance among profile groups, with speech variables accounting for 93% of the variance. Classification agreement varied from 74% to 97% using four different classification paradigms. CONCLUSIONS: Results provide preliminary support for the classification of speech and language abilities of children with CP into four initial profile groups. Further research is necessary to validate the full classification system.

International Journal of Paediatric Dentistry 2010 Objectives. To assess and compare the oral health status of preschool children with and without cerebral palsy (CP). Methods. Preschool children with CP (72) were recruited from 23 Special Child Care Centers in Hong Kong. An age (+/-3 months) and gender matched sample of preschool children from mainstream preschools were recruited as the control group. Dental caries status, gingival health status, tooth wear, developmental defect of enamel, malocclusion, dental trauma and oral mucosal health were assessed and compared between the two groups. Results. Significant differences in gingival health status were found between children with and without CP (mean plaque index scores, P = 0.001 and mean gingival index scores, P < 0.05). Tooth wear involving dentine was more prevalent among CP children (P < 0.001), as were evidence of anterior open-bite (P < 0.001) and oral mucosal lesions (P < 0.05). Children with and without CP had similar caries experiences (P > 0.05), prevalence of enamel defects (P > 0.05) and dental trauma (P > 0.05). Conclusions. Differences of oral health status exist among preschool children with and without CP. Preschool children fare worse in terms of gingival health, tooth wear, oral mucosal health and malocclusion.

Hypoxic ischemic encephalopathy (HIE) describes neonatal encephalopathy that is caused by intrapartum asphyxia and it can result in the long term sequelae of cerebral palsy which is a major cause of disability. The incidence of cerebral palsy has not changed over the last few decades and the challenge to obstetricians remains how best to recognise those babies at risk of this intrapartum insult both before and during labour. Many associations and risk factors are unavoidable or unrecognisable, and others are fairly common and associated with poor predictive value. Intrapartum fetal heart monitoring remains the main focus of attention but how this is best achieved is still the subject of research. Computerised decision support systems built into fetal heart rate monitoring and non-invasive fetal ECG signal pick-up are currently being explored. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.