Effect of Biomechanical Constraints on Neural Control of Head Stability in Children With Moderate to Severe Cerebral Palsy.

External support has been viewed as an important biomechanical constraint for children with deficits in postural control. Nonlinear analysis of head stability may be helpful to confirm benefits of interaction between external trunk support and level of trunk control. The purpose of this study was to compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control. This was a quasi-experimental repeated-measures study. Data from 15 children (4-16 years of age) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8 [4 boys, 4 girls]) or severe (GMFCS V; n=7 [4 boys, 3 girls]) cerebral palsy (CP) were compared with previous longitudinal data from infants with typical development (TD) (3-9 months of age). Kinematic data were used to document head sway with external support at 4 levels (axillae, midrib, waist, and hip). Complexity, predictability, and active degrees of freedom for both anterior-posterior and medial-lateral directions were assessed. Irrespective of level of support, CP groups had lower complexity, increased predictability, and greater degrees of freedom. The effect of support differed based on the child's segmental level of control. The GMFCS V and youngest TD groups demonstrated better head control, with increased complexity and decreased predictability, with higher levels of support. The GMFCS IV group had the opposite effect, showing decreased predictability and increased complexity and degrees of freedom with lower levels of support. Infants with typical development and children with CP were compared based on similar segmental levels of trunk control; however, it is acknowledged that the groups differed for age, cognitive level, and motor experience. The effect of external support varied depending on the child's level of control and diagnostic status. Children with GMFCS V and young infants with TD had better outcomes with external support, but external support was not enough to completely correct for the influence of CP. Children with GMFCS IV performed worse, with increased predictability and decreased complexity, when support was at the axillae or midribs, suggesting that too much support can interfere with postural sway quality.

da Costa CS ，Saavedra SL ，Rocha NA ，Woollacott MH ... -  《-》

Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy.

To examine postural constraints in children with moderate-to-severe cerebral palsy (CP) using a segmental approach. Quasi-experimental repeated-measures study; case series. Motor control research laboratory. Children (N=15; age range, 4-16y) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8; 4 boys) or severe (GMFCS V) (n=7; 4 boys) CP. Each child participated in 3 data collection sessions. During each session, we evaluated postural control for sitting using kinematics and clinical assessments. Kinematic data were used to document head alignment and stabilization with external support at 4 levels (axillae, midrib, waist, hip). Two clinical assessments, the Segmental Assessment of Trunk Control and behavioral assessment for stage of trunk control, were also used to compare results for children with CP to previous longitudinal data from typically developing (TD) infants (3-9mo of age). Children with GMFCS V had difficulty aligning and stabilizing their head along the medial-lateral and anterior-posterior axes. External support improved postural control for children with GMFCS V but not for those classified as GMFCS IV, who had opposite responses to support compared with TD infants. Children with GMFCS V have limited trunk control but respond to support similarly to young TD infants, suggesting delayed postural control. Response to external support for children with GMFCS IV suggests a unique strategy for trunk control not observed in typical infants. Overall a segmental approach offers new insights into development of trunk control in children with moderate-to-severe CP.

Saavedra SL ，Woollacott MH 《-》

Locomotion and cadence detection using a single trunk-fixed accelerometer: validity for children with cerebral palsy in daily life-like conditions.

Paraschiv-Ionescu A ，Newman CJ ，Carcreff L ，Gerber CN ，Armand S ，Aminian K ... -  《-》

Analysis of orthopedic surgical procedures in children with cerebral palsy.

Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America. To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP. This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test. A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05). The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.

Rehbein I ，Teske V ，Pagano I ，Cúneo A ，Pérez ME ，von Heideken J ... -  《-》

Spectrum of gross motor function in extremely low birth weight children with cerebral palsy at 18 months of age.

Vohr BR ，Msall ME ，Wilson D ，Wright LL ，McDonald S ，Poole WK ... -  《-》