bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between ICIDH handicap code and Gross Motor Function Classification System in children with cerebral palsy
Authors: Beckung Eva , Hagberg Gudrun
Published: July 2010

The aim of this study was to apply the International Classification of Impairments, Disabilities and Handicap (ICIDH; WHO 1980) parallel to the Gross Motor Function Classification System (GMFCS; Palisano et al. 1997) in a population‐based series of children with cerebral palsy (CP). Of the 116 children studied, birth characteristics, data on gross motor function, and level of handicap at 5 to 6 years of age, were retrospectively collected from medical records and documentation made by rehabilitation team members. Low handicap scores and mild levels of gross motor disability were present in children with hemiplegic CP, moderate scores in children with diplegic CP, simple ataxia, and athetotic CP, and high scores in children with dystonic CP and tetraplegic CP. A significant correlation was found between high handicap scores as well as high levels on the GMFCS and the presence of learning disability, epilepsy, and obvious aetiology of CP. A strong correlation was found between the handicap code and the GMFCS, the strongest concerning the dimension of mobility (r=0.95, p<0.0001). A striking similarity in the grading of disability was present between the ICIDH handicap code and the GMFCS. The GMFCS is considerably less time‐consuming and can be evaluated retrospectively. The handicap code requires more detailed information and is more useful for a comprehensive profile of the child.
Reduced visual resolution acuity and cerebral white matter damage in very‐low‐birthweight infants
Authors: SanGiovanni John Paul , Allred Elizabeth N , Mayer D Luisa , Stewart Jane E , Herrera M Guillermo , Leviton Alan
Published: July 2010

Neonatal cerebral white matter echolucencies predict visual resolution acuity deficits in very‐low‐birthweight (VLBW) infants. We examined maternal sociodemographic, lifestyle, intrapartum, infant birth/perinatal, and ocular motor/refractive characteristics to determine whether they accounted for this association in infants who were tested once between postnatal age 25 and 56 weeks (corrected for gestational age at birth). Cranial ultrasound scans were read by consensus to identify echolucency in a population of VLBW infants with no known ocular abnormalities. Visual resolution acuity was measured with the Acuity Card Procedure (ACP) in 14 infants with echolucency and compared with that of 81 VLBW infants born in the same hospitals with normal ultrasound scans. In time‐oriented logistic regression models, echolucency remained a consistent predictor of abnormal visual resolution acuity after adjustment for covariates in three developmental periods (pre‐, peri‐, and postnatal). Odds ratios ranged from 19.3 (95% confidence interval, 4.5 to 82.2;p=0.001) to 10.4 (95% confidence interval, 1.3 to 81.9; p=0.03). Reduced visual resolution acuity in VLBW infants appears to be due to cerebral white matter damage.
Work experience in adolescents with spinal cord injuries
Authors: Anderson Caroline J , Vogel Lawrence C
Published: July 2010

The purpose of this study is to compare the work experiences of adolescents with spinal cord injuries (SCI) to peers without disabilities. Twenty‐eight adolescents with SCI and 25 age‐matched individuals without disabilities (controls) took part in the study. A structured telephone questionnaire was used to assess their experience of household chores, volunteer jobs, and paid work. The mean age at interview was 16.2 years for those with SCI and 16.0 years for control participants. There was no significant difference between the individuals with SCI and the control participants in chores or volunteer work experiences, but the individuals with SCI were significantly less likely to have paid work experience than control participants (χ2= 13.670, p<0.001). Of the older adolescents, aged >15 to 19 years, five of 15 individuals with SCI and 16 of 16 control participants had paid work (Fisher exact test p<0.001). Of individuals with SCI, those with milder injuries and those injured at a younger age were more likely to have work experience.
Kinaesthetic judgements and refinement of striking action
Authors: Roberts Andrew B , Mon‐Williams Mark , Tresilian James R , Burgess‐Limerick Robin
Published: July 2010

Little is known about the developmental course of striking action. This cross‐sectional study explored the refinement of striking in 28 children aged between 4 and 12 years and investigated how well they could use kinaesthesis to gauge the length of an unseen bat. The kinematic data (including smoothness of movement) showed quantitative differences between the age groups. In contrast, no differences were found in the children's ability to judge the length of the unseen bat: within three strikes all of the children had made a clean hit, indicating that they had successfully judged bat length. The children then appeared to memorize the bat with which they had accurately hit the target and made: (1) minimal errors when using this bat in later trials and (2) predictable errors when using two other bats of different sizes. The results show that the striking action becomes optimized over childhood, with smoothness of movement providing an index of this refinement. The findings also suggest that young children have a higher level of kinaesthetic sensitivity than has been assumed previously on the basis of static limb positioning tasks. The results suggest that the striking task used in this study might be a useful tool for investigating the development of movement skills in children with developmental disorders.
Passive resistance of hamstring muscles in children with severe multiple disabilities?
Authors: Holt S , Baagøe S , Lillelund F , Magnusson S P
Published: July 2010

The purposes of this study were to evaluate whether resistance to stretch could be measured in a reproducible manner from day to day in children with severe multiple disabilities, and whether 6 weeks of daily activity, including one daily stretch, would modify passive resistance to stretch. Passive resistance to stretch was measured in six children using an established model that synchronously and continuously measured knee flexion moment (Nm) and EMG activity of the hamstring, while the velocity and angle of a static stretch was controlled. Resistance to stretch was evaluated in the absence of EMG activity. Measurements were taken on two separate occasions with a 2‐week hiatus, and before and after a 6‐week activity period which included a daily 1‐minute static stretch. There was no significant change in resistance to stretch when tested 2 weeks apart (test 1,8.6 ± 1.2Nm; test 2, 8.3 ± 1.2Nm,p>0.05) which yielded a strong correlation coefficient (Spearman r=1.0,p<0.01; Pearson r=0.953,p<0.01). Similarly, there was no difference in resistance to stretch before and after the 6‐week period (mean difference 0.22 ±0.75Nm, p<0.05). Data from this study demonstrate that resistance to stretch of the hamstring muscle group could be measured in a reproducible manner from day to day in children with multiple disabilities. Further, resistance to stretch was unchanged after 6 weeks of daily activity, including a daily 1‐minute static stretch.
Strength, power, and coactivation in children with developmental coordination disorder
Authors: Raynor Annette J
Published: July 2010

Strength, power, and coactivation levels were measured during knee extension and flexion tasks in 20 children (13 males, 7 females) with developmental coordination disorder (DCD) and 20 age‐matched control children (12 males, 8 females). Participants were classified according to results obtained on the McCarron Assessment of Neuromuscular Development, with each group including two age levels: 6 to 7 and 9 to 10 years. Tasks were performed on a Biodex dynamometer under isometric and isokinetic conditions with surface EMG recorded from the vastus lateralis and biceps femoris muscles. Significant effects of group and age were observed for the measures of peak torque (isometric and isokinetic) and power, with the decreased power in the group with DCD being more apparent at higher velocities. A lower flexor‐extensor percentage was recorded for the group with DCD but only under isokinetic conditions. From a neuromuscular perspective, the group with DCD had increased levels of coactivation (RMS agonist: RMS antagonist) during the isometric flexion and isokinetic extension actions. Possible causes of the strength and power deficits observed in children with DCD are discussed.
Autistic features in Cohen syndrome: a preliminary report
Authors: Howlin Patricia
Published: July 2010

Cohen syndrome is a rare, genetic, connective‐tissue disorder, with the genetic abnormality linked to chromosome 8q22. Its physical features (particular facial characteristics; body, limb, and visual abnormalities; height and weight problems) have been well documented but little is known about the psychological and behavioural development of individuals with the condition. Suggestion of a dual diagnosis of autism in a small minority of individuals led to a more detailed survey of parents belonging to the Cohen Syndrome Support Group, based in the UK. Thirty‐three individuals, 18 males and 15 females, aged from 2 to 45 years (mean age 15 years) were involved in the study. Over half of the participants (n=19) showed a pattern of impairments in social and communication skills, together with rigid and stereotyped behaviours or interests that seemed to meet DSM‐IV/ICD‐10 criteria for autism.‘Autistic‐type’problems were as common in females as in males. In almost all cases, parents had noted difficulties in their child before the child reached the age of 1 year. This study suffers from a number of methodological shortcomings including the fact that it was a postal survey, the sample size was small, and no standardized diagnostic or psychometric data were available. However, the incidence of social, communication, and behavioural problems would seem to warrant further research and a larger‐scale study is planned in association with an independent investigation of physical and genetic characteristics in the same group of individuals.
Topiramate‐induced metabolic acidosis: report of two cases
Authors: Ko Chun‐hung , Kong Chi‐keung
Published: July 2010

Two children who presented with symptomatic metabolic acidosis after being put on topiramate (TPM) are reported. The first patient was an 11‐year‐old male with refractory complex partial epilepsy who was put on TPM for 13 months. He developed hyperventilation 1 week after increasing the dose to 300mg/day. Arterial blood gas revealed hyperchloraemic metabolic acidosis with partial respiratory compensation: pH 7.36, PCO2 27.2 mmHg, bicarbonate 14.9 mEq/L, base excess ‐8.9 mmol/L. Hyperventilation and acidosis resolved after administration of sodium bicarbonate and reduction of the dose of TPM. The second patient was a female who developed increasing irritability at age 16 months and 21 months, each time associated with introduction of TPM and resolved promptly upon withdrawal of the drug. Venous blood gas taken during the second episode revealed pH 7.34, PCO2 37.4 mmHg, bicarbonate 20.4 mEq/L, base excess ‐4.2 mmol/L. The predominant mechanism of TPM‐induced hyperventilation involves inhibition of carbonic anhydrase at the proximal renal tubule, resulting in impaired proximal bicarbonate reabsorption. The occurrence of hyperpnoea or mental status change in any patient who is on TPM should prompt an urgent blood gas sampling, with correction of the acid‐base disturbances accordingly.
Is thrombophilia a factor in the development of hemiplegic cerebral palsy?
Authors: Smith Robert A , Skelton Martin , Howard Martin , Levene Malcolm
Published: July 2010

A population‐based study of children with hemiplegic cerebral palsy (CP) was performed to investigate whether thrombophilic tendencies are implicated in the aetiology of the condition. Thirty‐eight children (23 males, 15 females; mean age 8.7 years, SD 4.1 years) with hemiplegic CP were ascertained. Twenty‐seven children(18 males, nine females; mean age 8.4 years, SD 4.3) gave consent for inclusion. The non‐study group comprised five males and six females; mean age 9.4 years, SD 4.1. In six children, seven thrombophilic‘abnormalities’were identified. Five of these abnormalities were of an equivocal nature and probably did not represent true clinical thrombophilia; reasons for this interpretation are discussed. Contrary to other published non‐population‐based studies, we have not shown an association between thrombophilia and hemiplegic CP. More studies, including maternal studies, are required to explore this complex subject further.
Melatonin is useful for recording sleep EEGs: a prospective audit of outcome
Authors: Wassmer Evangeline , Carter Paul F B , RET Elaine Quinn , RET Novlette McLean , RET Gina Welsh , Seri Stefano , Whitehouse William P
Published: July 2010

The study aimed to determine if melatonin could reliably induce sleep in children undergoing sleep EEG without affecting the usefulness of the EEG itself. One hundred and sixty three children (112 males, 51 females; mean age 8 years, range 1 to 16 years) referred for sleep EEG were studied. The children were given 2 to 10 mg of melatonin, depending on age, just before EEG recording. Measurements included sleep‐onset latency, adverse effects, and acceptability of the EEG. Usefulness and acceptability of melatonin‐induced sleep EEG were compared with the standard technique of sleep EEG following sleep deprivation in 30 children (matched for sex and age). Sleep was obtained in 79% of the 163 children who received melatonin after an average of 33 minutes. Yield of epileptiform abnormalities demonstrated in the melatonin sleep EEG was similar to that reported in the literature for sleep‐deprived EEGs. There was no significant adverse effect. When compared, a melatonin‐induced sleep EEG was as useful as a sleep‐deprived EEG. However, the children's behaviour on the day of the melatonin‐induced sleep EEG recording was more acceptable to parents.
Autistic disorders in Down syndrome: background factors and clinical correlates
Authors: Rasmussen Peder , Börjesson Ola , Wentz Elisabet , Gillberg Christopher
Published: July 2010

A study of a clinic‐based sample of 25 individuals (12 females, 13 males; age at diagnosis 14.4 years, SD 7.4 years; age range 4 to 33 years) with Down syndrome (DS) and autism spectrum disorders, demonstrates that autism is by no means rare in DS. Results showed that there was a considerable delay in the diagnosis of autism as compared with children with autism who did not have DS. In 11 participants medical factors were identified that were likely to be of importance in contributing to the development of autism, and in four further participants there were factors of possible significance. Such factors include a history of autism or autism‐related disorders in first‐ or second‐degree relatives (n=5), infantile spasms (n=5), early hypothyroidism (n=3), evidence of brain injury after complicated heart surgery (n=2), or a combination of these factors. It is important that autism is recognised, identified, and fully assessed in individuals with DS in order for them to receive appropriate education and support.
Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening
Authors: Beals Rodney K
Published: July 2010

Results of surgery to correct fixed flexion contracture of the knee and improve voluntary knee extension in 39 knees in 20 children (11 females, 9 males; mean age 12 years 8 months, age range 5 to 20 years) with cerebral palsy were analyzed. All patients had neuromotor disease and 18 children had spastic diplegia or quadriplegia. All patients could initiate voluntary knee extension but lacked full passive extension. Five patients (10 knees) were free walkers with a mean motor severity index of 19 and mean fixed knee contracture of 20 degrees. Fifteen patients (29 knees) were not free walkers and 13 were wheelchair ambulators. They had a mean motor severity index of 8 and mean fixed knee contractures of 30 degrees. Surgical procedures included various combinations of hamstring lengthening and/or posterior capsulotomy to allow free passive knee extension, with or without quadriceps mechanism shortening, to enhance voluntary extension. The best results were in patients who had hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening.
Hip pain in 234 non‐ambulatory adolescents and young adults with cerebral palsy: a cross‐sectional multicentre study
Authors: Hodgkinson I , Jindrich M L , Duhaut P , Vadot J P , Metton G , Bérard C
Published: July 2010

In orthopaedic clinical practice hip pain is the main complaint of adults with cerebral palsy (CP). The aim of this descriptive study was to specify prevalence of hip pain and to propose methods of care other than surgery. The study was a cross sectional multicentre one based in the Rhône‐Alpes region. Patients over 15 years of age, with CP who were non‐ambulatory were included. Two hundred and thirty‐four patients were questioned. Mean age of the patients was 27 years 10 months, median 26 years 1 month, with 59.3% males and 40.7% females. Patients were questioned about pain with precise information about the circumstances of pain, tolerance, and treatment. Pain was judged to be intolerable if it prevented usual activities. Prevalence of hip pain was 47.2%. Pain was judged to be tolerable in 35.6% of the 234 patients, i.e. in 75.5% of patients with hip pain. There were three types of pain: provoked pain, pain linked to position, and spontaneous pain. Medical treatment was given to only 13.6% of patients with hip pain. The first treatment for hip pain is to avoid circumstances where pain occurs; medical treatment is reserved for when daily life cannot be adapted sufficiently to prevent pain. Medical treatment must be appropriate with doses of adequate strength before proposing surgery.
Abilities and attainment in Smith‐Magenis syndrome
Authors: Udwin Orlee , Horn Isobel
Published: July 2010

This study reports on cognitive abilities and attainment in 29 children and 21 adults with Smith‐Magenis syndrome. There were 13 boys and 16 girls aged 6 to 16 years, and nine men and 12 women aged 16 to 52 years. All had mild to severe learning disabilities* with no differences overall between verbal and performance skills, but with a particular profile of cognitive strengths and weaknesses. Levels of attainment and of adaptive behaviour were strikingly low, and the group of adults emerged as much more dependent on carers than might have been expected from their general level of intellectual functioning. Reasons for this discrepancy are explored in terms of the severe behavioural difficulties characteristic of the syndrome.
Vigabatrin
Authors: Lewis Hilary , Wallace Sheila J
Published: July 2010

The new antiepileptic drugs introduced over the last decade provide a welcome increase in the therapeutic options available for the 25% of children with epilepsy who remain refractory to traditional therapy.1 In the mid 1980s, vigabatrin (VGB) was the first of these to be made available in clinical practice. In 1997, the visual field deficits reported in association with VGB prompted a review of its place in the management of epilepsy. We provide an overview of the uses of VGB and a discussion of the difficulties which currently affect our clinical practice.
Factors influencing ambulation in myelomeningocele: a cross‐sectional study
Authors: Bartonek Åsa , Saraste Helena
Published: July 2010

A consecutive series of 53 children with myelomeningocele (mean age 7.6, range 3.2 to 11.4 years) was assessed in order to see if the children with motor paresis of the lower limbs achieved the expected level of ambulation, and if not, to identify possible causative factors. Methods used were clinical examination of orthopaedic and neurological status, information from medical reports, and documentation of orthoses use. Functional skills were documented and energy expenditure was examined. Thirty‐one of 53 children had reached the expected ambulation considered possible according to their motor paresis, whereas 22 of the 53 performed worse than expected. Balance disturbances, occurrence of spasticity in knee and hip joints, and number of shunt revisions made differed significantly between the groups that achieved and did not achieve expected ambulation. Functional skills of mobility differed significantly between two muscle‐function levels in children who had walking ability. Energy expenditure was higher in the non‐achieving group than in the group who achieved expected ambulation in each of the muscle‐function levels. Results show that children with similar muscle paresis exhibit different ambulatory function. This indicates the importance of a close analysis of other factors which may cause ambulation to deteriorate in order to predict future ambulation in children with myelomeningocele.
Compliance with home rehabilitation therapy by parents of children with disabilities in Jews and Bedouin in Israel
Authors: Galil Aharon , Carmel Sara , Lubetzky Hasi , Heiman Nurit
Published: July 2010

Among key points in making progress and succeeding with a therapeutic programme for children with disabilities is parental compliance with the regime for their child. The purpose of this study was to evaluate factors influencing compliance with home therapy in the Jewish and Bedouin populations. Data were collected by structured questionnaires. A total of 193 families participated (84% response rate) with children who ranged in age from 6 months to 6 years (mean age at first visit to the centre was 9.5 years in Jews and 16.1 years in Bedouin). Compliance was significantly lower among the Bedouin. Multivariate regression analysis showed that the strongest contributory factor in lack of compliance was being Bedouin. The second factor was intensity of questioning destiny, indicating that parents with these feelings may be less likely to comply with therapeutic regimes. Other factors which were associated with compliance were parents’education and socioeconomic status: lower levels on these dimensions corresponded with lower parental compliance. These results were illuminated by a trial intervention programme for Bedouin families which involved telephone contact, translation facilities, and detailed explanations during visits to the centre. Intervention increased the compliance rate of the Bedouin appointments with specialists to 76% (91 of 120 appointments) thereby reaching similar levels to those of the Jewish group. These preliminary results indicate that the strong association between non‐compliance and being Bedouin may be due to factors of communication, and that the Bedouin are receptive to therapeutic interventions when communicated in their own language.
Energy requirements of spasticity
Authors: Hemingway Cheryl , Freeman John M
Published: July 2010

Direct measurement of energy expended by spasticity in children with severe spastic quadriparesis is difficult. Insertion of an intrathecal baclofen pump in a 13‐year‐old boy with severe spasticity and profound mental retardation* resulted in an estimated 30 to 40% decrease in his spasticity. As he had been on a carefully calculated ketogenic diet and fed by gastrostomy, his precise caloric intake was known. Decrease in spasticity, on the same caloric intake, led to marked weight gain. Reduction of 100 calories intake resulted in new weight stability. It was possible therefore, to estimate indirectly energy used by his spasticity. This 100 calories, representing 34% of calories above his resting energy requirement, corresponded to an independently estimated 30 to 40% of caloric expenditure of his spasticity. It was concluded that when calculation of calories is critical, energy utilization by spasticity must be taken into consideration.
Differential development of infants at risk for psychopathology: the moderating role of early maternal responsivity
Authors: Laucht Manfred , Esser Günter , Schmidt Martin H
Published: July 2010

The development of behaviour problems in infants born with biological risk (low birthweight) and psychosocial risk (psychosocially disadvantaged family) was studied in a sample of 347 children (171 males, 176 females) at the ages of 2, 4:6, and 8 years. In the search for factors that moderate the effects of early risks, the role of early responsive caregiving was examined. Results indicate that infants at psychosocial risk exhibited both more externalizing and internalizing problems across ages than infants not at psychosocial risk, while no overall differences were apparent between normal‐and low‐birthweight groups. With one exception, no interactions between biological and psychosocial risk factors emerged, suggesting that their simultaneous effect is largely additive. Maternal responsivity was found to moderate the effects of low birthweight on hyperkinetic and internalizing problems as well as to influence the consequences of family disadvantage on total problems. These findings stress the importance of early parenting in the behavioural development of at‐risk children.
Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity
Authors: Booth Christine M , Cortina‐Borja Mario J F , Theologis Tim N
Published: July 2010

Muscle function often becomes progressively more compromised in children with spastic cerebral palsy, leading to reduced mobility. This study aimed to examine the role that muscle connective tissue plays in this process. Severity of spasticity as determined by a range of clinical measures was assessed in 26 children (14 males 12 females; age range 4 to 17 years) with either diplegic or quadriplegic cerebral palsy (CP). Muscle biopsies from the vastus laeralis muscle were obtained for biomedical and histological analysis during orthopaedic surgery as part of the child's ongoing care. Total collagen was quantified by hydroxyproline determination. Two clinical measures of severity, Modified Ashworth Scale and Balance, were shown to have a highly significant correlation with collagen content, and Ambulatory Status, Clonus, and Selective Muscle Control all showed positive trends. Collagen I accumulated in spastic muscle's endomysium which appeared to be thickened, and fibrotic regions with sparse muscle fibres were evident in more severe cases. This suggests that collagen may be involved in increases in muscle stiffness observed in spasticity. Once developed, these changes are essentially irreversible and we suggest that future treatments should consider including prevention of muscle fibrosis.
Visual and visuospatial development in young children with Williams syndrome
Authors: Atkinson Janette , Anker Shirley , Braddick Oliver , Nokes Louise , Mason Alexandra , Braddick Fleur
Published: July 2010

This study investigated the relation between sensory visual problems and the severity of visuospatial difficulties in a large group of young children with Williams’syndrome (WS). A questionnaire describing visual and associated problems was completed by the families of 108 children with WS and detailed follow‐up assessments were conducted, including visual, spatial, motor, visuocognitive, and linguistic tests of 73 of these children (mean age 7 years 3 months; 40 males, 73 females). Children with WS showed a much higher incidence of common paediatric sensory vision problems (strabismus, visual acuity loss, amblyopia, reduced stereopsis) than normally developing children. It was found that delays with respect to age normative values increased with age on all tests. No significant correlation was found between the presence of a visual deficit and the severity of the visuospatial problems, suggesting that the difficulties children with WS have in understanding spatial arrangements are not simply a result of their earlier sensory visual problems. Results confirm the dissociation between visuospatial and language abilities in children with WS, and support the neurobiological model of a split between ventral and dorsal stream processing of visual information with a generalized deficit in dorsal stream processing in young children with WS.
Health status of children with moderate to severe cerebral palsy
Authors: Liptak Gregory S , O'Donnell Maureen , Conaway Mark , Chumlea W Cameron , Worley Gordon , Henderson Richard C , Fung Ellen , Stallings Virginia A , Samson‐Fang Lisa , Calvert Randy , Rosenbaum Peter , Stevenson Richard D
Published: July 2010

The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition‐specific measures, and assessments of health care use. A multicenter population‐based cross‐sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n= 56), IV (n=55), and V (n=122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty‐nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health‐related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well‐being and should be used in combination to reflect children's overall health status.
Assessment of upper‐limb function and movement in children with cerebral palsy wearing lycra garments
Authors: Nicholson J H , Morton R E , Attfield S , Rennie D
Published: July 2010

It has recently been suggested that lycra garments are helpful for children with cerebral palsy (CP). Twelve children, with athetosis, ataxia, and spasticity, were fitted with lycra garments (Kendall‐Camp UK Ltd). Scores on the Paediatric Evaluation of Disability Inventory (PEDI) scales were determined before and after wearing the garment for at least 6 hours a day for 6 weeks. Five children with motor problems representative of the whole group were investigated during a reach‐and‐grasp task by kinematic motion analysis; reflective markers were used with and without the garment. Carers were given a questionnaire concerning the practicalities of using the garments. All 12 children made improvements in at least one of the functional scales of the PEDI, and scores for the whole group showed significant gains (Wilcoxon X2 test, self‐help p<0.01; mobility p<0.5; social p<0.1). These changes were usually slight, although noticed by carers. Six children made gains of at least one scale of the caregiver assistance scores, two of the children showed losses (due to difficulties removing the garment for toileting), and four showed no change. Motion analysis indicated that (1) two children with athetosis had improved proximal stability in sitting and in smoothness of arm movements, (2) one child with ataxia had improved in proximal and distal stability, and (3) two children with spasticity had more jerky movements, although one improved in proximal stability. All children had problems in wearing the garments, including problems with toileting and incontinence of urine; the parents of only one child wanted to continue using it. Results suggest that the functional benefit of lycra garments for children with CP is mainly due to improvements in proximal stability but this should be weighed against the inconvenience and loss of independence.
Clinical findings, consanguinity, and pedigrees in children with anophthalmos in southern India
Authors: Hornby Stella J , Dandona Lalit , Foster Allen , Jones R Barry , Gilbert Clare E
Published: July 2010

This study aimed to describe clinical findings, pedigrees, and possible environmental risk factors in children with clinical anophthalmos and remnant microphthalmos in either eye in southern India. Twenty‐four children (14 male, 10 female; mean age 10.3 years, age range 1.3 to 18 years,) were recruited from schools for the blind, hospitals, and community‐based rehabilitation programmes in Andhra Pradesh, India, over 1 year. Family members were examined, and mothers interviewed. Fifteen children had anophthalmos and nine had remnant microphthalmos in one or both eyes. Twelve children had associated systemic findings, of which six were major and six were minor abnormalities. Information on consanguinity was available in 19 children, 12 of whom had consanguineous parents. Five children had a positive family history. Two mothers had a history of night blindness, and one had a history of pesticide exposure during pregnancy. High rates of consanguinity suggest a genetic recessive aetiology.
Health‐related quality of life and functional outcome measures for children with cerebral palsy
Authors: Schneider Jane W , Gurucharri Linda M , Gutierrez Allison L , Gaebler‐Spira Deborah J
Published: July 2010

The aim of this study was to examine measures of health‐related quality of life (HRQL) in children with cerebral palsy (CP) by comparing scores of a generic HRQL measure, the Child Health Questionnaire (CHQ); a disease‐specific HRQL measure for children with CP, the Caregiver Questionnaire (CQ); and a pediatric functional measure, the Wee‐Functional Independence Measure (WeeFIM(r)). Participants included 30 caregivers of children with CP. The caregivers’children were a mean age of 8 years 6 months (17 females, 13 males). The ethnic origin of the children was 18 African‐American, 8 white, 3 Hispanic, and 1 Middle Eastern. Significant correlations were found between the CQ and WeeFIM total and subscale scores (r=0.388 to 0.641). There was no correlation between the CHQ and CQ total summary scores, but significant correlations were found between the CHQ subscales related to parent time and family cohesion and the CQ total and subscale scores (r=0.386 to 0.481). The lack of correlation between the CHQ and WeeFIM indicates HRQL and function are different constructs that cannot be inferred from each other. The fair relationship found between the CQ and WeeFIM suggests that the constructs measured in these two assessments overlap. The lack of correlation between the total summary scores of the CHQ and CQ suggests the CQ may be a more specific measure of HRQL for this population that reflects the impact of the child's condition on the caregiver.
Therapeutic electrical stimulation in cerebral palsy: a randomized, controlled, crossover trial
Authors: Sommerfelt K , Markestad T , Berg K
Published: July 2010

The aim of this study was to evaluate the effect of therapeutic electrical stimulation (TES) applied to antagonists of spastic leg muscles on gross motor function in children with spastic diplegic cerebral palsy. Twelve children between 5 and 12 years of age completed a 24‐month crossover study in which six were randomly assigned to receive TES for the first 12 months and the remaining six for the last 12 months. Physiotherapy and a home training program were not altered. All were evaluated blindly in terms of tests of motor function and video recordings at the start and at 12 and 24 months. At the end of the study parents/carers gave a subjective assessment of the effect of TES. No significant effect of TES on motor or ambulatory function was found on the blinded evaluation, but parents of 11 of the 12 children stated that TES had a significant effect. We conclude that it is unlikely that TES has a significant effect on motor and ambulatory function in spastic diplegia.
Neuropsychological profile of a 9‐year‐old child with subcortical band heterotopia or‘double cortex’
Authors: Jacobs Rani , Anderson Vicki , Simon Harvey A
Published: July 2010

Subcortical band heterotopia (SBH) or‘double cortex’, is a congenital brain abnormality that results from aberrant migration of neurons during development of the cortex. MRI shows a continuous band of heterotopic grey matter located between the cortex and ventricular walls, separated from them by a thin layer of white matter. The condition is quite rare, found predominantly in females, and is occasionally familial with an X‐linked dominant inheritance. Current research has focused on genetic and neurological correlates, with cognitive assessment restricted to a global measure of general intellectual functioning. This paper describes in detail the results of a neuropsychological assessment of a 9‐year‐old female recently diagnosed with SBH. Predominant features were a significantly reduced speed of processing for visuomotor and oral output and reduced immediate registration of information. This difficulty has functional implications affecting skill acquisition, learning in the classroom, and social interaction.
Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months
Authors: Bower E , Michell D , Burnett M , Campbell M J , McLellan D L
Published: July 2010

This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal‐setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 × 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six‐month treatment period there was a further six‐month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three‐month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim‐directed and goal‐directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal‐setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.
Feeding problems in Silver‐Russell syndrome
Authors: Blissett J , Harris G , Kirk J
Published: July 2010

In order to identify the prevalence and severity of feeding problems in children with Silver‐Russell syndrome(SRS) the feeding difficulties of 32 children with SRS and 32 age‐ and sex‐matched control children were assessed using the Feeding Assessment Questionnaire (Harris and Booth 1992). Children's ages ranged from 2 to 11 years, with 19 male and 13 female pairs. In a subset of matched pairs, parent‐child interaction at mealtimes was examined using video recording; food intake was also assessed over a 3‐day period using weighed food diaries. Children with SRS experienced significantly more feeding problems than children without growth disorders. Common feeding problems for children with SRS were poor appetite, fussiness, slow feeding, and problems associated with oral‐motor dysfunction. Feeding problems did not significantly affect intake of kilocalories, protein, fat, or carbohydrates. Mealtime interaction between children with SRS and their parents was significantly more negative than interactions between control‐group children and their parents. The focus of intervention packages in SRS should be to reduce negative parent‐child interactions and reduce parental anxiety about feeding, growth, and weight.
Brain injuries in early foetal life: consequences for brain development
Authors: Mancini J , Lethel V , Hugonenq C , Chabrol B
Published: July 2010

Learning disability and cerebral palsy are often related to factors present before birth. We report three patients (two with schizencephaly, one with unilateral cerebellar agenesis) in whom the timing of an insult to the foetus was known. In the first case, the mother had a trauma at 16 weeks of pregnancy and schizencephaly was discovered in the male infant associated with a left hemiplegia. In the second child, amniocentesis performed at 16 weeks into pregnancy may have been responsible for the same cortical anomaly. In the third case, sequential foetal echographies clearly demonstrated that an apparent unilateral cerebellar agenesis was related to an haemorrhagic event secondary to cerebellar trauma that occurred at 19 weeks of pregnancy. It is suggested that these brain malformations are related to an ischemic mechanism or a traumatic event in foetal life.
Longitudinal stability of visual evoked potentials in children and adolescents with hydrocephalus
Authors: Desch Larry W
Published: July 2010

There were two purposes for this study: to determine the within‐subject changes of visual evoked potentials (VEPs) over time, and to evaluate the usefulness of baseline VEP testing in the early diagnosis of increased intracranial pressure (ICP). Twenty children with hydrocephalus between the ages of 4 and 18 years (18 males, 2 females) were evaluated monthly for up to four months. Flash‐evoked VEP tests were done in a standardized manner using a Cadwell Quantum 84 evoked potential stimulation and recording instrument. One participant had abnormal VEPs found during a previous episode of shunt malfunction. For all of the other VEP tests, the latency of the N2 response was in the range of adult normal values. For 15 participants with multiple evaluations there were non‐significant differences in N2 latency from one session to the next. This study's results provide evidence that within‐subject VEP measurements in children with hydrocephalus appear to be relatively stable over limited periods. However, considerable differences were found when comparing VEPs between participants. Further research may provide additional evidence that periodic, routine VEP testing is an effective way to monitor individuals who have shunted hydrocephalus in order to detect increased ICP before the appearance of obvious symptoms.
Impact of the therapist‐child dyad on children's pain and coping during medical procedures
Authors: Miller A Cate , Johann‐Murphy Marjorie , Zhelezniak Victor
Published: July 2010

This study examined the effects of physical therapists' behaviors on the levels of distress and coping of 32 children (19 males, 11 females; age range 2.6 to 9.1 years) during a painful medical procedure. This is the second study to assess children throughout rehabilitation following selective posterior rhizotomy and the first to assess the impact of physical therapists’behaviors. Results of the Child‐Adult Medical Procedure Interaction Scale‐Revised confirmed the hypotheses that: (1) children exhibit more coping behaviors and fewer distress behaviors over time, and (2) positive relationships exist between coping‐promoting behaviors in physical therapists and coping in children, and distress‐promoting behaviors in physical therapists and distress in children. Prompts for children to use a coping strategy, reassuring comments, and non‐procedural talk by therapists explained 67% of the variance in children's coping. Criticism, reassurance, checking child's status, praise, and empathic statements by therapists explained 65% of the variance in children's distress. Older children and children with higher IQ scores exhibited more coping behaviors.
Abnormal developmental patterns of suck and swallow rhythms during feeding in preterm infants with bronchopulmonary dysplasia
Authors: Gewolb Ira H , Bosma James F , Taciak Vicki L , Vice Frank L
Published: July 2010

Infants with bronchopulmonary dysplasia (BPD) often have difficulty achieving coordinated suckle feeding. To analyze rhythmic differences during feeding in infants with BPD we performed weekly studies of 14 infants with BPD (eight male, six female; postmenstrual age [PMA] 32.1 to 39.7 weeks); and a PMA‐matched control group without BPD (n=20), from initiation of bottle feeding until discharge, with simultaneous digital recordings of pharyngeal and nipple (teat) pressure. Unlike the control group, there was no significant correlation between PMA and stability of suckle rhythm, aggregation of suckles or swallows into runs, or length of suckle runs. Comparing those infants >35 weeks' PMA, the group with BPD had significantly decreased stability of suckle rhythm (increased coefficient of variation of suckle‐suckle intervals: 0.34, SE 0.02 vs 0.254, SE 0.014; p=0.003), decreased aggregation into suckle runs (71.1, SE 3.4% vs 85.4, SE 2%;p=0.001), and decreased length of suckle runs (7.2, SE 0.9 vs 13.1, SE 1.9 suckles/run; p=0.003). Percentage of swallows in runs was also decreased in the cohort with BPD (58, SE 3.8% vs 77.2, SE 3.5%; p<0.001), as was length of swallow run (5.3, SE 0.5 vs 10.7, SE 1.1;p<0.001). Thus, in infants with BPD, anticipated maturational patterns of suckle and swallow rhythms did not occur. Delay in attainment of stable suckle and swallow rhythms in preterm infants, especially after 35 weeks' PMA, may predict subsequent feeding and neurological problems.
Functional MRI of visual cortex in sedated 18 month‐old infants with or without periventricular leukomalacia
Authors: Sie L T L , Rombouts S A R B , Valk J , Hart A A M , Scheltens Ph , van der Knaap M S
Published: July 2010

Functional MRI (fMRI) of the visual cortex was evaluated in 42 sedated 18‐month‐old infants (mean corrected age; 31 males, 11 females) with or without periventricular leukomalacia (PVL). Data from 14 infants could not be evaluated because of movement artefacts. Ten of the remaining 28 infants showed no significant fMRI response upon visual stimulation. In 18 infants, a significant signal change upon stimulation was found in the visual cortex: in 17 a signal decrease and in one a signal increase. Functional changes were located mainly in the anterior part of the visual cortex. Seven of the 28 infants had normal MRI and 21 showed variable occipital PVL. An fMRI response was equally frequent in infants without PVL (4 of 7 infants) and with PVL (14 of 21 infants). In conclusion, fMRI was shown to be feasible in sedated infants. No correlation was found between functional activation and the presence or absence of occipital PVL. Type of fMRI response (signal decrease) and localization (anterior part of the visual cortex) are different from those seen in adults, probably reflecting a combination of sedation effects and immaturity of the visual system. At present, fMRI is a highly promising research tool; its clinical relevance still has to be established.