Changes in masticatory muscle activity in children with cerebral palsy

The objective of the study was to determine whether children with cerebral palsy (CP) have abnormal bilateral masseter and temporal muscle activation during mastication. The muscular activity of 32 children aged between 7 and 13 years was assessed during the task of non-habitual mastication by means of surface electromyograms. During non-habitual mastication, the amplitude of all assessed muscles in the inactive period and the amplitude of the Right Masseter and Left Temporal muscles in the active period of children with CP was greater (p < 0.05) in relation to the group of children with Typical Development (TD). Considering each muscle individually, only the duration of the active period of Right Masseter and Right Temporal muscles in children with CP was lower (p < 0.05) than in the TD children. Considering the four analyzed muscles, the duration of time of general active period, when at least one muscle should be activated, was higher in children with CP (p < 0.05) than in children with TD showing greater time variation in inactivation (p < 0.05). The higher muscle activity during the phases of the masticatory cycle, with longer duration of the active period and with greater variability between the muscles to inhibit this activity show greater difficulty in coordinating the muscles of mastication in children with CP compared to children with TD.     

Ocular defects in children with cerebral palsy.

Children with cerebral palsy have a high incidence of ocular abnormalities. All such children should be examined by an ophthalmologist soon after cerebral palsy is diagnosed.     

Life expectancy in children with cerebral palsy.

OBJECTIVE--To determine life expectancy of children with cerebral palsy. DESIGN--Cohort analysis, by means of register compiled from multiple sources of ascertainment, of all children with cerebral palsy born during 1966-84 to mothers resident in Mersey region. Status of children was determined by flagging through NHS central register. SUBJECTS--1258 subjects with idiopathic cerebral palsy, of whom 1251 were traced and included in analysis. MAIN OUTCOME MEASURES--Effect of functional ability (ambulation, manual dexterity, and mental ability), sex, birth weight, and gestational age on survival. RESULTS--20 year survival for whole cohort was 89.3% for females and 86.9% for males. For subjects with no severe functional disabilities 20 year survival was 99% (95% confidence interval 98% to 100%), while subjects severely disabled in all three functional groups had 20 year survival of 50% (42% to 58%). Subjects with birth weight < or = 2500 g had 20 year survival of 92% (89% to 95%), while those with birth weight > 2500 g had survival of 87% (84% to 89%). Subjects with gestational age of > 37 weeks had 20 year survival of 93% (91% to 96%), while those with gestational age > or = 37 weeks had survival of 85% (83% to 88%). Birth weight and gestational age were less predictive of survival than functional disability. Best statistical model used gestational age and number of severe functional disabilities as predictors. CONCLUSIONS--Life expectancy of this cohort of children with cerebral palsy was greater than has been suggested in some previous studies. This has important implications for social, educational, and health services.     

Effect of locomotor training and functional electrical stimulation on postural function in children with severe cerebral palsy

Cerebral palsy (CP) considerably impairs the ability to maintain upright stance. The effects of locomotor training and functional electrical stimulation (FES) on postural control were determined in 27 children aged 6–12 years with severe CP. The severity level of the clinical manifestations of CP was classified as 3 according to the Gross Motor Function Classification System (GMFCS). All patients participated in 15 30-min mechanical therapy sessions using robot-assisted passive stepping. In 12 out of 27 children, the locomotion therapy was accompanied by FES. Stabilometry and plantography tests were performed in 23 healthy age-matched children. Postural control in children with CP differed from the stabilograms of healthy children in a forward shift of the center of pressure (COP) projection; higher values of the COP trajectory area and length, the mean amplitude of the COP oscillations, and the absence of COP response to the eyes closed condition. After treatment, the posturographic characteristics tended to normalize in relation to the values obtained in neurologically intact children. The improvement was observed in 43% of children without FES and in 75% of children in the group with FES. Analysis of plantograms revealed normalization of footprints in children who received FES. Thus, it was demonstrated that FES combined with locomotor training resulted in the improvement in vertical posture control in children with severe CP.     

Antioxidant enzymes and lipid peroxides in children with cerebral palsy

Impaired antioxidant mechanisms are unable to inactivate free radicals that may induce a number of pathophysiological processes and result in cell injury. Thus, any abnormality in antioxidant defense systems could affect neurodevelopmental processes and could have an important role in the etiology of cerebral palsy (CP). The plasma levels of lipid peroxidation as plasma levels of malondialdehyde (MDA), activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR) in plasma and erythrocytes were investigated in 34 CP children and compared with 61 normal controls. SOD, GPx and GR activities were spectrophotometrically assayed. Activities of SOD, GPx and GR in plasma did not differ significantly between CP children and the control group. Activities of erythrocyte GR in the CP patients were significantly lower compared with controls. MDA concentration did not differ statistically between the CP children and healthy subjects. In conclusion our results suggest that increased activities of erythrocyte GPx and decreased erythrocyte GR activities might be due to lesser physical activity of children with CP.     

Dental health and dental care in children with cerebral palsy

The aim of this study was to determine a difference between children with cerebral palsy (CP) and healthy children, regarding health condition of teeth and oral tissuses. Disfunction of masticatory system, in children with CP, causes many problems with mastication. Nonfunctional mastication is related with the consumption of mushy food and decreased selfcleaning of occlusal and aproximal surfaces. All that leads to higher incidence of dental caries. Comparing the DMTF/dft (decayed, missing, filled tooth) index, it is evident that there is no statistically significant difference in a tooth morbidity between the group of healthy children and group of children with CP. The healthy children have statistically significant more teeth with fillings with respect to children with CP. Extractions are more common in children with CP. There is no statistically significant difference between those two groups regarding decayed teeth, one of components of DMFT index. Decayed components are more common than the extractions and fillings in both groups, which shows the insufficient curative care for all children in both groups. It can be concluded that there is a certain need of early beginning and a better organization of the preventive pediatric and dental care, in order to decrease the appearence of dental decay and increase the level of dental health, in this challenged population.     

Individualized,home-based interactive training of cerebral palsy children delivered through the Internet

Background  

The available health resources limit the amount of therapy that may be offered to children with cerebral palsy and the amount of training in each session may be insufficient to drive the neuroplastic changes, which are necessary for functional improvements to take place. The aim of this pilot study was to provide proof of concept that individualized and supervised interactive home-based training delivered through the internet may provide an efficient way of maintaining intensive training of children with cerebral palsy over prolonged periods.     

脑瘫伴癫痫儿童肠道菌群变化

目的 探讨脑瘫伴癫痫儿童肠道菌群的变化。方法 选择龙岗区社会福利中心诊断为脑瘫伴癫痫的31例患儿作为疾病组;另外选取同龄健康儿童30例作为健康组。留取受试者的粪便标本,提取总DNA,并对16S rRNA基因的V3‒V4可变区进行扩增,并在Illumina MiSeq平台进行高通量测序。结果 与健康儿童相比,疾病组儿童肠道内微生物多样性出现明显差异。在门水平优势菌群中,疾病组儿童放线菌的相对丰度明显高于健康组（32.87% vs 3.56%）,而拟杆菌的相对丰度明显低于健康组（22.66% vs 53.59%）。在属水平优势菌群中,疾病组儿童双歧杆菌属、副拟杆菌属的相对丰度均明显高于健康组（26.94% vs 2.61%,5.72% vs 1.90%）,其中肠杆菌属的相对丰度达6.00%,而拟杆菌属、粪杆菌属的相对丰度明显低于健康组（11.38% vs 45.16%,0.63% vs 12.78%）,普雷沃菌属的相对丰度也低于健康组（3.11% vs 5.30%）。结论 与同龄健康儿童相比,脑瘫伴癫痫儿童肠道菌群改变明显,菌群门水平和属水平均有明显差异。     

Altered sense of Agency in children with spastic cerebral palsy

Background  

Children diagnosed with spastic Cerebral Palsy (CP) often show perceptual and cognitive problems, which may contribute to their functional deficit. Here we investigated if altered ability to determine whether an observed movement is performed by themselves (sense of agency) contributes to the motor deficit in children with CP.     

Frontal EMG-biofeedback training of athetoid cerebral palsy patients

Six athetoid cerebral palsy patients participated in the following: speech and motor prebiofeedback training evaluation; frontal EMG biofeedback training, 6 wk; speech and motor postbiofeedback training evaluation, Frontal pretraining levels for the subjects averaged 28.9 µV p-p. Subjects' feedback consisted of an auditory signal(clicks) varying proportionately with frontal EMG activity. A visual meter display of the integrated EMG was also provided. Self-regulation of frontal EMG was evident for all subjects within session 1. Throughout all sessions, EMG levels of 2–4 µV were often attained. Trend analysis of EMG acquisition curves showed significant reduction in frontal tension across sessions for all but one subject. Frontal posttraining levels averaged 13.0 µV p-p. Parents or subjects, or both, reported subtle improvements in various speech and motor functions, a finding confirmed by objective postbiofeedback training evaluation. Only the 2 most severely impaired subjects, JA and DS, failed to improve significantly on the speech measures. All subjects improved significantly on those measures that tapped fine and gross motor skills. Collectively, these results indicate that EMG biofeedback training shows promise as an additional treatment modality in the habilitation of cerebral palsy patients.     

Mechanobiological prediction of proximal femoral deformities in children with cerebral palsy

Children with cerebral palsy (CP) walk with altered gait and frequently exhibit proximal femoral deformities, such as anteversion and coxa valga. The objective of this research was to investigate the effect of specific gait patterns on the femoral morphology in CP.

In this study, the mechanobiological principles were implemented on a 3D finite element (FE) model of the proximal femur in order to predict changes in morphology over time in healthy and CP children. This model relies on the assumption that cyclic octahedral shear stress promotes growth and cyclic hydrostatic compressive stress inhibits growth. Growth was simulated over 16 iterations, representing approximately 5 months of growth.

The FE model predicts an increase in the femoral anteversion and coxa valga for CP loading conditions when compared with healthy ones. Understanding the role of loading in skeletal morphogenesis may help prevent bone deformities and improve function in children with gait abnormalities.     

Serum trace element and amino acid profile in children with cerebral palsy

BackgroundThe existing data demonstrate that both trace elements and amino acids play a significant role in neurodevelopment and brain functioning. Certain studies have demonstrated alteration of micronutrient status in children with cerebral palsy, although multiple inconsistencies exist.The objectiveof the present study was to assess serum trace element and mineral, as well as amino acid levels in children with cerebral palsy.Methods71 children with cerebral palsy (39 boys and 32 girls, 5.7 ± 2.3 y.o.) and 84 healthy children (51 boys and 33 girls, 5.4 ± 2.3 y.o.) were enrolled in the present study. Serum trace element and mineral levels were assessed using inductively-coupled plasma mass-spectrometry (ICP-MS). Amino acid profile was evaluated by means of high-pressure liquid chromatography (HPLC).ResultsChildren with cerebral palsy are characterized by significantly lower Cu and Zn levels by 6% and 8%, whereas serum I concentration exceeded the control values by 7%. A tendency to increased serum Mn and Se levels was also observed in patients with cerebral palsy. Serum citrulline, leucine, tyrosine, and valine levels were 15 %, 23 %, 15 %, and 11 % lower than those in healthy controls. Nearly twofold lower levels of serum proline were accompanied by a 44 % elevation of hydroxyproline concentrations when compared to the control values. In multiple regression model serum I, Zn, and hydroxyproline levels were found to be independently associated with the presence of cerebral palsy. Correlation analysis demonstrated a significant correlation between Cu, Mn, Se, I, and Zn levels with hydroxyproline and citrulline concentrations.ConclusionThe observed alterations in trace element and amino acid metabolism may contribute to neurological deterioration in cerebral palsy. However, the cross-sectional design of the study does not allow to estimate the causal trilateral relationships between cerebral palsy, altered trace element, and amino acid metabolism.