Browsing by Subject "Cerebral palsy"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Barriers to Upper Extremity Reconstruction for Patients With Cerebral Palsy
    (Sage, 2022) Loewenstein, Scott N.; Angulo-Parker, Francisco; Timsina, Lava; Adkinson, Joshua; Surgery, School of Medicine
    Background: Reconstructive surgery for upper extremity manifestations of cerebral palsy (CP) has been demonstrated to be safe and effective, yet many potential candidates are never evaluated for surgery. The purpose of this study was to determine barriers to upper extremity reconstruction for patients with CP in a cohort of upper extremity surgeons and nonsurgeons. Methods: We sent a questionnaire to 4167 surgeons and nonsurgeon physicians, aggregated responses, and analyzed for differences in perceptions regarding surgical efficacy, patient candidacy for surgery, compliance with rehabilitation, remuneration, complexity of care, and physician comfort providing care. Results: Surgeons and nonsurgeons did not agree on the literature support of surgical efficacy (73% vs 35% agree or strongly agree, respectively). Both surgeons and nonsurgeons felt that many potential candidates exist, yet there was variability in their confidence in identifying them. Most surgeons (59%) and nonsurgeons (61%) felt comfortable performing surgery and directing the associated rehabilitation, respectively. Neither group reported that patient compliance, access to rehabilitation services, and available financial resources were a major barrier, but surgeons were more likely than nonsurgeons to feel that remuneration for services was inadequate (37% vs 13%). Both groups agreed that surgical treatments are complex and should be performed in the setting of a multidisciplinary team. Conclusions: Surgeons and nonsurgeons differ in their views regarding upper extremity reconstructive surgery for CP. Barriers to reconstruction may be addressed by performing higher level research, implementing multispecialty educational outreach, developing objective referral criteria, increasing surgical remuneration, improving access to trained upper extremity surgeons, and implementing multidisciplinary CP clinics.
  • Thumbnail Image
    Item
    Characteristics of extremely low birth weight infant survivors with unimpaired outcomes at 30 months of age
    (Springer Nature, 2013) Kumar, Praveen; Shankaran, Seetha; Ambalavanan, Namasivayam; Kendrick, Douglas E.; Pappas, Athina; Vohr, Betty R.; Poindexter, Brenda B.; Das, Abhik; Higgins, Rosemary D.; NICHD Neonatal Research Network; Pediatrics, School of Medicine
    Objective: To evaluate characteristics of unimpaired outcome in extremely low-birth-weight (ELBW) survivors. Study design: ELBW infants (n=714) with 30 months' assessments were analyzed. Logistic regression was used to develop a model for the binary outcome of unimpaired versus impaired outcome. Result: Thirty-three percent of infants had an unimpaired outcome. Seventeen percent of ELBW survivors had a Bayley II Mental Developmental Index score of ≥ 101 and 2% had a score of ≥ 116. Female gender, use of antenatal steroids (ANS), maternal education ≥ high school and the absence of major neonatal morbidities were independent predictors of unimpaired outcome. The likelihood of an unimpaired outcome in the presence of major neonatal morbidities was higher in infants exposed to ANS. Conclusion: The majority of unimpaired ELBW survivors had cognitive scores shifted toward the lower end of the normal distribution. Exposure to ANS was associated with higher likelihood of an unimpaired outcome in infants with major neonatal morbidities.
  • Thumbnail Image
    Item
    Hammersmith Infant Neurological Examination Subscores are Predictive of Cerebral Palsy
    (Elsevier, 2024) Kapil, Namarta; Majmudar-Sheth, Bittu; Johnson, Tara; Neurology, School of Medicine
    Background: The Hammersmith Infant Neurological Examination (HINE) is a standardized assessment that identifies early signs of cerebral palsy (CP). In practice, the clinician performs this assessment in its entirety, yielding a global score. This study aimed to investigate the individual HINE subscores and "asymmetries" as predictive indicators of CP. Methods: In this retrospective nested case-control study, a pediatric neurologist performed the HINE on a cohort of three- to four-month-old former neonatal intensive care unit infants. The infants' neurodevelopmental outcomes were determined by chart review when they were aged two to three years. We performed univariate and multivariable logistic regression analyses to yield the accuracy of the global HINE score, HINE subscores, and "asymmetries" in classifying infants with and without CP. Results: Of the 108 infants on whom HINE was performed, 50 were either discharged due to normal developmental progress or were lost to follow-up. Of the remaining 58 subjects, 17 had CP and 41 did not. Receiver operator characteristic (ROC) curves of univariate models yielded the following area under the curve (AUC) scores: global HINE score (AUC = 0.75), "reflexes and reactions" (AUC = 0.80), "cranial nerve function" (AUC = 0.76), "asymmetries" (AUC = 0.75), and "movements" (AUC = 0.71). The ROC for our multivariable model (AUC = 0.91) surpassed the global HINE score's predictive value for CP. Conclusions: The weighted combination of HINE subscores and "asymmetries" outperforms the global HINE score in predicting CP. These findings suggest the need for revisiting HINE, but further validation with a larger dataset is required.
  • Thumbnail Image
    Item
    The MR1/MAIT cell axis in CNS diseases
    (Elsevier, 2024) Shrinivasan, Rashmi; Wyatt-Johnson, Season K.; Brutkiewicz, Randy R.; Microbiology and Immunology, School of Medicine
    Mucosal-associated invariant T (MAIT) cells are a subpopulation of innate-like T cells that can be found throughout the body, predominantly in mucosal sites, the lungs and in the peripheral blood. MAIT cells recognize microbial-derived vitamin B (e.g., riboflavin) metabolite antigens that are presented by the major histocompatibility complex class I-like protein, MR1, found on a variety of cell types in the periphery and the CNS. Since their original discovery, MAIT cells have been studied predominantly in their roles in diseases in the periphery; however, it was not until the early 2000s that these cells were first examined for their contributions to disorders of the CNS, with the bulk of the work being done within the past few years. Currently, the MR1/MAIT cell axis has been investigated in only a few neurological diseases including, multiple sclerosis and experimental autoimmune encephalomyelitis, brain cancer/tumors, ischemia, cerebral palsy, general aging and, most recently, Alzheimer's disease. Each of these diseases demonstrates a role for this under-studied innate immune axis in its neuropathology. Together, they highlight the importance of studying the MR1/MAIT cell axis in CNS disorders. Here, we review the contributions of the MR1/MAIT cell axis in the progression or remission of these neurological diseases. This work has shed some light in terms of potentially exploiting the MR1/MAIT cell axis in novel therapeutic applications.
  • Thumbnail Image
    Item
    Trial of Erythropoietin for Hypoxic-Ischemic Encephalopathy in Newborns
    (Massachusetts Medical Society, 2022) Wu, Yvonne W.; Comstock, Bryan A.; Gonzalez, Fernando F.; Mayock, Dennis E.; Goodman, Amy M.; Maitre, Nathalie L.; Chang, Taeun; Van Meurs, Krisa P.; Lampland, Andrea L.; Bendel-Stenzel, Ellen; Mathur, Amit M.; Wu, Tai-Wei; Riley, David; Mietzsch, Ulrike; Chalak, Lina; Flibotte, John; Weitkamp, Joern-Hendrik; Ahmad, Kaashif A.; Yanowitz, Toby D.; Baserga, Mariana; Poindexter, Brenda B.; Rogers, Elizabeth E.; Lowe, Jean R.; Kuban, Karl C. K.; O'Shea, T. Michael; Wisnowski, Jessica L.; McKinstry, Robert C.; Bluml, Stefan; Bonifacio, Sonia; Benninger, Kristen L.; Rao, Rakesh; Smyser, Christopher D.; Sokol, Gregory M.; Merhar, Stephanie; Schreiber, Michael D.; Glass, Hannah C.; Heagerty, Patrick J.; Juul, Sandra E.; HEAL Consortium; Pediatrics, School of Medicine
    Background: Neonatal hypoxic-ischemic encephalopathy is an important cause of death as well as long-term disability in survivors. Erythropoietin has been hypothesized to have neuroprotective effects in infants with hypoxic-ischemic encephalopathy, but its effects on neurodevelopmental outcomes when given in conjunction with therapeutic hypothermia are unknown. Methods: In a multicenter, double-blind, randomized, placebo-controlled trial, we assigned 501 infants born at 36 weeks or more of gestation with moderate or severe hypoxic-ischemic encephalopathy to receive erythropoietin or placebo, in conjunction with standard therapeutic hypothermia. Erythropoietin (1000 U per kilogram of body weight) or saline placebo was administered intravenously within 26 hours after birth, as well as at 2, 3, 4, and 7 days of age. The primary outcome was death or neurodevelopmental impairment at 22 to 36 months of age. Neurodevelopmental impairment was defined as cerebral palsy, a Gross Motor Function Classification System level of at least 1 (on a scale of 0 [normal] to 5 [most impaired]), or a cognitive score of less than 90 (which corresponds to 0.67 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition. Results: Of 500 infants in the modified intention-to-treat analysis, 257 received erythropoietin and 243 received placebo. The incidence of death or neurodevelopmental impairment was 52.5% in the erythropoietin group and 49.5% in the placebo group (relative risk, 1.03; 95% confidence interval [CI], 0.86 to 1.24; P = 0.74). The mean number of serious adverse events per child was higher in the erythropoietin group than in the placebo group (0.86 vs. 0.67; relative risk, 1.26; 95% CI, 1.01 to 1.57). Conclusions: The administration of erythropoietin to newborns undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy did not result in a lower risk of death or neurodevelopmental impairment than placebo and was associated with a higher rate of serious adverse events.
  • Thumbnail Image
    Item
    Unveiling the Immediate Impact of Prechtl’s General Movement Assessment Training on Inter-Rater Reliability and Cerebral Palsy Prediction
    (MDPI, 2024-07-23) Kapil, Namarta; Majmudar-Sheth, Bittu; Escapita, Alexa Celeste; Johnson, Tara; Neurology, School of Medicine
    Prechtl's General Movement Assessment (GMA) is a qualitative video assessment that is an early predictor of cerebral palsy (CP) in infants. GMA raters undergo two levels of training: basic and advanced. Using a retrospective study design, we evaluated the impact of the GMA training level on three key measures: inter-rater reliability (IRR), predictability for a later CP diagnosis, and generalizability for both medically trained and non-medically trained raters. As part of a larger study on former level-IV neonatal intensive care unit (NICU) infants, participants had a GMA video at 3-4 months of corrected age with parental consent. Four GMA raters with basic training interpreted the videos. Subsequently, two raters underwent advanced training and reinterpreted the videos. We evaluated IRR with Gwet's AC1 coefficient, CP prediction with logistic regression, and generalizability with Gwet's Linearization method and McNemar's test. Following basic GMA training, all four raters had moderate to almost perfect agreement. The CP predictability of the raters' individual GMA scores ranged from 73% to 81%. Advanced GMA training significantly improved IRR and enhanced CP predictability. GMA rater proficiency was similar regardless of medical training. Advanced GMA training improved readers' capabilities to correctly identify abnormal movement patterns and aid in early CP diagnosis.