Browsing by Subject "cerebral palsy"

Now showing 1 - 4 of 4
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    The Association of Cerebral Palsy with Other Disability in Children with Perinatal Arterial Ischemic Stroke
    (2007-10) Golomb, Meredith R.; Saha, Chandan; Garg, Bhuwan P; Azzouz, Faouzi; Williams, Linda S.
    The association of cerebral palsy with other disabilities in children with perinatal stroke has not been well-studied. We examined this association in 111 children with perinatal stroke: 67 with neonatal presentation, and 44 with delayed presentation. Seventy-six children (68%) had cerebral palsy, which was hemiplegic in 66 and tri- or quadriplegic in 10. Fifty-five (72%) children with cerebral palsy had at least one other disability: 45 (59%) had a cognitive/speech impairment (moderate-severe in 20), and 36 (47%) had epilepsy (moderate-severe in 11). In children with neonatal presentation, cerebral palsy was associated with epilepsy (P = 0.0076) and cognitive impairment (P = 0.0001). These associations could not be tested in children with delayed presentation because almost all children in this group had cerebral palsy. In another analysis with multivariate logistic regression for children with cerebral palsy, children who had both neonatal presentation and history of cesarean-section delivery were more likely to have epilepsy (P = 0.001). Children with cerebral palsy after perinatal stroke who had neonatal presentation were more likely to have severe cognitive impairment (odds ratio, 7.78; 95% confidence interval, 1.80-47.32) or severe epilepsy (odds ratio, 6.64; 95% confidence interval, 1.21-69.21) than children with delayed presentation. Children with cerebral palsy after perinatal stroke are likely to have an additional disability; those with neonatal presentation are more likely to have a severe disability.
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    The Impact of Variable Dosage Using Robotic-assisted Task-Specific Upper Extremity Training in Children with Cerebral Palsy
    (Office of the Vice Chancellor for Research, 2014-04-11) Mathews, Courtney D; Schwipps, Alicia R; Cardinal, Ryan E; Altenburger, Peter A
    Background: Cerebral Palsy (CP) and other acquired neurological disorders result from brain lesions that alter motor function in children. The impact of these deficits can impair a child’s ability to use their upper extremity (UE) for normal daily activities such as eating and playing. Robotic-assisted therapy has been shown to improve motor function in children with CP. Training parameters such as intensity and frequency were initially based on findings from studies measuring change in adults following stroke. Based on this, high intensity (960 repetitions per session) and increased frequency (2 times per week, 9 weeks) were initially implemented for children. Early findings demonstrated improvement in UE function for children with CP; however, training sessions were long, making them difficult to complete given the shorter attention span of the pediatric population. Determining the potential impact of a shorter, more optimal, dosage of robotic-assisted therapy for children would facilitate rehab training efficiency and maximize cost effectiveness. Purpose: The purpose of this study was to identify the impact on motor impairments and movement capacity with variances in treatment intensity (number of repetitions per session) while holding constant the frequency of the application (2 times per week, 9 weeks) for robotic-assisted UE training for children with CP. Methods: Six children between the ages of 6 and 8 were analyzed from two separate studies evaluating the effectiveness of robotic-assisted training for UE functional improvement. The first study featured training at high intensity and frequency while the second study used lower intensity parameters but the same frequency. To be eligible for either study, children were required to have UE hemiplegia and the ability to participate in a task for up to 60 minutes. Twice weekly, each child participated in robotic training sessions consisting of either 960, 640, or 320 task-specific reaching movements of the affected UE. Each child completed a total of 16 robotic training sessions over a 9-week period as well as one pre- and one post-test session. Outcome measures included active range of motion (AROM), strength testing and tone using the Modified Ashworth Scale (MAS). The children’s motor capacity was evaluated using the adaptive Fugl-Meyer scale (FM). Results: Percent change scores were calculated for each participant for each outcome measurement. AROM results for the shoulder resulted in an average increase of 10.6% for flexion and a 13.3% increase for abduction in both the 320 and 640 groups. Shoulder external rotation increased by an average of 13.6% for all three groups. Arm strength increased an average of 12.3% for all three groups. The MAS had an average decrease in tone of 23.8% across all 3 groups. Scores on the FM increased an average of 23% with in-depth analysis revealing shoulder movement to be the primary area for motor capacity change at 96%. Conclusion: These findings indicate that lower intensities of robotic-assisted therapy (320 and 640 repetitions) were as effective as the larger dose originally prescribed for children with CP. Outcome measures improved in all 3 groups and did not vary between dosing groups. This suggests that longer intensity sessions of robotic-assisted therapies may not be necessary to produce AROM, strength, and motor capacity changes. Further trials with more subjects are needed to validate these results.
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    Pediatric Cerebral Palsy and Activities of Daily Living: Rapid Systematic Review
    (202-04-28) Farnlacher, Danielle F.; Lentz, Jordan L.; Ortega Monge, Diana O.; Nycz, Kimberly N.; Parker, Kirsten P.; Pence, Grace P.; Chase, Anthony C.; Petrenchik, Terry P.; Ralston, Rick R.; Department of Occupational Therapy, School of Health and Human Sciences
    Cerebral palsy (CP) is a common motor disability seen in children who often receive occupational therapy (OT) services. Because of this, there is an increased need for research on new clinical, group, and home-based OT interventions. OT practitioners play a critical role in providing developmental interventions to improve upper extremity function, balance, and motor processing for activities of daily living (ADLs), including self-care tasks and functional mobility. In order to assist OTs in making informed decisions regarding developmental interventions to improve performance, participation, and independence in ADLs for children aged zero to eighteen with CP, a rapid systematic review (RSR) was completed and includes the best available evidence within the reviewed literature. The findings of this review support functional training, education, technology, and supplemental modalities as interventions to improve performance in ADLs of children with CP. Overall, this review works to provide leading evidence supporting the use of various interventions in OT sessions.
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    Safety and efficacy of a propofol and ketamine based procedural sedation protocol in children with cerebral palsy undergoing botulinum toxin A injections.
    (Wiley, 2019) Louer, Ryan; McKinney, Renee C.; Abu-Sultaneh, Samer; Lutfi, Riad; Abulebda, Kamal; Pediatrics, School of Medicine
    Background Pediatric patients with cerebral palsy (CP) often undergo intramuscular botulinum toxin (BoNT‐A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Objective To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT‐A injections. Design This is a retrospective chart review of children with CP undergoing propofol and ketamine based sedation for injections with botulinum toxin A. Setting The sedations took place in a procedural sedation suite at a tertiary children’s hospital from Feb 2013 through Sept 2017. Patients 164 patients with diagnoses of cerebral palsy were included in this study. Methods An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT‐A injections. Main Outcome Measurements Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed. Results 345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (IQR 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events. Conclusion Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT‐A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients.