Cerebral Palsy Research – August 23, 2012

The Cerebral Palsy Alliance has compiled the attached list of the latest cerebral palsy research articles, as indexed in the NCBI PubMed (Medline) and Entrez (GenBank) databases for the week ending 26, August 2012

1. Am J Phys Med Rehabil. 2012 Sep;91(9):747-60.

The effect of treadmill training on gross motor function and walking speed in ambulatory adolescents with

cerebral palsy: a randomized controlled trial.

Chrysagis N, Skordilis EK, Stavrou N, Grammatopoulou E, Koutsouki D.

From the Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Department of Physical

Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece.

OBJECTIVE: The aim of this study was to evaluate the effect of a treadmill program on gross motor function,

walking speed, and spasticity of ambulatory adolescents with spastic cerebral palsy (diplegia and tetraplegia).

DESIGN: In this randomized controlled trial, 22 adolescents (13-19 yrs old) from a special school for children with

physical disabilities were randomly allocated to the experimental and control training groups. The experimental

training group underwent a treadmill program without body weight support at a comfortable speed. The control

group received treatment with conventional physiotherapy, which consisted of three sets of exercises with mat

activities, balance, gait training, and functional gross motor activities. The program lasted 12 wks with a frequency

of three times per week for both groups. Pretest and posttest measurements of self-selected walking speed, gross

motor function, and spasticity were conducted. RESULTS: The analysis of covariance findings examining posttest

differences between groups were significant with respect to self-selected walking speed (F = 8.545, P = 0.000) and

gross motor function (F = 9.088, P = 0.007), whereas no significance was found for spasticity. CONCLUSIONS:

Treadmill training may improve the walking speed and gross motor function of adolescents with spastic cerebral

palsy, without adverse effects on spasticity.

PMID: 22902937 [PubMed - in process]

2. Am J Physiol Endocrinol Metab. 2012 Aug 21. [Epub ahead of print]

Secondary Muscle Pathology and Metabolic Dysregulation in Adults with Cerebral Palsy.

Peterson MD, Hurvitz EA, Burant CF.

University of Michigan.

Monday 27 August 2012

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Professor Nadia Badawi

Macquarie Group Foundation Chair of Cerebral Palsy

PO Box 560, Darlinghurst, New South Wales 2010 Australia

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Cerebral palsy (CP) is caused by an insult to, or malformation of the developing brain which affects motor control

centers, and causes alterations in growth, development, and overall health throughout the lifespan. In addition to

the disruption in development caused by the primary neurologic insult, CP is associated with exaggerated

sedentary behaviors and a hallmark accelerated progression of muscle pathology compared to typically developing

children and adults. Factors such as excess adipose tissue deposition and altered partitioning, insulin resistance,

and chronic inflammation may increase the severity of muscle pathology throughout adulthood, and lead to

cardiometabolic disease risk and/or early mortality. We describe a model of exaggerated health risk represented in

adults with CP, and discuss the mechanisms and secondary consequences associated with chronic sedentary

behavior, obesity, aging, and muscle spasticity. Moreover, we highlight novel evidence that implicates aberrant

inflammation in CP as a potential mechanism linking both metabolic and cognitive dysregulation in a cyclical


PMID: 22912367 [PubMed - as supplied by publisher]

3. Disabil Rehabil. 2012 Aug 20. [Epub ahead of print]

Investigation of quality of life in mothers of children with cerebral palsy in Iran: association with socioeconomic

status,marital satisfaction and fatigue.

Mahani MK, Rostami HR, Amirsalari S, Karimloo M.

Occupational Therapy Department, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University

of Medical Sciences , Ahvaz , Iran.

Purpose: This study aimed to compare the quality of life (QOL) of Mothers of Children with Cerebral Palsy (MCCPs)

with mothers of Typically Developing (TD) children as a Control Group (CG). The association of the mediating

variables including socio-economic status (SES), marital satisfaction and fatigue with maternal QOL was also

evaluated. Method: The MCCPs group consisted of 120 mothers (mean age: 30.3?±?5.5 years) of children with CP.

The CG included 100 mothers (mean age: 29.9?±?4.5 years) of TD children. Demographic characteristics of the

participants were recorded and the data was collected by World Health Organization Quality of Life-BREF

(WHOQOL-BREF), SES Questionnaire, Index of Marital Satisfaction (IMS) and Fatigue Severity Scale-Persian

(FSS-P). Data analysis was done by SPSS version 16.0. Results: The QOL and SES were lower, while FSS-P and

IMS were higher in MCCPs group than CG (p < 0.001). The SES, IMS and FSS-P associated with all domains of

QOL in MCCPs group, while they did just with some domains of QOL in CG (p < 0.05). Conclusions: The lower

QOL in MCCPs group is supposed to be mediated by the SES, marital satisfaction and fatigue so, maternal

empowerment in terms of these mediators and family-centered approach are recommended. [Box: see text].

PMID: 22900516 [PubMed - as supplied by publisher]

4. Int J Pediatr. 2012;2012:387280. Epub 2012 Aug 7.

Play and be happy? Leisure participation and quality of life in school-aged children with cerebral palsy.

Shikako-Thomas K, Dahan-Oliel N, Shevell M, Law M, Birnbaum R, Rosenbaum P, Poulin C, Majnemer A.

School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.

The objective of this study was to examine the association between leisure participation and quality of life (QoL) in

school-age children with cerebral palsy (CP). Leisure participation was assessed using the Children’s Assessment

of Participation and Enjoyment (CAPE) and QoL using the Pediatric Quality of Life Inventory (PedsQL). Pearson

correlation coefficients were calculated to examine the association between CAPE and PedsQL scores, and a

multiple linear regression model was used to estimate QoL predictors. Sixty-three children (mean age 9.7 ± 2.1

years; 39 male) in GMFCS levels I-V were included. Intensity of participation in active-physical activities was

significantly correlated with both physical (r = 0.34, P = 0.007) and psychosocial well-being (r = 0.31, P = 0.01).

Intensity and diversity of participation in skill-based activities were negatively correlated with physical well-being (r =

-0.39, P = 0.001, and r = -0.41, P = 0.001, resp.). Diversity and intensity of participation accounted for 32% (P =

Cerebral Palsy Research News ~ Monday 27 August 2012

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0.002) of the variance for physical well-being and 48% (P < 0.001) when age and gross motor functioning were

added. Meaningful and adapted leisure activities appropriate to the child’s skills and preferences may foster QoL.

PMID: 22919403 [PubMed]

5. J Pain Symptom Manage. 2012 Aug 20. [Epub ahead of print]

Cross-Cultural Translation and Adaptation to Brazilian Portuguese Version of the Paediatric Pain Profile in

Children With Severe Cerebral Palsy.

Pasin S, Avila F, de Cavatá T, Hunt A, Heldt E.

Post Graduate Program in Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de

Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

CONTEXT: Pain is a prevalent symptom in children with severe cerebral palsy (CSCP), mainly as a result of the

progression of muscle contractures, bone deformities, gastroesophageal reflux, and recurrent infections.

Considering the lack of verbal communication in this population, both pain diagnosis and assessment of the

analgesic treatment are often neglected. Although the Paediatric Pain Profile (PPP), an instrument with 20 items, is

used to assess behavior indicative of pain in CSCP, it is not validated in Brazil. OBJECTIVES: To translate, adapt,

and evaluate the psychometric properties of PPP to Brazilian Portuguese. METHODS: The study was carried out at

a philanthropic institution for CSCP and a university hospital. The sample of CSCP unable to communicate through

speech or any device, their respective parents or primary caregivers, and health professionals were included. First,

the instrument was translated and then back translated, and its clarity was evaluated by parents, primary

caregivers, and professionals. The psychometric properties of the final version were evaluated for internal

consistency (Cronbach’s a) and stability (test-retest). RESULTS: Forty-five children with a mean (SD) chronological

age of 16 (8.69) years, 26 of whom were male, were included in the study. A total of 150 applications of PPP were

carried out: 30 to assess clarity and 120 to assess the psychometric properties. Each item of the translated version

showed a median between 3.00 and 4.00, considered to be clear and very clear, respectively. The internal

consistency of the items was a=0.864, with no significant difference between test and retest (P=0.271).

CONCLUSION: The adapted version of PPP in Brazilian Portuguese demonstrated good internal consistency

(similar to the original instrument) and stability over time, decisive for the next step of clinical validation for CSCP.

Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

PMID: 22917714 [PubMed - as supplied by publisher]

6. Nurs Womens Health. 2012 Feb;16(1):36-44. doi: 10.1111/j.1751-486X.2012.01698.x.

Postpartum care of a woman with cerebral palsy and deep vein thrombosis: a case study.

Phillips C, Bulmer J.

Pregnancy can be challenging for women with cerebral palsy. Physical limitations and comorbidities can predispose

them to complications during pregnancy, such as deep vein thrombosis and pulmonary embolism, making their care

needs more complex. A multidisciplinary care plan, as well as clear and effective communication among different

health care providers, will help ensure safe and optimal postpartum care of women with cerebral palsy and their


© 2012 AWHONN.

PMID: 22900725 [PubMed - in process]

Cerebral Palsy Research News ~ Monday 27 August 2012

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6. Childs Nerv Syst. 2012 Aug 23. [Epub ahead of print]

Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm


Klebermass-Schrehof K, Czaba C, Olischar M, Fuiko R, Waldhoer T, Rona Z, Pollak A, Weninger M.

Division of Neonatology; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna,

Waehringer Guertel 18-20, 1090, Vienna, Austria, katrin.klebermass-schrehof@meduniwien.ac.at.

PURPOSE: Despite a decreasing incidence, intraventricular hemorrhage (IVH) remains a point of major concern in

neonatology due to its association to adverse neurodevelopmental outcome (NDO). Aim of this study was to

compare outcome of preterm infants with different grades of IVH born below 32 weeks of gestational age (GA) with

outcome of controls without IVH and to especially evaluate the influence of low grade IVH on NDO. METHODS:

Four hundred seventy-one preterm infants with a GA below 32 weeks were admitted to our neonatal intensive care

unit between 1994 and 2005 and included into analysis. RESULTS: IVH patients showed significantly lower mean

psychomotor and mental developmental indices and a significantly higher percentage of cerebral palsy and visual

impairment. Results of IVH patients born below 28 weeks of GA were significantly worse than results of IVH

patients born at or above 28 weeks of GA. In all parameters, an increase of abnormal results with increasing grade

of IVH could be observed; even patients with low-grade IVH (grades I and II) showed higher percentages of

impairment compared to controls without any IVH. CONCLUSION: Even low-grade IVH has an significant impact on

neurodevelopmental outcome of preterm patients and gestational age influences the impact of intraventricular

hemorrhage on neurodevelopmental outcome.

PMID: 22914924 [PubMed - as supplied by publisher]

7. Genet Mol Res. 2012 Aug 6;11(3):2035-44.

Combined genetic and imaging diagnosis for two large Chinese families affected with Pelizaeus-

Merzbacher disease.

Lv Y, Cao LH, Pang H, Lu LN, Li JL, Fu Y, Qi SL, Luo Y, Li-Ling J.

Department of Medical Genetics, School of Basic Medicine, China Medical University, Shenyang, China.

Pelizaeus-Merzbacher disease (PMD) is a rare X-linked recessive disorder characterized by nystagmus, impaired

motor development, ataxia, and progressive spasticity. Genetically defective or altered levels of proteolipid protein

(PLP1) or gap-junction alpha protein 12 gene have been found to be a common cause. Here we report on two large

Han Chinese families affected with this disease. The probands of both families had produced sons featuring

cerebral palsy that had never been correctly diagnosed. PMD was suspected after careful analysis of family history

and clinical features. Three rounds of molecular testing, including RT-PCR, genetics linkage and SRY sequence

analyses, in combination with fetal ultrasound and magnetic resonance imaging, confirmed the diagnosis. In Family

1, in addition to two patients, three carriers were identified, including one who was not yet married. Genetic testing

indicated that a fetus did not have the disease. A healthy girl was born later. In Family 2, two patients and two

carriers were identified, while a fetus was genetically normal. A healthy girl was born later. We concluded that by

combining genetic testing and imaging, awareness of the symptoms of PMD and understanding of its molecular

biology, there is great benefit for families that are at risk for producing offspring affected with this severe disease.

PMID: 22911587 [PubMed - in process]

Cerebral Palsy Research News ~ Monday 27 August 2012

Prevention and Cure

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7. Neuropsychology. 2012 Aug 20. [Epub ahead of print]

Visuospatial Perception in Children Born Preterm With No Major Neurological Disorders.

Butcher PR, Bouma A, Stremmelaar EF, Bos AF, Smithson M, Van Braeckel KN.

Objective: Many investigations have found deficits in visuospatial perception in children born preterm, however, it is

not clear whether the deficits are specific to visuospatial perception or the consequences of deficits in other

functional areas, which often accompany preterm birth. This study investigated whether children born preterm show

a specific deficit in visuospatial perception. Method: Fifty-six 7- to 11-year-old preterm born children (gestational

age <34 weeks) without cerebral palsy and 51 age-matched, full-term children completed four computerized tasks

tapping different levels and types of visuospatial perception. Accuracy and speed of responses were recorded.

Task formats were designed to reduce demands on attentional deployment. Measures of intelligence and parental

education were included in the analysis. Results: Children born preterm performed less accurately and/or less

rapidly on all tasks. Their poorer performance did not reflect differences in speed-accuracy trade-off. Parental

education and IQ, both significantly lower in the preterm children, contributed positively to performance on all tasks.

IQ mediated the association between preterm birth and visuospatial performance on the most cognitively

demanding task. Conclusion: Children born preterm performed more poorly than full-term controls on four

visuospatial perceptual tasks. Although intelligence and parental education were also associated with performance,

preterm birth contributed independently of these factors on three of four tasks. Many children born preterm are thus

multiply disadvantaged on visuospatial tasks: the lower IQ scores and parental educational levels frequently found

in this group increase the deficit associated with preterm birth. (PsycINFO Database Record (c) 2012 APA, all rights


PMID: 22905735 [PubMed - as supplied by publisher]

8. Obstet Gynecol. 2012 Sep;120(3):542-550.

Association of Polymorphisms in Neuroprotection and Oxidative Stress Genes and Neurodevelopmental

Outcomes After Preterm Birth.

Costantine MM, Clark EA, Lai Y, Rouse DJ, Spong CY, Mercer BM, Sorokin Y, Thorp JM Jr, Ramin SM, Malone

FD, Carpenter M, Miodovnik M, O’sullivan MJ, Peaceman AM, Caritis SN.

From the Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas,

University of Utah, Salt Lake City, Utah, University of Alabama at Birmingham, Birmingham, Alabama, Case

Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, University of Tennessee, Memphis,

Tennessee, Wayne State University, Detroit, Michigan, University of North Carolina at Chapel Hill, Chapel Hill,

North Carolina, University of Texas Health Science Center at Houston, Houston, Texas, Columbia University, New

York, New York, Brown University, Providence, Rhode Island, University of Cincinnati, Cincinnati, Ohio, University

of Miami, Miami, Florida, Northwestern University, Chicago, Illinois, University of Pittsburgh, Pittsburgh,

Pennsylvania, and The George Washington University Biostatistics Center, Washington, DC; and the Eunice

Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

OBJECTIVE: To estimate the associations between polymorphisms in neuronal homeostasis, neuroprotection, and

oxidative stress candidate genes and neurodevelopmental disability. METHODS: This was a nested case-control

analysis of a randomized trial of magnesium sulfate administered to women at imminent risk for early (before 32

weeks) preterm birth for the prevention of death or cerebral palsy in their offspring. We evaluated 21 singlenucleotide

polymorphisms (SNPs) in 17 genes associated with neuronal homeostasis, neuroprotection, or oxidative

stress in umbilical cord blood. Cases included infant deaths (n=43) and children with cerebral palsy (n=24), mental

delay (Bayley Mental Developmental Index less than 70; n=109), or psychomotor delay (Bayley Psychomotor

Developmental Index less than 70; n=91) diagnosed. Controls were race-matched and sex-matched children with

normal neurodevelopment. Associations between each SNP and each outcome were assessed in logistic

regression models assuming an additive genetic pattern, conditional on maternal race and infant sex, and adjusting

for study drug assignment, gestational age at birth, and maternal education. RESULTS: The odds of cerebral palsy

were increased more than 2.5 times for each copy of the minor allele of vasoactive intestinal polypeptipe (VIP,

rs17083008) (adjusted odds ratio 2.67, 95% confidence interval 1.09-6.55, P=.03) and 4.5 times for each copy of

the minor allele of N-methyl-D-aspartate receptor subunit 3A (GRIN3A, rs3739722) (adjusted odds ratio 4.67, 95%

Cerebral Palsy Research News ~ Monday 27 August 2012

CI 1.36-16.01, P=.01). The association between the advanced glycosylation end product-specific receptor (AGER,

rs3134945) SNP and mental delay was modulated by study drug allocation (P=.02). CONCLUSION: Vasoactive

intestinal polypeptipe and GRIN3A SNPs may be associated with cerebral palsy at age 2 in children born preterm.


PMID: 22914463 [PubMed - as supplied by publisher]

9. Semin Fetal Neonatal Med. 2012 Aug 17. [Epub ahead of print]

MicroRNAs and neuronal development.

Motti D, Bixby JL, Lemmon VP.

Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA; Miller School of Medicine, University of

Miami, Miami, FL, USA.

The importance of the involvement of non-protein coding RNAs in biological processes has become evident in

recent years along with the identification of the transcriptional regulatory mechanisms that allow them to exert their

roles. MicroRNAs (miRNAs) are a novel class of small non-coding RNA that regulates messenger RNA abundance.

The capacity of each miRNA to target several transcripts suggests an ability to build a complex regulatory network

for fine tuning gene expression; a mechanism by which they are thought to regulate cell fate, proliferation and

identity. The brain expresses more distinct miRNAs than any other tissue in vertebrates and it presents an

impressive variety of cell types, including many different classes of neurons. Here we review more than 10 years of

miRNA research, and discuss the most important findings that have established miRNAs as key regulators of

neuronal development.

Copyright © 2012 Elsevier Ltd. All rights reserved.

PMID: 22906916 [PubMed - as supplied by publisher]