Cerebral Palsy Research – Aug 6, 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 6 August 2012.

1. Dev Med Child Neurol. 2012 Aug 13. doi: 10.1111/j.1469-8749.2012.04385.x. [Epub ahead of print]

The natural history of hip development in cerebral palsy.

Terjesen T.

Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway.

Aim: The purpose of this study was to evaluate a population-based radiographic hip surveillance programme for

children with cerebral palsy (CP) and to assess the natural history of hip displacement. Method: The study

comprised 335 children (188 males, 147 females), born during 2002 to 2006 in the 10 south-eastern counties in

Norway. Their mean age at the first radiograph was 3 years (range 6mo-7y 11mo) and the mean age at the most

recent follow-up was 5 years 5 months. Distribution according to CP type was spastic hemiplegia in 38%, diplegia

in 27%, quadriplegia in 21%, dyskinesia in 10%, and ataxia in 3%; Gross Motor Function Classification System

(GMFCS) levels I to V were, 44%, 14%, 8%, 11%, and 23% respectively. Migration percentage (MP), acetabular

index, and pelvic obliquity were measured on the radiographs. Results: Hip displacement (MP>33%) occurred in

26% of all children (subluxation in 22% and dislocation in 4%) and in 63% of those in GMFCS levels IV or V.

Dislocation occurred in 14 children at a mean age of 4 years 5 months (range 1y 10mo-9y 7mo). The mean

migration percentage was 20.4% at the initial radiographs and 34.0% at the last follow-up. Mean progression in

migration percentage increased markedly with decreasing functional level, from 0.2% per year at GMFCS level I to

9.5% at level V. Interpretation: There is a pronounced trend towards hip displacement in nonambulant children.

Close surveillance from age 1 to 2 years is needed to find the appropriate time for preventive surgery. Since 12%

of the nonambulant children developed dislocation, our routines for hip surveillance need improvement.

© 2012 The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

PMID: 22881288 [PubMed - as supplied by publisher]

2. Dev Med Child Neurol. 2012 Aug 13. doi: 10.1111/j.1469-8749.2012.04380.x. [Epub ahead of print]

Are hips stable in children with cerebral palsy?

Rutz E.

Department of Orthopaedics, University Children’s Hospital, Basle, Switzerland.

Monday 20 August 2012

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Interventions and Management

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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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PMID: 22881187 [PubMed - as supplied by publisher]

3. J Pediatr Orthop. 2012 Sep;32(6):600-4.

Hip flexion contracture and diminished functional outcomes in cerebral palsy.

Pinero JR, Goldstein RY, Culver S, Kuhns CA, Feldman DS, Otsuka NY.

*Center for Children, NYU Hospital for Joint Diseases, New York, NY †University of Missouri Health System,

Jefferson City, MO.

BACKGROUND: Hip flexion contracture (HFC) in the ambulatory child with cerebral palsy (CP) may impair function

and lead to deteriorations in health-related quality of life. Furthermore, increasing HFC may lead to increasing

disability. However, the association between passive range of motion and the measures of function and well-being

is unclear. This study was designed to determine whether increasing HFC is associated with functional outcome.

METHODS: A total of 181 children, with an average age of 14.0±10.2 years, were evaluated as part of a multicenter

prospective data collection of patients with ambulatory CP. Measurements of HFC were recorded, and patients

were evaluated using walking score from Gillette Functional Assessment Questionnaire (FAQ), Gross Motor

Function Measure (GMFM), and the Pediatric Outcome Data Collection Instrument (PODCI). Patients were grouped

on the basis of severity of HFC: group A, 0 to 14 degrees; group B, 15 to 29 degrees; and group C =30 degrees.

Associations were examined using the Spearman correlation. RESULTS: There was an inverse association

between degree of HFC and FAQ walking score (P<0.01, ?=-0.25). Similarly, there was an inverse association

between the degree of HFC and GMFM parts D (P<0.001, ?=-0.31) and E (P<0.001, ?=-0.32). Lastly, the PODCI

domains of global function, mobility, and physical function also showed an inverse association with degree of HFC

(P<0.001, ?=-0.24). CONCLUSIONS: As surgeons treating children with CP, we often rely on joint measurements

as an indirect measure of function. This study of children with ambulatory CP suggests that increased HFC from the

physician’s perspective is associated with deterioration in function from a patient and a therapist’s perspective.

LEVEL OF EVIDENCE: Level II, prospective study.

PMID: 22892622 [PubMed - in process]

4. Arch Phys Med Rehabil. 2012 Aug 11. [Epub ahead of print]

Reliably Measuring Ambulatory Activity Levels of Children and Adolescents with Cerebral Palsy.

Ishikawa S, Kang M, Bjornson KF, Song K.

Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN.

OBJECTIVE: To identify sources of variance in step counts and to examine the minimum number of days required

to obtain a stable measure of habitual ambulatory activity in the cerebral palsy (CP) population. DESIGN: Crosssectional.

SETTING: Free-living environments. PARTICIPANTS: A total of 209 children and adolescents with CP

[mean age (SD) = 8 years 4 months (3 years 4 months); n = 118 boys; Gross Motor Functional Classification

System (GMFCS) levels I-III] were recruited through three regional pediatric specialty care hospitals.

INTERVENTIONS: Daily walking activity was measured with the two-dimensional StepWatch accelerometer over 7

consecutive days. Individual information-centered approach was applied to days with <100 steps, and participants

with =3 days of missing values were excluded from the study. Participants were categorized into 6 groups

according to age and functional level. Generalizability theory was used to analyze the data. MAIN OUTCOME

MEASURES: Mean step counts, relative magnitude of variance components in total step activity, and G-coefficients

of various combinations of days of the week. RESULTS: Variance in step counts attributable to participants ranged

from 33.6% to 65.4%. For youth ages 2-5 years, a minimum of 8, 6, and 2 days were required to reach acceptable

reliability (G) coefficient of=.80 for GMFCS Levels I, II, and III, respectively. For those ages 6-14 years, a minimum

of 6, 5, 4 days were required to reach stable measures of step activity for GMFCS Levels I, II, and III, respectively.

CONCLUSION: The findings of the study suggest that activity monitoring period should be determined based on the

GMFCS levels to reliably measure ambulatory activity levels in youth with CP.

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Copyright © 2012 the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

PMID: 22892322 [PubMed - as supplied by publisher]

5. Eur Neurol. 2012;67(4):211-6. Epub 2012 Mar 8.

Medial lemniscus lesion in pediatric hemiplegic patients without corticospinal tract and posterior thalamic

radiation lesion.

Jung YJ, Jang SH, Yeo SS, Lee E, Kim S, Lee DG, Kim HS, Son SM.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic

of Korea.

OBJECTIVES: Using diffusion tensor imaging (DTI), we investigated the state of medial lemniscus (ML),

corticospinal tract (CST), and posterior thalamic radiation (PTR), which were expected as probable reasons for

clinical hemiplegia in pediatric patients, especially those who showed impaired fine motor control and

proprioception, but no definite motor weakness or spasticity. METHODS: We recruited 13 hemiplegic patients and 8

age-matched healthy control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for the

bilateral ML, CST, and PTR were calculated and compared between the affected hemisphere of the patient (AP),

the unaffected hemisphere of the patient (UP), and the mean value of the bilateral hemispheres in control subjects

(MC). RESULTS: FA and ADC values for the CST and PTR did not differ significantly between the AP, UP, and MC

subgroups (p > 0.05). However, the FA value for the ML in AP showed a significant decrease, compared with that in

UP (p = 0.012) and MC (p = 0.047). DTT for the CST and PTR showed preserved integrity and ML in the UP also

had continuity to the cortex; however, ML in AP showed disruption. CONCLUSIONS: Using DTI, we demonstrated

that the ML lesion might be related to clinical hemiplegia in pediatric patients.

Copyright © 2012 S. Karger AG, Basel.

PMID: 22414658 [PubMed - indexed for MEDLINE]

6. J Physiother. 2012;58(3):197.

Functional progressive resistance training improves muscle strength but not walking ability in children

with cerebral palsy.

Boyd RN.

Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Australia.

SUMMARY OF: Scholtes VA et al (2012) Effectiveness of functional progressive resistance exercise training on

walking ability in children with cerebral palsy: a randomized controlled trial. Res Dev Disabil 33: 181-188. [Prepared

by Nora Shields, CAP Editor.]

QUESTION: Does functional progressive resistance exercise (PRE) improve walking ability and participation in

school-aged children with cerebral palsy (CP)? DESIGN: Randomised, controlled trial with concealed allocation and

blinded outcome assessment. SETTING: Three special schools for children with physical disability in the

Netherlands. PARTICIPANTS: Ambulatory children (Gross Motor Function Classification System 1-3) with spastic

unilateral or bilateral cerebral palsy aged 6-13 years. Botulinum toxin injections in the previous three months or

orthopaedic surgery in the previous six months were exclusion criteria. Randomisation of 51 participants allocated

26 to the functional PRE group and 25 to a usual care group. INTERVENTIONS: The intervention group

participated in a 12-week functional PRE program, three times a week for 60 minutes in groups of 4 or 5. The

program comprised four exercises: one using a leg press machine and three functional exercises (sit-to-stand,

lateral step-up, half knee-rise) using body weight and a weighted vest to provide resistance. Participants completed

3 sets of 8 repetitions for each exercise. Intensity was increased progressively based on repeated estimation of 8

RM (repetition maximum). The control group received conventional physiotherapy 1-3 sessions a week. OUTCOME

MEASURES: The primary outcomes were walking ability (timed 10m walk, 1-minute fast walk test, timed stair test)

and participation (intensity scores of 17 items of Children’s Assessment of Participation and Enjoyment

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questionnaire recalculated on a 0-100 scale) measured at baseline, after 6 and 12 weeks training, and 6 weeks

after the intervention. Secondary outcome measures were anaerobic muscle power, muscle strength, spasticity and

range of movement (ROM). RESULTS: 49 participants completed the study. At the end of the intervention period,

there was no difference between the groups for comfortable (-0.04, 95% CI -0.18 to 0.1m/s) or fast walking speed

(0.04, 95% CI -0.04 to 0.12m/s), timed stair test (0.8, 95% CI -2.6 to 4.3s) or participation (-1, 95% CI -11 to 9).

Muscle strength improved significantly more in the intervention group than the control group immediately after the

intervention by 1.3N/kg (95% CI 0.6 to 2.5) for total isometric muscle strength and by 14% BW (95% CI 2 to 26) for

6 RM leg press. Knee flexion range had decreased in the intervention group by 15° (95% CI -29 to -1) compared to

the control group 6 weeks after training stopped. The groups did not significantly differ on anaerobic muscle power,

spasticity or other ROM outcomes. CONCLUSION: A 12-week functional PRE program improved muscle strength,

but did not improve functional walking activity in school-aged ambulatory children with CP.

Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

PMID: 22884187 [PubMed - in process]

7. Pediatr Phys Ther. 2012 Summer;24(2):215; author reply 215.

Effects of constraint-induced movement therapy on gait, balance, and functional locomotor mobility.

Coker-Bolt P, Karakostas T.

Comment on

Effects of constraint-induced movement therapy on gait, balance, and functional locomotor mobility. [Pediatr

Phys Ther. 2012]

PMID: 22466395 [PubMed - indexed for MEDLINE]

8. Int J Endocrinol. 2012;2012:469235. Epub 2012 Jul 22.

Aging and Bone Health in Individuals with Developmental Disabilities.

Jasien J, Daimon CM, Maudsley S, Shapiro BK, Martin B.

Metabolism Unit, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100,

Baltimore, MD 21224, USA.

Low bone mass density (BMD), a classical age-related health issue and a known health concern for fair skinned,

thin, postmenopausal Caucasian women, is found to be common among individuals with developmental/intellectual

disabilities (D/IDs). It is the consensus that BMD is decreased in both men and women with D/ID. Maintaining good

bone health is important for this population as fractures could potentially go undetected in nonverbal individuals,

leading to increased morbidity and a further loss of independence. This paper provides a comprehensive overview

of bone health of adults with D/ID, their risk of fractures, and how this compares to the general aging population.

We will specifically focus on the bone health of two common developmental disabilities, Down syndrome (DS) and

cerebral palsy (CP), and will discuss BMD and fracture rates in these complex populations. Gaining a greater

understanding of how bone health is affected in individuals with D/ID could lead to better customized treatments for

these specific populations.

PMID: 22888344 [PubMed - as supplied by publisher] PMCID: PMC3408668

9. Musculoskelet Surg. 2012 Aug 15. [Epub ahead of print]

Wrist fusion in patients with severe quadriplegic cerebral palsy.

Thabet AM, Kowtharapu DN, Miller F, Dabney KW, Shah SA, Rogers K, Holmes L Jr.

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Department of Orthopedics, Alfred I. duPont Hospital for Children, Nemours Children’s Clinic, 1600 Rockland Road,

Wilmington, DE, 19803, USA, ahmed_thabetortho@yahoo.com.

We report clinical and radiographic outcomes of wrist fusion achieved with pin or plate fixation in 14 patients with

severe quadriplegic cerebral palsy (CP) (19 wrists). Average patient age at the time of surgery was 16.8 ± 1.7 years

(14-20 years). Mean follow-up time for the 14 patients was 5.9 ± 3.1 years (range, 1-11 years). Indication for

surgery was severe wrist deformity that interfered with hygienic care. Few complications occurred, and outcomes

were satisfactory. Statistically significant mean difference was shown between the pre- and postoperative

radiographic angles (37°, P = 0.001, and 24°, P = 0.04, for lateral and anteroposterior views, respectively).

Caregivers reported that appearance was the most perceived rationale for surgery (63 %). Improved hygienic care

was the primary perceived benefit. The majority (88 %) were satisfied with the results. We recommend wrist fusion

to improve hygienic care, positioning, and appearance of the wrist, hand, and fingers in patients with severe

quadriplegic CP.

PMID: 22893448 [PubMed - as supplied by publisher]

10. Child Care Health Dev. 2012 Aug 15. doi: 10.1111/j.1365-2214.2012.01419.x. [Epub ahead of print]

A pilot study to measure marks in children with cerebral palsy using a novel measurement template.

Bennett T, Jellinek D, Bennett M.

Children’s Community Services, Central Manchester University Hospitals NHS Foundation Trust, Newton Heath

Health Centre, Manchester, UK.

AIM: The primary aim of this pilot study was to trial a method of assessing bruises in a population of disabled

children. If the method was found to be sufficiently robust it would be our intention to undertaking a more extensive

observational study. BACKGROUND: Less is known about normal bruising patterns in children with disability than

in those without. It is important that the method used to assess bruising is objective and repeatable. In an effort to

define and improve repeatability, we employed a novel bruise measurement template which was printed onto

transparent acetate sheets. METHOD: Twenty primary school age children, the majority of whom were nonambulant

and severely disabled with cerebral palsy, underwent full skin examination. The template was used to

assess any bruises seen. A comparison was then made between measurements made by experienced

paediatricians using the template and using a standard tape measure on a series of bruise images in 25

photographs. RESULTS: The majority of children in our pilot were found to have bruises, with one child having 6

and one 7 bruises. This comparative study showed that the two techniques had a very similar precision and that the

template was easy to use. Greater precision would require a tighter measurement protocol, whether with a template

or a tape measure. CONCLUSIONS: Further evaluation of the application of such a template would be worthwhile.

We would suggest that our finding of some bruising in this population of disabled children is borne in mind

whenever bruising is found in a non-ambulant child.

© 2012 Blackwell Publishing Ltd.

PMID: 22891762 [PubMed - as supplied by publisher]

11. Pediatr Phys Ther. 2012 Summer;24(2):131-40; discussion 140.

Effects of power wheelchairs on the development and function of young children with severe motor


Jones MA, McEwen IR, Neas BR.

Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center,

Oklahoma City, Oklahoma, USA. maria-jones@ouhsc.edu

PURPOSE: The purpose of this pilot randomized controlled study was to identify any effects of power wheelchairs

on the development and function of young children with severe motor impairments. METHODS: Participants were

28 children with various diagnoses, aged 14 to 30 months when they entered the study. The Battelle

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Developmental Inventory (BDI), Pediatric Evaluation of Disability Inventory, and Early Coping Inventory were

administered at entry and after 12 months. RESULTS: The on-protocol analysis comparing median change scores

showed the experimental groups’ BDI receptive communication scores, and their Pediatric Evaluation of Disability

Inventory mobility functional skills, mobility caregiver assistance, and self-care caregiver scores improved

significantly more than the control group’s scores. An intention-to-treat analysis upheld the findings and revealed an

additional difference between the groups’ BDI total score. CONCLUSION: The results support use of power

wheelchairs with children as young as age 14 months to enhance development and function, although additional

research is needed.

PMID: 22466379 [PubMed - indexed for MEDLINE]

12. Physiotherapy. 2012 Sep;98(3):238-42. Epub 2012 Jul 23.

Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing

country: a pilot study.

Gordon C, Roopchand-Martin S, Gregg A.

Section of Physical Therapy, University of the West Indies, Kingston, Jamaica.

OBJECTIVES: To explore the possibility of using the Nintendo Wii™ as a rehabilitation tool for children with

cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross

motor function. DESIGN: Pilot study with a pre-post-test design. SETTING: Sir John Golding Rehabilitation Center,

Jamaica, West Indies. PARTICIPANTS: Seven children, aged 6 to 12 years, with dyskinetic CP were recruited for

the study. One child dropped out at week 4. INTERVENTION: Training with the Nintendo Wii was conducted twice

weekly for 6 weeks. The games used were Wii Sports Boxing, Baseball and Tennis. MAIN OUTCOME

MEASURES: Percentage attendance over the 6-week period, percentage of sessions for which the full duration of

training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM).

RESULTS: All six participants who completed the study had 100% attendance, and all were able to complete the

full 45 minutes of training at every session. Those who were wheelchair bound participated in two games, whilst

those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation

(SD) 24.86] to 70.17 (SD 23.67). CONCLUSION: The Nintendo Wii has the potential for use as a rehabilitation tool

in the management of children with CP. Clinical trials should be conducted in this area to determine whether this

could be an effective tool for improving gross motor function.

Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

PMID: 22898581 [PubMed - in process]

13. Disabil Rehabil. 2012 Aug 16. [Epub ahead of print]

The course of health-related quality of life of preschool children with cerebral palsy.

Alsem MW, Ketelaar M, Verhoef M.

Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine,University Medical

Center Utrecht and Rehabilitation Center De Hoogstraat , Utrecht , The Netherlands.

Purpose: The purpose of this paper is to describe the course of the health-related quality of life (HR-QoL) of

children with cerebral palsy (CP) between the ages of 2.5 and 4.5 years, at both group and individual level. We also

examined whether CP characteristics are helpful in understanding which children show a decrease in HR-QoL.

Methods: HR-QoL of 72 children with CP was measured using the TNO-AZL Preschool children Quality of Life

(TAPQOL) questionnaire at the ages of 2.5, 3.5 and 4.5 years. The course of HR-QoL was compared between

groups with different CP characteristics. Results: Median scores for 10 of the 12 domains of the TAPQOL were

found to be stable between ages 2.5 and 4.5 years. However, individual children showed great changes in HR-QoL

at these ages, for all domains. A larger proportion of children with less severe CP showed a decrease in HR-QoL

for the behaviour problems domain (p = 0.02), and a larger proportion of unilaterally affected children showed a

decrease in HR-QoL regarding the anxiety (p < 0.001) and social functioning (p = 0.01) domains. Conclusions:

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Although the median HR-QoL of children with CP is generally stable at these ages, much variation in the course of

HR-QoL exists between individual children. There is no clear association between motor functioning or limb

distribution and a decrease in HR-QoL. [Box: see text].

PMID: 22897114 [PubMed - as supplied by publisher]

14. BMJ Open. 2012 Aug 13;2(4). pii: e001460. doi: 10.1136/bmjopen-2012-001460. Print 2012.

Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motor attainment,

growth and nutritional status in preschool children with cerebral palsy.

Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN.

Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School

of Medicine, The University of Queensland, Brisbane, Australia.

INTRODUCTION: The prevalence of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) is

estimated to be between 19% and 99%. OPD can impact on children’s growth, nutrition and overall health. Despite

the growing recognition of the extent and significance of health issues relating to OPD in children with CP, lack of

knowledge of its profile in this subpopulation remains. This study aims to investigate the relationship between OPD,

attainment of gross motor skills, growth and nutritional status in young children with CP at and between two crucial

age points, 18-24 and 36 months, corrected age. METHODS AND ANALYSIS: This prospective longitudinal

population-based study aims to recruit a total of 200 children with CP born in Queensland, Australia between 1

September 2006 and 31 December 2009 (60 per birth-year). Outcomes include clinically assessed OPD (Schedule

for Oral Motor Assessment, Dysphagia Disorders Survey, Pre-Speech Assessment Scale, signs suggestive of

pharyngeal phase impairment, Thomas-Stonell and Greenberg Saliva Severity Scale), parent-reported OPD on a

feeding questionnaire, gross motor skills (Gross Motor Function Measure, Gross Motor Function Classification

System and motor type), growth and nutritional status (linear growth and body composition) and dietary intake (3

day food record). The strength of relationship between outcome and exposure variables will be analysed using

regression modelling with ORs and relative risk ratios. ETHICS AND DISSEMINATION: This protocol describes a

study that provides the first large population-based study of OPD in a representative sample of preschool children

with CP, using direct clinical assessment. Ethics has been obtained through the University of Queensland Medical

Research Ethics Committee, the Children’s Health Services District Ethics Committee, and at other regional and

organisational ethics committees. Results are planned to be disseminated in six papers submitted to peer reviewed

journals, and presentations at relevant international conferences.

PMID: 22893668 [PubMed - as supplied by publisher]

15. Dev Med Child Neurol. 2012 Aug 9. doi: 10.1111/j.1469-8749.2012.04382.x. [Epub ahead of print]

Prevalence and predictors of drooling in 7- to 14-year-old children with cerebral palsy: a population study.

Reid SM, McCutcheon J, Reddihough DS, Johnson H.

Developmental Disability Research, Murdoch Childrens Research Institute, Melbourne Human Communication

Sciences, La Trobe University, Bundoora Department of Paediatrics, University of Melbourne, Melbourne

Developmental Medicine, Royal Children’s Hospital, Melbourne Scope, Box Hill, Australia.

Aim: To establish a prevalence estimate for drooling and explore factors associated with drooling in a population

sample of children with cerebral palsy (CP) aged 7 to 14 years living in Victoria, Australia. Method: A self-report

questionnaire was used to collect data on drooling from parents of children born between 1996 and 2001, and

registered with the Victorian Cerebral Palsy Register. Results: A total of 385 children (231 males, 154 females;

mean age 10y 9mo [SD 1y 7mo], range 8-14y) were studied. The clinical type and distribution of CP were spastic

(341), ataxic (16), dyskinetic (17), hypotonic (10), and unknown (1). Distribution in Gross Motor Function

Classification System (GMFCS) levels was I (103), II (98), III (52), IV (63), V (61), and unknown (8). After

adjustment for topographical pattern of motor impairment and GMFCS level, 40% were reported to have

experienced drooling between 4 years of age and the time of completing the questionnaire. A significantly higher

prevalence of drooling was found in children with poor gross motor function and in those with more severe

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presentations of CP, including poor head control, difficulty with eating, and inability to sustain lip closure (p<0.001

for each). Drooling was shown to be significantly associated with both intellectual disability and epilepsy in this

group of children (p<0.001 for both). Interpretation: With a prevalence of 40%, drooling is an important comorbidity

in CP. It was considered severe in 15% of children. Poor oromotor function was associated with drooling and could

be the target of interventions for this under-researched problem.

© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

PMID: 22881219 [PubMed - as supplied by publisher]

16. Braz Oral Res. 2012 Aug 14. pii: S1806-83242012005000018. [Epub ahead of print]

Factors associated with dental caries in the primary dentition of children with cerebral palsy.

Roberto LL, Machado MG, Resende VL, Castilho LS, Abreu MH.

Department of Community and Preventive Dentistry, School of Dentistry, Univ Federal de Minas Gerais, Belo

Horizonte, MG, Brazil.

The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to

five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was

measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal

reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria,

excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without

caries experience and subcategorized into the following age groups: one year; two to three years; and four to five

years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson

regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first

appointment was the only factor associated with caries experience among two-to-fiveyear-old children with cerebral


PMID: 22892879 [PubMed - as supplied by publisher]

17. Disabil Rehabil. 2012 Aug 16. [Epub ahead of print]

Sequence memory skills in Spastic Bilateral Cerebral Palsy are age independent as in normally developing


Gagliardi C, Tavano A, Turconi AC, Borgatti R.

Neurorehabilitation Unit 1, “E. Medea”Scientific Institute , Bosisio Parini (LC) , Italy.

Purpose: To study the development of sequence memory skills in a group of participants with Spastic Bilateral

Cerebral Palsy (CP) and their matched controls (TD). Sequence memory skills are defined as a blend of implicit

and explicit competences that are crucial for the acquisition and consolidation of most adaptive skills along the

lifespan. Method: A computerized sequence learning task was administered to 51 participants with CP (age range:

4.1-14.7) and their controls. General performance, accuracy and learning strategy were analyzed, as well as

cognitive competencies (IQ and explicit visual spatial memory). Results: Explicit learning developed along with age

in all participants. Sequence learning skills were age independent and unevenly distributed among CP participants:

most TD (96.1%) and only about half (58.8%) of CP participants succeeded in sequence learning, in dynamic

relation with cognitive and manipulation abilities. Conclusion: Sequence memory skills should be verified to plan

therapeutic strategies. Therapeutic plans based on implicit learning (more resistant to disruption and stress) could

be effective and highly advantageous for most but not for all CP children. Independently from age, many CP

children could fix sequences more efficiently by explicit strategies, a more effortful but probably more effective way.

PMID: 22897566 [PubMed - as supplied by publisher]

Cerebral Palsy Research News ~ Monday 20 August 2012

Cerebral Palsy Alliance

PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au 9

18. J Child Neurol. 2012 Aug 16. [Epub ahead of print]

Error Detection and Response Adjustment in Youth With Mild Spastic Cerebral Palsy: An Event-Related

Brain Potential Study.

Hakkarainen E, Pirilä S, Kaartinen J, van der Meere JJ.

This study evaluated the brain activation state during error making in youth with mild spastic cerebral palsy and a

peer control group while carrying out a stimulus recognition task. The key question was whether patients were

detecting their own errors and subsequently improving their performance in a future trial. Findings indicated that

error responses of the group with cerebral palsy were associated with weak motor preparation, as indexed by the

amplitude of the late contingent negative variation. However, patients were detecting their errors as indexed by the

amplitude of the response-locked negativity and thus improved their performance in a future trial. Findings suggest

that the consequence of error making on future performance is intact in a sample of youth with mild spastic cerebral

palsy. Because the study group is small, the present findings need replication using a larger sample.

PMID: 22899795 [PubMed - as supplied by publisher]

19. Arq Neuropsiquiatr. 2012 Aug;70(8):593-8.

Differences in walking attainment ages between low-risk preterm and healthy full-term infants.

Restiffe AP, Gherpelli JL.

Department of Neurology, Medical School, Universidade de São Paulo, São Paulo, SP, Brazil.

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy fullterm

(FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and

FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study

compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. Results: Mean

scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking

attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay.

CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months

of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of

neonatal intensive unit stay.

PMID: 22899030 [PubMed - in process]

20. Pediatr Neurol. 2012 Sep;47(3):186-92.

Evaluation of etiologic and prognostic factors in neonatal convulsions.

Yildiz EP, Tatli B, Ekici B, Eraslan E, Aydinli N, Caliskan M, Ozmen M.

Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.

This study evaluated etiologic and risk factors affecting long-term prognoses of neurologic outcomes in newborns

with neonatal seizures. We enrolled patients at chronologic ages of 23-44 months, referred to the Department of

Pediatric Neurology, Istanbul Medical Faculty, from January 1, 2007-December 31, 2009, after manifesting seizures

in their first postnatal 28 days. Of 112 newborns, 41 were female, 71 were male, 33 were preterm, and 79 were fullterm.

Perinatal asphyxia (28.6%) and intracranial hemorrhage (17%) were the most common causes of neonatal

seizures. Cerebral palsy developed in 27.6% of patients during follow-up. The incidence of epilepsy was 35.7%.

Almost 50% of patients manifested developmental delay in one or more areas. Global developmental delay was the

most common (50.8%) neurologic disorder. The correlation between gestational age or birth weight and adverse

Cerebral Palsy Research News ~ Monday 20 August 2012

Prevention and Cure

Cerebral Palsy Alliance

PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au

outcomes was nonsignificant. Etiology, Apgar score, need for resuscitation at birth, background

electroencephalogram, neonatal status epilepticus, cranial imaging findings, type/duration of antiepileptic treatment,

and response to acute treatment were all strong prognostic factors in neurologic outcomes. Neonatal seizures pose

a threat of neurologic sequelae for preterm and full-term infants. Although the number of recognized etiologic

factors in neonatal seizures has increased because of improvements in neonatology and diagnostic methods,

perinatal asphyxia remains the most common factor.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID: 22883283 [PubMed - in process]

21. Arch Pediatr. 2012 Aug 9. [Epub ahead of print]

Long-term cerebral effects of perinatal inflammation [Article in French]

Chhor V, Schang AL, Favrais G, Fleiss B, Gressens P.

Inserm U676, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Faculté de médecine Denis-

Diderot, université Paris-7, 75205 Paris cedex 13, France; PremUP, 75006 Paris, France.

Perinatal inflammation can lead to fetal/neonatal inflammatory syndrome, a risk factor for brain lesions, especially in

the white matter. Perinatal inflammation is associated with increased incidence of cerebral palsy in humans and

animal models and there is a strong relationship with increased incidence of autism and schizophrenia in humans.

Perinatal inflammation causes acute microglial and astroglial activation, blood-brain barrier dysfunction, and

disrupts oligodendrocyte maturation leading to hypomyelination. Inflammation also sensitizes the brain to additional

perinatal insults, including hypoxia-ischemia. Furthermore, long after the primary cause of inflammation has

resolved, gliosis may also persist and predispose to neurodegenerative diseases including Alzheimer’s and

Parkinson’s disease, but this relation is still hypothetical. Finding of acute and chronic changes in brain structure

and function due to perinatal inflammation highlights the need for treatments. As gliosis appears to be involved in

the acute and chronic effects of perinatal inflammation, modulating the glial phenotype may be an effective strategy

to prevent damage to the brain.

Copyright © 2012. Published by Elsevier SAS.

PMID: 22885003 [PubMed - as supplied by publisher]

22. Zhonghua Yi Xue Za Zhi. 2012 May 29;92(20):1400-4.

Meta-analysis of mild hypothermia for gestational age over 35-week newborns with hypoxic-ischemic

encephalopathy [Article in Chinese]

Wang LS, Cheng GQ, Zhou WH, Sun JQ, Cao Y, Shao XM.

Department of Neonatology, Children’s Hospital of Fudan University, Shanghai 201102, China.

OBJECTIVE: To determine the effects of therapeutic hypothermia (TH) in encephalopathic asphyxiated newborn

infants on mortality, long-term neurodevelopmental disability and side effects by summarizing the data of hypoxicischemic

encephalopathy(HIE) newborns undergoing mild hypothermia using meta-analysis. METHODS: The

standard searching strategy of the Neonatal Review Group as outlined in the Cochrane Library was used to retrieve

all clinical literatures about TH on HIE. RevMan 5.1 software was used to perform the meta-analysis of target

papers. The primary outcome measure was a combination of death and severe major neurodevelopmental

disabilities at 18 – 24 months of age. Secondary outcomes included mortality, cerebral palsy (CP),

neurodevelopmental delay, blindness, deafness and main side effects of cooling therapy. RESULTS: A total of 276

papers fulfilled the search strategy and 11 trials were included. Overall TH resulted in a statistically significant and

clinically important reduction in the combined outcome of death or major neurodevelopmental disabilities to 18-24

months of age (RR = 0.76, 95%CI: 0.68 – 0.84, P < 0.01). Moreover, as compared with the control group, TH

significantly decreased the incidence of mortality (RR = 0.76, 95%CI: 0.65 – 0.90, P < 0.01), psychomotor

development index(RR = 0.69, 95%CI: 0.55 – 0.87, P < 0.01), mental development index (RR = 0.66, 95%CI: 0.53 -

Cerebral Palsy Research News ~ Monday 20 August 2012

0.83, P < 0.01), CP (RR = 0.70, 95%CI: 0.54 – 0.91, P < 0.01) and blindness (RR = 0.54, 95%CI: 0.33 – 0.90, P <

0.05)except for severe hearing loss (deafness) (RR = 0.69, 95%CI: 0.35 – 1.34, P = 0.3000) in survivors. Adverse

effects included significant thrombocytopenia in the TH group (P = 0.0400) but without deleterious consequences.

There were no significant differences in arrhythmia, coagulopathy, hypotension requiring inotropic supports, sepsis

and pulmonary hypertension between the TH and control groups (all P > 0.05). CONCLUSIONS: Mild hypothermia

is effective in reducing death and major disabilities in infants with moderate-to-severe HIE without significant side

effects. Infants presenting within the first hours after birth with the signs and symptoms of moderate-to-severe

encephalopathy should be cooled in accordance with the established protocols of previous randomized controlled


PMID: 22883198 [PubMed - in process]