Health and social outcomes of children with cerebral palsy

doi:10.1016/j.jpeds.2004.05.021

The Journal of Pediatrics

Volume 145, Issue 2, Supplement, August 2004, Pages S36-S41

https://doi.org/10.1016/j.jpeds.2004.05.021 Get rights and content

Health and social outcomes in children who have cerebral palsy (CP) depend on several factors, including the severity of the CP, medical interventions, and the child's environment. One of the hallmarks of cerebral palsy is its variability. Several formal methods of classifying persons with CP, such as the Gross Motor Function Classification System, have been developed to standardize that variability. Children and adults with CP must contend with increased mortality as well as many secondary conditions that can affect activities and participation in society. Predicting outcomes for children with CP, establishing realistic goals, and determining the best interventions to improve functioning are facilitated by applying research results to individual decisions. Many more such studies are needed—especially those performed with large representative samples. In addition, the childhood factors that affect outcomes in adults with CP still need to be elucidated.

Section snippets

Clinical factors and the classification of cerebral palsy

Lloyd and Gould⁴ noted that variability is the fundamental reality of nature. One of the striking characteristics of CP is its variability. CP can be classified according to the type of motor impairment, which includes spasticity, dyskinesia (dystonia and choreoathetosis), and ataxia. Sometimes hypotonia is included in this classification scheme. Many children have mixed CP that involves two or more of these elements. Another way to classify CP is by location—for instance, quadriplegia,

Secondary conditions

The International Classification of Functioning, Disability and Health¹⁰ provides a classification scheme for understanding outcomes that includes body function and structure (impairments), activities, and participation (Fig 2). Environmental and personal factors are postulated to affect outcomes in all categories. Children who have CP have outcomes in all three categories. They are likely to have comorbid conditions that accompany the primary diagnosis and affect outcome, as well as secondary

Mortality

Most children with CP survive to adulthood, although the death rate is higher than in children who do not have CP. Strauss et al²⁰ found that children with severe impairment of mobility and feeding skills had the greatest risk of dying during childhood. Data from the Western Australian Cerebral Palsy Register of children with CP born between 1958 and 1994 showed a mortality rate greater than 1% per year in the first 5 years of life; it then declined to 0.35% over the period of the next 20 years.

Interventions to improve outcomes

Most children who have CP receive multimodal therapy—for example, physical, occupational, and speech therapies; orthopedic surgery; spasticity management; and special educational support services. These therapies tend to be complementary. For example, orthopedic interventions have no effect on spasticity but address secondary problems such as contractures and lever-arm dysfunction. On the other hand, reducing spasticity has no effect on existing bony problems. Neither can improve selective

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Numerical cognition in children with cerebral palsy
2021, Research in Developmental Disabilities
Citation Excerpt :
The diversity of the motor and cognitive impairments is due to the heterogeneity of brain injuries (Sankar & Mundkur 2005; Bax et al., 2005; Straub & Obrzut, 2009; van Rooijen et al., 2015). Around 75 % of children with CP show disorders of higher cortical functioning (Liptak & Accardo, 2004). Consequently, they run the risk of presenting learning difficulties, especially regarding mathematical skills (Critten et al., 2018; van Rooijen et al., 2011).
Children with Cerebral Palsy (CP) often perform poorly in mathematics. It is not yet clear to what extent mathematics difficulties in this clinical condition are similar to those observed in developmental dyscalculia. To better elucidate this issue, we conducted an exploratory cross-sectional study with a sample of children and adolescents with congenital brain injuries and educational history of problems in Mathematics. Fifty students aged 7–15 years, of both genders (28 males) participated in the study, 31 with typical development (TD) and 19 of whom diagnosed with spastic CP. Nine had hemiplegia and ten diplegia. Assessment procedures included a neuropsychological battery covering numerical cognition (ZAREKI-R) and working memory (AWMA) skills, and a computerized task for comparing non-symbolic magnitudes as a measure of number sense. Despite average intelligence coefficient, participants with CP underperformed the TD in five of the 12 ZAREKI-R subtests, as well as in the number sense and working memory tasks. scores were lower among hemiplegic children compared to diplegic, numerical cognition was impaired in all CP group, unveiling a dyscalculia secondary to neurodevelopmental impairments. Therefore, we can consider that mathematical learning difficulties in CP as being heterogeneous and associated with the immaturity of neuropsychological functions, with consequences for the development of numerical cognition.
Automatic classification of gait patterns in children with cerebral palsy using fuzzy clustering method
2020, Clinical Biomechanics
Citation Excerpt :
The variability in clinical presentation and gait pattern in cerebral palsy (CP) may complicate the decision-making process (Liptak and Accardo, 2004).
Subjective classification of gait pattern in children with cerebral palsy depends on the assessor's experience, while mathematical methods produce virtual groups with no clinical interpretation.
In a retrospective study, gait data from 66 children (132 limbs) with a mean age of 9.6 (SD 3.7) years with cerebral palsy and no history of surgery or botulinum toxin injection were reviewed. The gait pattern of each limb was classified in four groups according to Rodda using three methods: 1) a team of experts subjectively assigning a gait pattern, 2) using the plantarflexor-knee extension couple index introduced by Sangeux et al., and 3) employing a fuzzy algorithm to translate the experiences of experts into objective rules and execute a clustering tool. To define fuzzy repeated-measures, 75% of the members in each group were used, and the remaining were used for validation. Eight parameters were objectively extracted from kinematic data for each group and compared using repeated measure ANOVA and post-hoc analysis was performed. Finally, the results of the clustering of the latter two methods were compared to the subjective method.
The plantarflexor-knee extension couple index achieved 86% accuracy while the fuzzy system yielded a 98% accuracy. The most substantial errors occurred between jump and apparent in both methods.
The presented method is a fast, reliable, and objective fuzzy clustering system to classify gait patterns in cerebral palsy, which produces clinically-relevant results. It can provide a universal common language for researchers.
From numeracy to arithmetic: Precursors of arithmetic performance in children with cerebral palsy from 6 till 8 years of age
2015, Research in Developmental Disabilities
Children with cerebral palsy (CP) are generally delayed in arithmetic compared to their peers. The development of early numeracy performance in children with CP is not yet evident, nor have the factors associated with change over time been identified. Therefore, we examined the development of numeracy in children with CP over a two year period and studied which cognitive factors were predictive of arithmetic performance. A longitudinal study with three measurement waves separated by one year was conducted. 56 children participated (37 boys, M = 6.0 years, SD = .58). Standardized tasks were used to assess verbal- and visual–spatial working memory, executive functioning, fine motor skills and early numeracy performance. In addition, experimental tasks were developed to measure counting and arithmetic. The results showed that early numeracy performance of children with CP increased between 6 and 8 years of age. Structural equation modelling showed that early numeracy was strongly related to arithmetic performance at the consecutive year. Working memory, counting and fine motor skills were all positively related to early numeracy performance a year later. Furthermore, working memory and fine motor skills were precursors of the development of early numeracy. Considering the importance of numeracy and arithmetic in daily life and in academic and work success, children with CP could substantially benefit from intervention programs aimed at increasing working memory and early numeracy performance.
Deficit in implicit motor sequence learning among children and adolescents with spastic Cerebral Palsy
2013, Research in Developmental Disabilities
Citation Excerpt :
Although visible motor difficulties like spasticity and limited range of motion are defining characteristics of the impairment in CP, it has been recently acknowledged that higher-order motor planning and motor learning deficiencies also exist (Bar-Haim et al., 2010; Steenbergen & Gordon, 2006). Considering intensive efforts invested in teaching motor skills to children with CP with only limited results (Liptak & Accardo, 2004), it has been suggested that the implicit system might offer a better avenue for improvement (Steenbergen, van der Kamp, Verneau, Jongbloed-Pereboom, & Masters, 2010). This necessitates investigation of the implicit system in children with CP.
Skill learning (SL) is learning as a result of repeated exposure and practice, which encompasses independent explicit (response to instructions) and implicit (response to hidden regularities) processes. Little is known about the effects of developmental disorders, such as Cerebral Palsy (CP), on the ability to acquire new skills. We compared performance of CP and typically developing (TD) children and adolescents in completing the serial reaction time (SRT) task, which is a motor sequence learning task, and examined the impact of various factors on this performance as indicative of the ability to acquire motor skills. While both groups improved in performance, participants with CP were significantly slower than TD controls and did not learn the implicit sequence. Our results indicate that SL in children and adolescents with CP is qualitatively and quantitatively different than that of their peers. Understanding the unique aspects of SL in children and adolescents with CP might help plan appropriate and efficient interventions.
Increased complications after appendectomy in patients with cerebral palsy: Are special needs patients at risk for disparities in outcomes?
2013, Surgery (United States)
Cerebral palsy (CP) is a nonprogressive neurologic disorder. Anecdotal evidence suggests there are worse outcomes in this population after common operative procedures like appendectomy. This study aims to classify whether there are relevant disparities in postoperative outcomes in CP versus non-CP patients after open or laparoscopic appendectomy.
Hospital discharge data from the 2003–2009 weighted Nationwide Inpatient Sample were used. Unadjusted and adjusted multiple logistic regression were used to assess postoperative complications, as well as inpatient mortality, average duration of hospital stay, and cost.
Approximately 1,250 patients with CP met the inclusion criteria. After adjusted analysis, CP patients displayed significantly greater odds of the following postoperative complications: Sepsis/organ failure, operation-related infection, pneumonia, urinary tract infection, and acute respiratory distress syndrome. Patients with CP also had a greater cost and in-hospital stay after appendectomy.
Patients with CP have greater adjusted odds of complications after open or laparoscopic appendectomy. The mechanisms that led to these disparities need to be studied and may include difficulties in patient assessment and communication. Additional education of healthcare providers to improve recognition of symptoms and care for patients with disabilities may be more immediately helpful in decreasing disparities in outcomes.
Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy
2012, Journal of Pediatrics
To explore facilitators and barriers to participation in physical activity and sport in youth with cerebral palsy (CP).
This was a qualitative study involving in-depth focus group interviews with 33 ambulatory youth with CP and their parents. The interviews were conducted until informational redundancy was achieved.
Youth with CP and their parents reported personal and environmental facilitators and barriers to participation in physical activity. Seven major themes related to personal and environmental factors were identified.
This study suggests that various personal and environmental factors play a key role in determining the extent to which youth with CP participate in physical activity. The facilitators and barriers identified provide important theoretical insights into how and why youth with CP and their parents might change their physical activity behavior.

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Health and social outcomes of children with cerebral palsy

Section snippets

Clinical factors and the classification of cerebral palsy

Secondary conditions

Mortality

Interventions to improve outcomes

Pediatr Neurol

J Am Diet Assoc

J Pediatr

Phys Med Rehabil Clin N Am

J Orthop Sci

Am J Gastroenterol

Lancet

Cerebral palsy: what parents and doctors want to know

BMJ

Relationships among musculoskeletal impairments and functional health status in ambulatory cerebral palsy

J Pediatr Orthop

Understanding health care outcomes research

Species selection on variability

Proc Natl Acad Sci U S A

Walking prognosis in cerebral palsy: a 22-year retrospective analysis

Dev Med Child Neurol

Development and reliability of a system to classify gross motor function in children with cerebral palsy

Dev Med Child Neurol

The gross motor function classification system for cerebral palsy: a study of reliability and stability over time

Dev Med Child Neurol

Melbourne Assessment of Unilateral Upper Limb Function: construct validity and correlation with the Pediatric Evaluation of Disability Inventory

Dev Med Child Neurol

Prognosis for gross motor function in cerebral palsy: creation of motor development curves

JAMA

International classification of functioning, disability and health

Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey

BMJ

The longitudinal stability of psychiatric problems in children with hemiplegia

J Child Psychol Psychiatry

Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy

Dev Med Child Neurol

Secondary conditions in children with disabilities: spina bifida as a case example

Ment Retard Dev Disabil Res Rev

The children of Kauai; a longitudinal study from the prenatal period to age ten

Babies at double hazard: early development of infants at biologic and social risk

Pediatrics

Change in cognitive function over time in very low-birth-weight infants

JAMA

Childhood neglect and cognitive development in extremely low birth weight infants: a prospective study

Pediatrics

Neuromotor development of cocaine-exposed and control infants from birth through 15 months: poor and poorer performance

Pediatrics

Life expectancy among people with cerebral palsy in Western Australia

Dev Med Child Neurol

The Child Health Questionnaire users manual