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Challenges and Opportunities in Cerebral Palsy

Challenges and Opportunities in Cerebral Palsy

Myradova, S., Devesa, P., Guerra, J., & Devesa, J. (2022)


A common problem in children affected by cerebral palsy, independently of its etiology, is the existence of visual impairment. In this retrospective study we analyzed the effects of Growth hormone (GH) administration (0,04 mg/kg/day, 5 days/week) together with visual stimulation with a tachistoscope in 42 children with cerebral palsy (22 boys, 20 girls, aged 2,48 ± 1,5 years [mean ± SD) in whom there was an evident lesion of the visual pathway. In 17 of these cases, prematurity was the responsible factor, while in the other 25 children, ischemic encephalopathy due to pre/perinatal problems was the origin of visual impairment. In addition, we analyzed three other children (1, 2 months and 1 year of age) in whom multicystic encephalopathy (due to severe hypoxia-ischemia at delivery) mainly affecting the occipital lobes was the responsible factor. Visual evoked potentials were recorded before beginning and after treatment, assessing the latency in ms of the N75, P100 and N140 waves, as well as the amplitude of the waves (µV). Treatment duration (mean ± SD) was 5.20 + 2.05 months. Completion of treatment was established by clinical criteria. The statistical significance of the data was carried out using the Wilcoxon test.

The treatment induced a significant decrease in the latency of N75, P100 and N140 (p < 0.001), as well as a clear tendency to increase the amplitude of the waves (p < 0.05). Of special interest is the case of a child affected by Multicystic Encephalopathy in which the cystic cavities in the occipital lobes detected by MRI before starting treatment (15 days of age) completely disappeared in a new MRI performed 1 year later. That child is now totally independent for activities of daily living. GH treatment did not produce any adverse effects. In summary, from our results we can conclude that the administration of GH added to visual stimulation with a tachistoscope is an effective and safe method for the repair of visual deficiencies in children with cerebral palsy, regardless of the existence or not of GH deficiency.

Brunner, R. (2023)


Spasticity in patients with cerebral palsy is still an unclear concept which bases on the lesion of the upper motor neuron. The consequence is a loss of reflex control. The diagnosis is made during the static clinical exam and is transported into function. Spasticity is seen as an important factor which causes functional handicap as well as functional and later structural deformities. Because spasticity is considered a deteriorating factor for function, treatment of spasticity is one of the main columns in the treatment of children with spastic cerebral palsy. However, the diagnosis of spasticity during function is not possible up to now. Recent publications even raise doubts on the efficacy of spasticity treatment. On the other hand, spasticity is seen as a factor to compensate for weakness. New studies highlight the possibility of conditioning reflexes leading to an increase or decrease of reflex expression, hence spasticity. These facts query the treatment of spasticity and pave the way to new treatment concepts where experiencing successful movements can condition control of reflexes positively, without treating spasticity. This paper looks at the recent literature on new aspects of spasticity and describes the possible therapeutic consequences. The main shift in the treatment concept is to help patients cope with their spasticity and discover movement strategies in a large spectrum of movements. We describe possible modifications of the current treatment concepts. Movements should be carried out as an automatic muscle activity to reach the goal of an action which lets the patients experience success and joy. Dynamic orthotics help to keep the body segments in a functional adequate alignment, for an optimal movement experience under gravity, while the therapist intends to activate necessary but inactive muscles including eccentric muscle contractions. The patients discover new abilities and learn to move in a more efficient way. New feed-forward movement strategies are built up which help for activities in general. The need of spasticity compensating for weakness is reduced. These principles should be transported into daily life and sports. Sportive activities involve these therapeutic aims and the patients challenge themselves when they endeavour to improve.

Tammela, O. (2022).


About 80% of premature (< 37 gestational weeks) infants have been born moderately preterm (32+0-33+6 weeks) and late preterm (34+0-36+6 weeks). Very preterm birth (<32 weeks) is a well-known risk factor for adverse neurodevelopmental outcome, but the risks concerning moderately and late preterm infants have earlier been underestimated. Lately, concern about later neurodevelopmental impairments among these children has been emerged. Our project was to undertake a national register study on the incidence and risk factors of sensory impairments, cerebral palsy (CP) and intellectual disabilities (ID). The aim of this review article is to provide a summary of our work and earlier publications on this topic.

Our study comprised all children (N= 1039263) born alive in Finland in 1991-2008. After exclusions (missing data on gestational age (N=5520), major congenital malformations (N= 13007) and death before the age of one year (N=2659) the population consisted of 1018256 children, who were followed up to the age of seven years or up to 2009. They were divided into four groups as follows: very preterm (N= 6329), moderately preterm (N=6796), late preterm (N= 39928) and term (N=965203). Incidences of sensory impairments, CP and ID (intellectual quotient ≤ 70) were explored by linking health register data. Antenatal, birth-related and neonatal predictors of disabilities were established by multivariate analysis.

The incidences of sensory impairments, CP and ID decreased with increasing gestational age. Compared with term birth, moderately and late preterm births were significantly associated with the risk of visual disturbances, blindness and CP. Late preterm birth predicted a risk of hearing loss. Preterm birth seemed not to be associated with an increased risk of intellectual disability. The most significant predictors of neurodevelopmental disabilities among moderately and late preterm born children included one-minute Apgar score < 7, intracranial hemorrhage, male sex, small for gestational age, smoking during pregnancy and early antibiotic treatment. These results are mostly in accordance with other reports on the outcome of moderately and late preterm born children.

In conclusion, moderately and late preterm born children seemed to be at an increased risk of sensory impairments and cerebral palsy, but not intellectual disability.

Geijen, M., Smeets, R., Rameckers, E., Gordon, A., & Bastiaenen, C. H. G. (2022)


Aim: Investigate aspects of construct validity of parameters “mean peak force” and “number of successful attempts” of the press button task using the Task-oriented Arm-hAnd Capacity (TAAC) in children with unilateral cerebral palsy (CP) by comparing them to outcomes of comparative measures using Consensus-based Standards for the selection of health Measurement INstruments guidelines.

Methods: 118 children with unilateral CP (mean age 1 year 2 months, standard deviation 3 year 5 months) were included. Fourteen a priori hypotheses were formulated for each parameter of the TAAC. Strength and direction of the relationship between the TAAC and comparative measures were investigated by calculating Pearson correlation coefficients.

Results: For the parameter “mean peak force” 8/14 (57%) hypotheses could be supported. For the parameter “number of successful attempts” 13/14 (93%) hypotheses could be supported.

Conclusion: The hypothesized construct of the parameter “mean peak force” is only partially in line with our idea about the potential relationship of the compared constructs. The relationship needs to be reconsidered to some extent. The hypothesized construct of the parameter “number of successful attempts” is in line with our idea about the potential relationship of the compared constructs and can be considered to have good validity compared to the other measures. Thus, the construct of this parameter adds new and meaningful information as an outcome measure for functional strength measurements.

Benito, N., Palao, L., & Valero, R. P. (2023)


The use of technology has been widely studied as an influential factor in children’s learning and development; however, the neurodevelopment of early childhood goes through critical periods that are very sensitive to technological overexposure. The literature reviewed links their early and abusive use with difficulties and negative consequences on executive functioning, as well as on cognitive, linguistic, and socio-emotional areas. Consequently, a systematic review of 14 articles is presented, prepared under the PRISMA guidelines, to understand the impact of the abusive use of screens on neurotypical neurodevelopment between 0 and 12 years, especially on executive functioning. The results find significant relationships between exposure to screens and lower executive performance from 14 months to 9 years of age, especially on inhibitory control. There is a negative impact immediately, in the short and long term. Likewise, other exposure variables that affect executive performance have been identified. More experimental studies are needed to support the causality and directionality of the findings, as well as quantitative instruments that allow real-time exposure to screens to be measured more objectively.