Indian Journal of Cerebral Palsy

Published by Medknow Publications
Print ISSN: 2395-4264
Context: For children with increased risk of neurodevelopmental deficiencies, such as preterm and low birth weight infants, it is desirable to make early predictions with regard to outcome. This is important for the family as well as the researchers designing appropriate follow-up and intervention programs. Aims: To evaluate the functional motor abilities in preterm children using GMFM 66. Settings and Design: Observational study design conducted at Physiotherapy OPD. Material and Methods: An observational study was conducted for 1 year involving hundred children who were born at 24-31 weeks of gestation, with age group ranging from 1 to 6 years and a mean age of 3 years. The sample selection was based on convenient sampling method. The children were evaluated according to their gestational age. This study was carried out in Dept. Of Physiotherapy. Children aged 1-6 years of either sex were included in this study, whereas patients who had no parental consent, uncooperative children, and children admitted for unstable medical conditions were excluded from the study. The study was approved by institutional ethical committee. The guardians signed an informed consent form allowing the children's participation. The GMFM 66 was administered on hundred preterm children, and collected data were compared with standard values of GMFM 66. The GMFM test activities in five dimensions, (lying and rolling; sitting, crawling and kneeling; standing and walking; running and jumping was performed). It has good reliability and validity in assessing gross motor functions of children less than three years old. (ICC = O.99). Statistical Analysis Used: Unpaired t was used for between group comparison. Results: The results of the present study indicated that the functional variability of premature children, it had significant variability in functionality within the different dimensions of GMFM. Conclusions: This study concluded the presence of significant functional variability in premature children.
Introduction: Spasticity and weakness are the two most important factors effecting gait in children with spastic diplegia. Spasticity in hip adductors and associated weakness in hip extensors and abductors leads to scissoring gait pattern. Proximal muscle stability is essential for distal mobility; this study focuses more on proximal muscle group facilitation for correction of deviations in scissoring gait. Objective: The objective of this study was to study the coupled effect of neuromuscular electrical stimulation (NMES) on glutei and transcutaneous electrical nerve stimulation (TENS) on hip adductors in improving gait parameters. Materials and Methods: The experimental group received NMES to hip extensors and hip abductors followed by TENS to hip adductors as an adjunct to conventional therapy for a period of 3 weeks whereas the control group received only conventional therapy. In experimental group, NMES was applied to gluteus maximus and medius for 10 min each and were asked them to perform the muscle action voluntarily. Later, TENS was applied to hip adductors for 10 min with passive hip abduction (HAB). Both the group received home program for the next 2 months. Results: A significant improvement was noted in spasticity, active range of motion (AROM) to HAB, extension, and gait parameters with P < 0.05. Conclusion: The coupled effect of NMES on glutei and TENS on hip adductors in children with scissoring gait gives rise changes in muscle tone, AROM, and gait parameter. All these contribute in improving the gait. These gains persist atleast for 3 months compared to the individuals who receive only conventional therapy. The improvement is seen within a short period of 3 weeks time compared to conventional therapy alone group which takes longer period of 12 weeks time. Key words: Neuromuscular electrical stimulation, scissoring gait, transcutaneous electrical nerve stimulation
ORIGINAL ARTICLE Year : 2016 | Volume : 2 | Issue : 1 | Page : 22-26 Efficacy of supracondylar knee ankle foot orthosis for hyperextended knee and heel rise in spastic cerebral palsy: A pilot clinical trial Rajesh Kumar Mohanty, Ullas Chandra Sahoo, Smruti Prava Sahoo Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India Correspondence Address: Rajesh Kumar Mohanty Swami Vivekanand National Institute of Rehabilitation Training and Research, Olatpur, Bairoi, Cuttack, Orissa India Source of Support: None, Conflict of Interest: None DOI: 10.4103/2395-4264.188151 Rights and Permissions Background: Guidelines to assist with decision making for orthotic management of gait dysfunction in individual with cerebral palsy (CP) is difficult to derive and remain controversial. The research question is whether supracondylar knee ankle foot orthosis (SKAFO) is one of best options for knee hyperextension and heel rise for spastic diaplegic Cerebral palsy. Aim: The purpose of this study was to check the efficacy of bilateral molded SKAFO for knee hyperextension and heel rise for Cerebral palsy in terms of gait parameters and energy expenditure. Materials and Methods: Five individuals (mean age 3.5 years) were diagnosed as spastic diplegic and one with hemiplegic (age 5 years old) Cerebral palsy with delayed milestone presented with knee hyperextension and heel rise during mid-stance and were fitted with bilateral molded SKAFO with pair of shoes. Observational gait analysis by video recording was performed and gait parameters by 10 m walk test and energy expenditure using physiological cost index was recorded in bracing and non-bracing conditions. Results: The orthosis controlled knee hyperextension by not allowing the knee to go beyond neutral position. The gait was more natural with proper heel strike and better push off. There was improvement in temporal-spatial gait parameters and gait was energy efficient. Conclusion: The SKAFO was found to be effective in controlling knee hyperextension and resulted in stable, natural, satisfactory and energy efficient gait in spastic Cerebral palsy with knee hyperextension and heel rise. Similar study involving case series can be used to set the prognosis of ambulation and the kind of orthotic interventions needed to optimize the walking ability.
Context: Many studies have found that there is an increased risk of neurodevelopmental impairments in preterm and low birth weight (LBW) infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. In 1972, Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life. Aims: To evaluate the functional performance (age specific motor development) in preterm infants using Infant Neurological International Battery (INFANIB). Settings and Design: Observational study design conducted at physiotherapy OPD. Subjects and Methods: An observational study was carried out in 100 infants who were born at 24-31 weeks gestation with age group from 4 to 9 months with a mean age of 4.3 months. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. The study was approved by Institutional Ethical Committee. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB. Statistical Analysis Used: Unpaired t -test was used for between group comparisons. Results: The present study shows that premature infants have high risk of delayed pattern of motor development which is different from those infants born at term. Conclusions: The premature infants show delayed pattern of motor development that is different from those born at term.
Background: Hearing is critical for the full development of language skills. Even a mild hearing impairment can interfere with speech and language development. Hearing impairment has the highest incidence rate for any pediatric disability, since several risk factors in infants with cerebral palsy (CP) are the same risk factors to develop hearing impairment. Thus, it should come as no surprise that hearing impairment occurs more frequently among children with cerebral palsy than in the general population. Recent studies have shown that up to 25% of children with cerebral palsy also suffer from a hearing impairment. However, no data of hearing impairment in cerebral palsy is available in India. Objective: The goal of this study was to determine the frequency and profile of hearing impairment in children with cerebral palsy. Methodology: This was a retrospective study involving 117 children of 2-10 years of age of both genders who were diagnosed with cerebral palsy. The audiometry, tympanometry, otoacoustic emission, and auditory brain stem response hearing tests were employed to categorize the hearing impairment. Results: Hearing impairment was observed in 39% of children. Sensorineural, conductive, and mixed hearing impairment was present in 48%, 41%, and 31% of the children, respectively. Among them, there was mild, moderate, and severe degree of hearing impairment in 52%, 26%, and 22% of the children with cerebral palsy, respectively. Conclusions: Prevalence of hearing impairment in children with cerebral palsy is alarming. This warrants early identification and diagnosis of hearing impairment, especially for medically treatable forms of hearing impairment such as secretory otitis media, Eustachian tube dysfunction, and presence of wax. This early identification may facilitate better development of speech and language as well as positive outcomes. Therefore audiological assessment should be incorporated into the diagnostic and therapeutic plan of all children with cerebral palsy.
Multisensory balance training exercise pictures 
(a-f) Components of Balance Evaluation-Systems Test. (a) Biomechanical constraints. (b) Stability limits. (c) Anticipatory postural adjustment. (d) Reactive postural response. (e) Sensory orientation. (f) Stability in gait 
Context: Involvement of sensory system affects the motor performance of children with cerebral palsy, and the literature on sensory-based balance training is scarce in such children. Aim: To test the feasibility of administering multisensory training in school going children with cerebral palsy and its effects on balance control as measured by Balance Evaluation – Systems Test (BESTest). Settings and Design: School setting and a baseline‑pre‑post feasibility trial. Subjects and Methods: Seventeen children with cerebral palsy (gross motor function classification system level 1–3) aged between 6 and 16 years participated in sensory-based balance training encompassing inputs from visual, vestibular, and proprioceptive systems. Children with mental delay, hearing, and visual impairments and those who underwent treatments such as BOTOX, tendon lengthening, derotation surgery, or selective rhizotomy in the past 6 months were excluded. Following 2 months run‑in period, each child underwent 45 min of training per session; a total of 18 sessions over 2 months duration. Statistical Analysis and Results: Repeated measures ANOVA and post‑hoc test was done to analyze within‑subject changes and with respect to time. P < 0.05 was statistically significant. After training, all the components of BESTest showed statistically significant change (P < 0.05). Conclusion: Multisensory training is a feasible mode of practice in a school setting and is beneficial in improving balance control in children with cerebral palsy.
Dissociated movements, Qb: Grasp, Qc: Weight Bearing, Qd: Protective Extension, Qt: Total Quest Score, PR: Pediatric Reach, SAS: Sitting Assessment Scale, e: Experimental and c: Control
Mean Values of Quest, PR, SAS in both groups on 1 st day and 14 th day
Introduction: Children having spastic diplegic cerebral palsy also have some impairment in upper extremity functions; hence, they have difficulty in performing certain activities such as pulling up to stand, support themselves to sit, and participate in surrounding environment. Trunk control is proposed to be a major contributing factor for voluntary upper limb motor functions including motor control. Objective: To study the effect of dynamic sitting balance on upper extremity skill in children having spastic diplegia. Materials and Methods: Study Design - Randomized control trial. Participants - The children were randomly divided into experimental (n = 15)and control group (n = 15). Experimental group received dynamic sitting balance training for a period of two weeks, whereas control groupreceived conventional physiotherapy for a period of two weeks. Results: A significant improvement was noted in dynamic sitting balance and upper extremity skill, and a positive correlation was found between these two parameters. Conclusion: This study showed that, for this cohort of children having spastic diplegic cerebral palsy, short duration of dynamic sitting balance training resulted in improvement in upper extremity function with improvement in dynamic sitting balance. Key words: Correlation, diplegia, skill, spastic, upper extremity
Background: Sensory processing disorders are one among the many complications of low birth weight and prematurity as multisensory integration is not adequately processed in them to provide appropriate responses to the demands of the environment. Early detection and screening of sensory integration dysfunction is one of the necessities for better developmental outcomes in preterm and low birth weight infants. Objective: To determine the prevalence of sensory integration dysfunction in low birth weight and preterm infants using short sensory profile. Methodology: This cross-sectional study included 100 infants with prematurity and low birth weight between the age group of 0 and 1 year who were recruited from a tertiary care hospital. Short sensory profile was used to assess the sensory integration dysfunction in these infants. Short sensory profile consists of seven sections and in each section there is a minimum of 3-6 questions which have to be answered by the primary caregiver of infants. The scores were recorded and the infants were categorized into typical performance, probable differences from typical, or definite differences from typical in each section, using predetermined score cut-offs. Results: The mean age of infants was 6.14 ± 3.49 months, gestational age was 33.95 ± 1.63 weeks, and birth weight was 1.88 ± 0.35 kg. Depending upon total performance score, 26% infants were found to have a definite difference from typical, 52% infants had a probable difference from typical, and 22% scored normal on short sensory profile. There was a significant correlation of gestational age ( P = 0.0421) and birth weight ( P = 0.0151) with sensory integration dysfunction. Conclusion: The prevalence of sensory integration dysfunction was found to be 26% in preterm and low birth weight infants.
Introduction: The etiology of cerebral palsy (CP) is very diverse and multifactorial including prenatal, natal, and postnatal factors. Objective: This study is an attempt to describe the distribution of risk factors among children with cerebral palsy. Materials and Methods: This study was conducted to explore perinatal risk factors among 307 children having cerebral palsy. Results: Major risk factors found in this study were history of spontaneous abortions in 33 (10.7%), anemia during pregnancy in 53 (17.3%), hypertension in 26 (8.5%), and history of infection in 22 (6.2%) mothers. In total, 141 (45%) children were born preterm and 28 (9.1%) were born in multiple births. Further, it was also found that 12 (3.9%) deliveries were forceps delivery. Out of the total 307 respondents, 208 (67.8%) reported a history of delayed crying of their child at birth. Out of the available record of 278 children, 108 (38.8%) had birth weights of Conclusions: In this study, factors related to poor antenatal care as well as other unavoidable risk factors were found; therefore, there is a need to prevent avoidable causes that lead to CP through strict standard practices, mass awareness programs, etc.
Prone position -Swiss ball training  
This case study describes the physical therapy of a 9-year-old male child with spastic diplegic cerebral palsy with the aim to improve his gross motor function and social skills. The child had severe impairments across the full spectrum of developmental functions, especially affecting the gross motor and self-care functions at Stage V of gross motor function classification system (GMFCS) in spastic diplegic cerebral palsy. His body was completely stiff with marked asymmetrical spasticity in lower limbs, truncal dystonia, and chest deformity with cardio respiratory complications. The physical therapy was performed by giving sessions of Roods approach, sensory integration, and static weight-bearing exercise for a period of 9 months. Pre- and post-therapy evaluation of child was done using GMFCS. There was an improvement in the child with his social skills, transitional activities, activities of daily living, and gross motor skills, reaching to Stage IV with the 9 months physiotherapy intervention given by a neurological physical therapist.
Correlation of QUEST with GMFCS, MACS, and self-care domain of functional skills along with caregiver assistance of PEDI 
Background: Most of the children having spastic diplegia show variability in upper limb and upper trunk functions. Due to this variation in upper limb and upper trunk, the quality of upper limb function may affect and limit the independence of functional activities in these children. Hence, this study aimed to find the relation of the quality of upper limb function to independent gross motor and manual ability function in children with spastic diplegia. Materials and Methods: Overall, 30 children (both girls and boys) who were diagnosed with spastic diplegia (age ranged 4 to 8 years) were included. Children having any musculoskeletal deformity of upper limb or fracture or who had undergone administration of botulinum toxin or soft tissue release surgery in last 6 months or who were unable to follow commands were excluded from this study. Included children were classified in gross motor function classification system (GMFCS) and manual ability classification system (MACS) level. The outcome measures used were quality of upper limb function, which was assessed using quality of upper extremity skills test, and self care was assessed using self care domain of functional skills with its caregiver assistance of pediatric evaluation of disability inventory (PEDI). The data were analyzed. Results: Spearman coefficient of correlation was calculated. The quality was found having moderate correlation with GMFCS (−0.459) and MACS (−0.589), while it strongly correlated with self care domain of functional skills (0.647) and caregiver assistance of PEDI (0.666). Conclusion: The quality of upper limb functions was affected in children with spastic diplegia. This was reflected on self care domain along with caregiver assistance of PEDI.
Cerebral palsy (CP) is one of the most common childhood physical disabilities and often requires various treatments. The experience of living with CP and receiving early-life medical treatments could be psychologically traumatic and stressful. Previous studies found that psychological problems are not uncommon among individuals with cerebral palsy. However, the comorbidity of CP and tertiary structural dissociation of the personality (TSDP) is an unaddressed topic in the field and has just been brought into the literature recently. TSDP is the extreme form of posttraumatic psychopathology, and its typical clinical example is the DSM-5 dissociative identity disorder. This paper provides a preliminary report of four patients with comorbidity of cerebral palsy and TSDP. This complicated comorbidity might be a new challenge in the field and more attention to it is needed. Further investigations of this comorbidity are necessary. Some implications for research and practice are discussed.
Background: Estimates of services use by children with developmental delay and disability are quite limited. Researches indicate that factors such as race, gender, poverty, nonavailability of health services, and health insurance are associated with lower rates of participation in early intervention services. Therefore, assessment of risk is considered nodal for nonparticipation in early intervention programmes. The aim of the present study was to compare the factors for poor follow‑up in early intervention programme for children with developmental delay. Methods: Nine children aged 0–3 years with developmental delay attending early intervention programme, and nine age‑matched children irregular in this programme were included using purposive sampling technique. Sociodemographic and clinical characteristics were compared. Identifiable factors for poor follow‑up were assessed and compared between both groups. Results: We found significantly higher rates of poor follow-up who belonged to lower socioeconomic status. Moreover, misconception about delay in development and medical morbidity of child were other reasons for poor follow‑ups. Interestingly, we also found delay in use of hand by the child was a reason for poor follow‑up. Conclusion: We conclude that some factors responsible for poor follow‑ups must be addressed at the beginning of enrollment in early intervention programmes in order to sustain them for long, thereby getting benefits out of it.
Top-cited authors
Prasenjit Sengupta
  • Burdwan Medical College
Asutosh Pal
  • Medical College Kolkata
Sandip Pal
  • Calicut Medical College
Jacky Ganguly
  • The University of Western Ontario
Chetana Sen
  • Institute of Neurosciences-Kolkata