Effect of VOJTA Therapy on Gross Motor Function in Children with Cerebral Palsy

Objective: To investigate the effect of VOJTA therapy on gross motor function in children with cerebral palsy. Methods: The 86 children with cerebral palsy were all from the First People’s Hospital of Jingzhou City from January 2023-December 2023, and were divided into the control group and the study group with 43 cases according to the principle of voluntariness. Results: In terms of total effective rate of treatment, the gross motor function scale-88 (GMFM-88) was used to evaluate the effective rate before and after treatment, and the effective rate of the study group was higher than that of the control group, and the difference was statistically significant, and the scores of gross motor items of GMFM-88 were better than those of the control group after treatment, and the difference was statistically significant (P 0.05). Conclusion: The application of VOJTA therapy in the treatment of children with cerebral palsy can not only promote the rehabilitation of gross motor function, but also help to improve the treatment effect, and the earlier the treatment, the better.

Mothers’challenges and experiences of children with cerebral palsy:a qualitative meta-synthesis

Objective:To examine what challenges and experiences a mother faces in caring for children with cerebral palsy(CP).As the main caregiver of children with CP,mothers are under multiple pressures.Even though mothers’challenges and experiences of children with CP will affect their quality of life and the rehabilitation of the children,little is known about their challenges and experiences during the whole care.Methods:A qualitative meta-synthesis was conducted to extract and analyze qualitative research from the PubMed,CINAHL,PsycINFO,Web of Science,Ovid and MEDLINE databases.Thirteen articles were selected and analyzed using thematic syntheses.Results:From 2522 screened abstracts,84 texts were reviewed,and 13 studies met the inclusion criteria.Mothers’challenges and experiences of children with CP include 4 themes,both positive and negative.Conclusions:The mothers of children with CP suffer from physical burden,as well as psychological pressure,in the care experience;social and healthcare support are their main challenges.Interventions to help them face the difficulties and adapt to the role of caregivers as soon as possible should target multiple aspects in order to maximize effectiveness,to promote the healthy growth of children with CP.

Effect of Lumbar Spinal Point Injection on Sitting Function in Children with Cerebral Palsy

Objective: To observe the effect of lumbar spinal point injection on sitting function in children with cerebral palsy. Method: Sixty-two children with post-confirmed cerebral palsy were randomly divided into control group and treatment group, 31 each. The control group was given conventional rehabilitation treatment, and the treatment group was given lumbar chiropspinal acupoint injection on the basis of the treatment method of the control group. After 3 consecutive courses of treatment, the sitting score of the two groups before and after treatment (GMFM88) was used to evaluate the sitting score before and after treatment. Outcome: Before treatment, the two groups were evaluated and the differences were not statistically significant (p > 0.05), which was comparable. The two groups (GMFM88) after treatment had significantly increased the differential values, and the difference was statistically significant compared with the same group before treatment (p Conclusion: Conventional rehabilitation combined with lumbar spinal point injection can effectively improve the sitting motor function of children with cerebral palsy.

Ultrasound guided neural stem cell transplantation through the lateral ventricle for treatment of cerebral palsy in children

A total of 24 children with cerebral palsy were enrolled in this study and underwent ultrasound guided transplantation of neural stem cells through the lateral ventricle. Neural stem cells （3.8 x 106-7.3 x 107） were injected into the lateral ventricles. Mild injury of lateral ventricular blood vessels occurred in only two cases （8.3%）. Seven cases （29.2%） experienced a fever. Clinical manifestations were improved to varying degrees in eight cases （28.0%） within 3 months after transplantation. Patient condition did not worsen, and no patient experienced severe adverse reactions.

Prevalence and predictors of urinary tract infections among children with cerebral palsy in Makurdi, Nigeria

Background: Children with cerebral palsy (CP) are prone to urinary tract infection (UTI), a common cause of childhood morbidity and mortality. However, there has been no report regarding the prevalence of UTI among this group of children inNigeria. Objectives: The study aims at determining the prevalence and the possible predictors of UTI in children with CP compared to age and sex matched children without CP. Methods: A prospective cross-sectional study was carried out among consecutive children with CP at the Neurologic Clinic in the Paediatric Department of the Federal Medical Centre, Makurdi, Nigeria, from December 2011 to May 2013. Results: The age range of the studied population was between 2 and 15 years with a mean age of 8.63 ± 3.83 years including 30 males and 22 females. UTI was confirmed in 20 (38.5%) children with cerebral palsy compared to 2 children (3.8%) without CP (p value 0.000). Among children with CP, Escherichia coli was the commonest organism isolated in 9 (9/20, 45.0%), Streptococcus faecalis in 4 (20.0%), Staphylococcus aureus in 3 (15%), while both Proteus spp., and Klebsiella spp., were isolated in 2 children (10.0%) each. Escherichia coli was also found in the 2 children without CP. All the organisms were resistant to co-trimoxazole, nalidixic acid, nitrofuratoin and amoxiclav, while they were 100% sensitive to ceftriazone and the quinolones. In a univariate regression, analysis only moderate to severe gross motor dysfunction predicted the risk of UTI (OR = 54.81, 95%CI, 2.27 - 1324.00, p value 0.014). Conclusion: Efforts should be put in place to aid mobility among children with CP in order to reduce risk of UT.

Effects of the Neurodevelopmental Treatment (NDT) on the Mobility of Children with Cerebral Palsy

The purpose of the present study was to examine the effectiveness of the NDT method (Bobath) in children with CP. Twenty children with cerebral palsy (7 with quadriplegia, 6 with diplegia and 7 with right hemiplegia), with mean age of 4. 85 ± 2. 49 years, took part in the study. Materials-Method: The children participated in an intervention that consisted of an 8-week Bobath program. GMFM-88, PEDI and TUG scores were measured across three time points during the intervention (a baseline measurement, a second at the end of the intervention and a post-intervention measurement one month after the end of the intervention). Results: The results of the NDT intervention showed that the participant children significantly improved their GMFM-88 and TUG scores between initial and final measurement and maintained this one month later (F2,36 = 69,778, p 0.001), while in PEDI the intervention program had no statistically significant effect (F2,36 = 0.844, p = 0.438). In conclusion, there is strong evidence of the effectiveness of the NDT (Bobath) method in improving the mobility of children regardless of the frequency of its application.

Clinical Observation of Double Tube Laryngeal Mask in Fast-Track Anesthesia for Limb Orthopedic Surgery in Children with Cerebral Palsy

Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.

Gait analysis of children with spastic hemiplegic cerebral palsy

An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebra palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.

Therapies for children with cerebral palsy A Web of Science-based literature analysis

OBJECTIVE： To identify global research trends in three therapies for children with cerebral palsy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on therapies for children with cerebral palsy from 2002 to 2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed published articles on botulinum toxin, constraint-induced movement therapy, or acupuncture for children with cerebral palsy indexed in Web of Science; （b） original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items; and （c） publication between 2002 and 2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） documents that were not published in the public domain; and （c） a number of corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1） Number of publications on the three therapies; （2） annual publication output, distribution by journals, distribution by institution, and top-cited articles on botulinum toxin; （3） annual publication output, distribution by journal, distribution by institution, and top-cited articles on constraint-induced movement therapy; （4） annual publication, distribution by journal, distribution by institution, and top-cited articles on acupuncture. RESULTS： This analysis, based on Web of Science articles, identified several research trends in studies published over the past 10 years of three therapies for children with cerebral palsy. More articles on botulinum toxin for treating children with cerebral palsy were published than the articles regarding constraint-induced movement therapy or acupuncture. The numbers of publications increased over the 10-year study period. Most papers appeared in journals with a focus on neurology, such as Developmental Medicine and Child Neurology and Journal of Child Neurology.Research institutes publishing on botulinum toxin treatments for this population are mostly in the Netherlands, the United States of America, and Australia; those publishing on constraint-induced movement therapy are mostly in Australia and the United States of America; and those publishing on acupuncture are mostly in China, Sweden and the United States of America.CONCLUSION： Analysis of literature and research trends indicated that there was no one specific therapy to cure cerebral palsy. Further studies are still necessary.

Clinical Study on Improving Articulation Clarity in Spastic Cerebral Palsy with 120 Cases of Oral-Facial Acupressure Combined with Oral Placement Therapy

Objective:To observe the efficacy of oral-facial acupressure combined with oral placement therapy(OPT)in improving articulation clarity in 120 children with spastic cerebral palsy,and to explore effective therapeutic solutions for speech disorders associated with spastic cerebral palsy.Methods:A total of 120 children with spastic cerebral palsy and speech disorders,meeting the inclusion criteria,were randomly assigned into two groups:60 cases in the treatment group and 60 cases in the control group.The treatment group received orofacial acupressure combined with OPT,while the control group received only OPT.The Oral Motor Function Assessment Scale(OMFAS),developed by the China Rehabilitation Research Centre(CRRC),was used to evaluate the treatment outcomes before and after the intervention.Results:After the treatment,both the treatment and control groups showed improved mobility of the mandible,lips,and tongue.However,the treatment group exhibited significantly better improvement than the control group,with the difference between the two groups being statistically significant(P<0.05).Conclusion:Oral-facial acupressure combined with OPT can effectively improve articulation clarity in children with spastic cerebral palsy.This combined therapy is recommended for clinical promotion and application.

Analysis of orthopedic surgical procedures in children with cerebral palsy

BACKGROUND Orthopedic surgery in children with cerebral palsy(CP)aims to improve function and prevent deformities.Each child’s condition in CP is unique and many covariables influence surgical decision-making including a patient's age and their functional level.Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels,particularly in countries from Latin America.AIM To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.METHODS This retrospective study included all children with CP(n=245)treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database.Eighteen children(7%)were lost to follow-up due to missing medical charts.Demographics,gross motor function classification(GMFCS),and orthopedic surgeries were obtained from the medical records of 227 children.Chi-squared tests and analysis of variance were used to assess the frequency of surgery,accounting for GMFCS levels.Mean age for soft tissue vs bone surgery was compared with the independent samples t-test.RESULTS A total of 711 surgical procedures were performed between 1998 and 2016.On average,children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years.There were no significant differences in age at first surgery among GMFCS levels(P=0.47).The most common procedures were lower leg soft tissue surgery(n=189,27%),hip tenotomy(n=135,19%),and hamstring tenotomy(n=104,14%).For children with GMFCS level Ⅰ,the mean number of surgeries per child[1.8(range 1-9)]differed significantly at P<0.05 in children with GMFCS levels Ⅱ[3.2(1-12)],Ⅲ[3.2(1-8)],Ⅳ[3.3(1-13)],and Ⅴ[3.6(1-11)].Within Ⅱ,Ⅲ,Ⅳ,and Ⅴ,there was no significant difference in mean number of surgeries per child when comparing across the groups.The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels Ⅰ-Ⅲ(80%-85%)compared to levels IV(68%)and V(55%)(P<0.05).CONCLUSION The frequency of surgical procedures per child did not increase with higher GMFCS level after level Ⅰ.However,the proportion of bone surgery was higher in GMFCS levels Ⅳ-Ⅴ compared to Ⅰ-Ⅲ.

Meta-analysis of the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy

Objective:To evaluate the clinical efficacy of Xingnao Kaiqiao acupuncture combined therapy in treating infantile cerebral palsy by meta-analysis.Methods:CNKI,VIP,Wanfang knowledge service platform,CBM,PubMed,Embase and Cochrane library databases were searched.The retrieval time period was pushed back to the establishment of the database in March 2021.Through layers of screening and quality evaluation of the included literature,the data were analyzed with Revman 5.4.Results:9 articles were included,a total of 748 cases.The results of meta-analysis showed that compared with other therapies(control group),Xingnao Kaiqiao acupuncture combined therapy(treatment group)could improve the total clinical effective rate(or=3.32,95%CI[2.14,5.13],P<0.00001),improve the ability of language acceptance(MD=1.13,95%CI[0.92,1.34],P<0.00001),and improve the ability of language expression(MD=1.28,95%CI[1.03,1.54],P<0.00001),improve gmfm88 score(MD=23.13,95%CI[18.75,27.51],P<0.00001),improve dysarthria score(MD=0.33,95%CI[0.26,0.41],P<0.00001),improve MCA of cerebral ultrasound blood flow examination(MD=13.12,95%CI[9.22,17.01],P<0.00001),and ACA of cerebral ultrasound blood flow examination(MD=9.45,95%CI[6.28,12.62],P<0.00001).Conclusion:Compared with other therapies,Xingnao Kaiqiao acupuncture combined therapy in the treatment of infantile cerebral palsy can improve the total clinical efficiency,and has obvious advantages in improving language function,gross motor function,dysarthria,MCA and ACA of cerebral ultrasonic blood flow examination,but it still needs more and higher quality literature to prove it.

Acupuncture for cerebral palsy: a meta-analysis of randomized controlled trials

OBJECTIVE： To evaluate the efficacy and safety of acupuncture therapy for children with cerebral palsy. DATA SOURCES： We conducted electronic searches of PUBMED（1950/2017）, EMBASE（1974/2017）, Science Direct（1986/2017）, Academic Source Premier（1887/2017）, the Cochrane Library（Issue 4, April 2017）, Science Citation Index Expanded（1900/2017）, China National Knowledge Infrastructure（1915/2017）, China Biological Medicine（1990/2017-04）, Wan Fang（1980/2017）, VIP（1989/2017）, and Chinese Science Citation Database（1989/2017）. DATA SELECTION： We included randomized controlled trials that aimed to compare the effect of acupuncture plus rehabilitation training versus rehabilitation training alone. Data about functional motor abilities, daily activity/social participation, effective rate, intellectual development, and adverse effects were included. We used Revman 5.2 software for statistical analysis. OUTCOME MEASURES： The primary outcomes included functional motor abilities, daily activity, and effective rate. The secondary outcomes included intellectual development and adverse effects.RESULTS： Twenty-one studies with a total of 1718 participants met the inclusion criteria. The effect size of gross motor function（SMD = 0.64, 95% CI： 0.52 to 0.76, P 〈 0.00001; I^2 = 0%, P = 0.69; in 13 studies with 1144 patients） and the total effective rate（RR = 1.28, 95% CI： 1.20 to 1.37, P 〈 0.00001; I^2 = 18%, P = 0.27; in 12 studies with 1106 patients） suggested that acupuncture plus rehabilitation produced a significant improvement in gross motor function and a high total effective rate. The pooled fine motor function（SMD = 3.48, 95% CI： 2.62 to 4.34, P 〈 0.00001; I^2 = 64%, P = 0.10; in 2 studies with 193 patients）, modified Ashworth scale scores（SMD = –0.31, 95% CI： –0.52 to –0.11, P = 0.003; I^2 = 74%, P = 0.004; in 5 studies with 363 patients） and activities of daily living（SMD = 1.45, 95% CI： 1.20 to 1.71, P 〈 0.00001; I^2 = 78%, P = 0.004; in 4 studies with 313 patients） also indicated improvements in children with cerebral palsy. Publication bias was not observed. Only mild adverse events related to acupuncture were reported. CONCLUSION： Acupuncture plus rehabilitation training improved gross motor function, reduced muscle spasms, and enhanced daily life activities in children with cerebral palsy. However, this conclusion should be interpreted with caution due to the small number of randomized controlled trials available and the small sample sizes. More high-quality and large-scale studies are needed.

Mononuclear cells from the cord blood and granulocytecolony stimulating factor-mobilized peripheral blood:is there a potential for treatment of cerebral palsy?

To investigate a possible therapeutic mechanism of cell therapy in the field of cerebral palsy using granulocyte-colony stimulating factor（G-CSF）-mobilized peripheral blood mononuclear cells（m PBMCs）,we compared the expression of inflammatory cytokines and neurotrophic factors in PBMCs and m PBMCs from children with cerebral palsy to those from healthy adult donors and to cord blood mononuclear cells donated from healthy newborns.No significant differences in expression of neurotrophic factors were found between PBMCs and m PBMCs.However,in cerebral palsy children,the expression of interleukin-6 was significantly increased in m PBMCs as compared to PBMCs,and the expression of interleukin-3 was significantly decreased in m PBMCs as compared to PBMCs.In healthy adults,the expression levels of both interleukin-1βand interleukin-6 were significantly increased in m PBMCs as compared to PBMCs.The expression of brain-derived neurotrophic factors in m PBMC from cerebral palsy children was significantly higher than that in the cord blood or m PBMCs from healthy adults.The expression of G-CSF in m PBMCs from cerebral palsy children was comparable to that in the cord blood but significantly higher than that in m PBMCs from healthy adults.Lower expression of pro-inflammatory cytokines（interleukin-1β,interleukin-3,and-6）and higher expression of anti-inflammatory cytokines（interleukin-8 and interleukin-9）were observed from the cord blood and m PBMCs from cerebral palsy children rather than from healthy adults.These findings indicate that m PBMCs from cerebral palsy and cord blood mononuclear cells from healthy newborns have the potential to become seed cells for treatment of cerebral palsy.

Research progress regarding the nutritional status and assessment methods of cerebral palsy patients

Cerebral palsy is a group of clinical disorders characterized by persistent central motor deficits and postural abnormalities due to non-progressive damage to the fetal or infant brain.Malnutrition is one of the most common clinical comorbidities in children with cerebral palsy and is the result of a combination of internal factors,such as the child’s structural and functional abnormalities,and external factors,such as the child’s feeding habits and family/social factors.The nutritional status of children with cerebral palsy is closely related to their development,quality of life,social participation,and life expectancy;thus,an objective and accurate understanding of the nutritional status of these children through rehabilitation assessment is essential for their growth and development.The current nutritional assessments include routine measurements of human nutritional parameters,scale-based assessments,and instrumental assessments.It is important to detect malnutrition in children with cerebral palsy at an early stage,reduce the prevalence of malnutrition,and improve the quality of survival.Therefore,this review aimed to analyze and summarize the nutritional status and assessment methods of children with cerebral palsy,to assess the nutritional status of children with cerebral palsy from multiple perspectives,indicators and directions,and to provide reference for the early detection of co-morbid malnutrition in children with cerebral palsy.

Clinical observation on scalp acupuncture for diffusion tensor imaging in cerebral palsy children with periventricular leukomalacia

Objective： To observe the effect of Governor Vessel-unblocking and mind-refreshing needling technique on diffusion tensor imaging （DTI） in cerebral palsy （CP） children with periventricular leukomalacia （PVL） and investigate the underlying mechanism. Methods： A total of 18 CP children with PVL received modern rehabilitation training and scalp acupuncture. The before-after study was conducted to compare the fractional anisotropy （FA） of the white matter fiber tracts, gross motor function measure （GMFM） score, Gesell developmental scale and changes in muscle tone. Results： For the comparison before and after the first course of treatment, there were no statistical differences in DTI findings and FA values （both P〉0.05）; there were statistical differences in GMFM dimensions A and B （both P〈0.05） and no statistical differences in dimensions C, D and E （all P〉0.05）; and there were statistical differences in six items of Gesell development test （P〈0.01 or P〈0.05）. For the comparison before and after two courses of treatment, there were statistical differences in DTI findings and FA values in 8 cases between before and after 30 and 60 treatments （both P〈0.05）; there were statistical differences in GMFM dimensions A, B and C between before and after 30 and 60 treatments and between 30 and 60 treatments （all P〈0.05）; there were no statistical differences in GMFM dimensions D and E （all P〉0.05）; and there were statistical differences in six items of Gesell developmental test between before, after 30 and 60 treatments and between 30 and 60 treatments （P〈0.05 or P〈0.01）. Conclusion： The Governor Vessel-unblocking and mind-refreshing scalp acupuncture has no significant efficacy on the repair and regeneration of white matter fibers in children with PVL and CP in a short period of time; however, it gradually works along with the prolonged treatment time. In addition, it can improve the motor function and mental development and the efficacy is closely associated with the time of treatment.

Effect of total number of pulses of radial extracorporeal shock wave therapy (rESWT) on hamstring muscle spasticity in children with spastic type cerebral palsy: A randomized clinical trial

Purpose To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP).Methods This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1, 000 pulses, Group III: 1, 500 pulses, and Group IV: 2, 000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points (pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT).Results All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1, 500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2(2)=3.907,P=0.272], immediately post-ESWT [|2(2)=1.250,P=0.741], 2 weeks post-ESWT vs pre-ESWT [|2(2)=3.367,P=0.338], and 4 weeks post-ESWT vs pre-ESWT [|2(2)=1.566,P=0.667].Conclusion The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses.

Differences in standing balance between patients with diplegic and hemiplegic cerebral palsy

Maintaining standing postural balance is important for walking and handling abilities in patients with cerebral palsy. This study included 23 patients with cerebral palsy （seven with spastic diplegia and 16 with spastic hemiplegia）, aged from 7 to 16 years of age. Standing posture balance measurements were performed using an AMTI model OR6-7 force platform with the eyes open and closed. Patients with diplegic cerebral palsy exhibited greater center of pressure displacement areas with the eyes open and greater center of pressure sway in the medial-lateral direction with the eyes open and closed compared with hemiplegic patients, Thus, diplegic patients exhibited weaker postural balance control ability and less standing stability compared with hemiplegic cerebral palsy patients.

Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications

AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.METHODS: Twenty-one non-ambulatory children and adolescents(22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS: Seventeen patients(81%) were classified as GMFCS level Ⅳ, and 4(19%) patients were classified as GMFCS level Ⅴ. At the time of surgery, the mean age was10.3 years(range: 4-15 years). The mean Reimers' migration percentage improved from 63%(range: 3%-100%) pre-operatively to 6.5%(range: 0%-70%) at the final follow-up(p < 0.05). The mean acetabular angle(AA) improved from 34.1°(range: 19°-50°) pre-operatively to 14.1°(range: 5°-27°)(P < 0.05). Surgical correction of MP and AA was comparable in hips with open(n = 14) or closed(n = 8) triradiate cartilage(P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.

Bone Mineral Density and Vitamin D Status in Children with Chronic Neurological Syndromes—Clinical Observations

Background: Some of the risk factors for osteoporosis population include: chronic immobilisation, insufficient dietary supply of calcium and vitamin D, decreased physical activity and long-term pharmacological treatment (glucocorticoids, anticonvulsant drugs). In disabled children and adolescents, the negative impact of these factors may cumulate to considerably impair the quality of life. Objectives: The aim of our study was to assess the vitamin D status and bone mineral density in children with chronic neurological syndromes. Material and Methods: A total of 34 children between 3 and 18 years of age were examined: 9 children with muscular dystrophy, 17 with cerebral palsy and 8 with lumbar myelomeningocele. All the subjects underwent the following assessments: measurement of the concentration of the hepatic metabolite of vitamin D and total body less head and/or lumbar spine densitometry by dual energy X-ray absorptiometry (DEXA). Low bone mass or low bone mineral density was diagnosed if the Z-score value was found to be equal to or below &minus;2.0. Results: Indications for the above tests were chronic immobilisation or motor activity restriction, and—in 10/34 children—femoral or vertebral fracture. Vitamin D deficiency (81%). Low bone mass on densitometry was demonstrated in 27/34 and osteoporosis in 10/34 subjects (Z-score &le;&minus;2.0). Conclusion: Bone densitometry should be included in the standard of care for children with chronic neurological syndromes, and early detection of low bone mass should be an indication for treatment with calcium and vitamin D.