Motor Cortex Plasticity in Children With Spastic Cerebral Palsy: A Systematic Review

A review of the literature was performed to answer the following questions: Does motor cortex excitability correlate with motor function? Do motor cortex excitability and cortex activation change after a rehabilitation program that results in improvements in motor outcomes? Can the 10–20 electroencephalography (EEG) system be used to locate the primary motor cortex when employing transcranial direct current stimulation? Is there a bihemispheric imbalance in individuals with cerebral palsy similar to what is observed in stroke survivors? the authors found there is an adaptation in the geometry of motor areas and the cortical representation of movement is variable following a brain lesion. The 10–20 EEG system may not be the best option for locating the primary motor cortex and positioning electrodes for noninvasive brain stimulation in children with cerebral palsy.     

Coping Strategies and Resolution in Mothers of Children With Cerebral Palsy

“Parental resolution” represents parents coming to terms with their child’s health condition. Differences in the use of coping strategies between mothers who were resolved versus unresolved to their child’s diagnosis was investigated, and a possible moderating effect of these strategies was explored. A strategy aimed at mobilizing the family to acquire and accept help (institutional, formal support) was shown to be a significant moderating variable, in a way that its more frequent use allowed mothers of children with better functional status (but not mothers of children with poorer functional status) to reach resolution.     

Lower Extremity Kinetics for Balance Control in Children With Cerebral Palsy

The authors examined and compared the effect of support-surface perturbations of various magnitudes on lower extremity kinetics of 7 children with cerebral palsy (CP) and 8 typically developing (TD) children. Results showed that the highest velocity tolerated without stepping was slower in children with CP than in either age-matched TD or younger TD children. Multimodal torque profiles were more frequent in children with CP than in TD controls. TD groups temporally and spatially organized torque activation, whereas children with CP activated all joints simultaneously and showed altered torque contribution patterns among joints. Those results suggest that impairments in reactive postural control in children with CP result not only from developmental delay but also from pathology. Evidence for pathology included increased numbers of torque bursts required to regain stability and less efficient temporal and spatial organization of torque activation patterns.     

Effects of Visual Manipulation in Sit-to-Stand Movement in Children With Cerebral Palsy

The authors sought to verify the effects of vision on sit-to-stand (STS) movement performance by means of postural sway in children with cerebral palsy (CP) and typical children (TC). Participants were 42 TC and 21 children with CP. STS movement was assessed with eyes open and with eyes closed. Area and velocity of center of pressure sway were analyzed in each of the 3 STS phases. We observed greater postural sway during STS movement with eyes closed. Children with CP presented greater postural sway than TC did. Both groups exhibited greater postural instability with absence of vision expressing the role of vision to keep postural stability. Moreover, the greater postural instability was observed in children with CP.     

Hands Support and Postural Oscillation During Sit-to-Stand Movement in Children With Cerebral Palsy and Typical Children

The authors aimed to compare the weight bearing on hands during sit-to-stand (STS) movement in children with cerebral palsy (CP) and typical children (TC), verify its effect on postural oscillation, and analyze the relationship between weight bearing on hands and postural oscillation. Twenty children with CP (Gross Motor Function Classification System levels I and II) and 35 TC performed STS with and without anterior hands support. Mann-Whitney test compared weight bearing between groups. Wilcoxon test investigated differences in postural oscillation between the conditions with and without anterior hand support for both groups. The Spearman correlation tested the relationship between weight-bearing and postural oscillation during the hand support condition. Children with CP bore more weight on hands than TC to perform STS. The hand support reduced postural oscillation during the second phase of STS in both groups. In the CP group, greater weight bearing was related with lower postural oscillation in the beginning of STS. Although children with CP were able to perform STS without support, they bore more weight on their hands to perform the task than TC. Moreover, children with CP and TC use mechanical and somatosensory information to modulate their postural control during STS in different ways.     

Predictors of Reading Comprehension in Children with Cerebral Palsy and Typically Developing Children

Predictors of reading comprehension were evaluated in 41 children with cerebral palsy and 74 typically developing children between the ages of 6 and 12 years. Regression analyses were conducted to determine the relative contributions of measures of phonemic awareness, receptive vocabulary, and general reasoning to variance in reading comprehension. All three independent variables were statistically significant predictors of reading comprehension in both groups of participants. The impact of phonemic awareness on reading comprehension was moderated by age, but only in the typically developing group. Within the group with cerebral palsy, there was an indirect effect of functional expressive ability on reading comprehension, mediated by phonemic awareness. It is concluded that largely the same variables predict reading comprehension in children with cerebral palsy as in typically developing children, but that children with cerebral palsy continue to rely on phonological processing for a more protracted period of time.     

Age-related Changes in Postural Sway During Sit-to-stand in Typical Children and Children with Cerebral Palsy

Objective: To assess age-related changes in postural sway during sit-to-stand (STS) in typical children (TC) and children with mild cerebral palsy (CP). Methods: Thirty-five TC and 23 children with mild CP were allocated in four different age groups: 5–6, 7–9, 10–12, and 13–15 years; they all performed STS movements over a force plate. Anterior-posterior and medial-lateral amplitude of center of pressure (CoP) displacement, area and velocity of CoP sway were analyzed and compared between the age groups for TC and children with CP. Results: TC at 5 to 6 years of age showed higher values of anterior-posterior CoP displacement and Area of CoP sway than at 10–12 years, during the stabilization phase. There were no age-related changes for CP. Conclusion: TC change their postural sway during the last STS phase over the years, reducing their body sway. Children with CP did not show age-related changes in sway during STS, reflecting a distinct rhythm of postural control development in this population.     

Head and Trunk Movements During Turning Gait in Children with Cerebral Palsy

Thirty children with cerebral palsy (CP) and 22 typical developing (TD) were tested with 3D-gait analysis. At turning, trunk rotation was larger in CP2 (GMFCS II) than in TD and CP1 (GMFCS I), and head flexion was larger in CP3 (GMFCS III) than TD. Maximum head and trunk flexion values during the entire trial were larger in CP3 than in the other groups, and trunk flexion was larger in CP2 than in TD. Trial time increased with GMFCS-level. Less trunk rotation than TD and CP1 reflects spatial insecurity in CP2, which in CP3 is compensated by the walker. The flexed head and trunk in CP3 and trunk in CP2 may reflect deficits in proprioception and sensation requiring visual control of the lower limbs.     

Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized,Controlled, Double-Blind,Clinical Trial

The authors' aim was to investigate the effects of continuous transcranial direct current stimulation (tDCS) combined with virtual reality training on static and functional balance in children with cerebral palsy (CP). Twenty children with CP (6 girls and 14 boys; M age = 7 years 6 months ± 2 years) were randomly allocated to two groups. The experimental group received active tDCS and the control group received sham stimulation during the 10 sessions of virtual reality mobility training protocols. The children were evaluated on 3 occasions (preintervention, postintervention, and 1-month follow-up). Static balance was evaluated using a force plate under 4 conditions: feet on force plate with (a) eyes open and (b) with eyes closed, and feet on foam mat with (c) eyes open and (d) with eyes closed. Functional balance was evaluated using the Pediatric Balance Scale and the Timed Up and Go Test. The analyses demonstrated statistically significant postintervention and follow-up effects favoring the experimental group over the control group with regard to the Pediatric Balance Scale, Timed Up and Go Test, and area of oscillation of the center of pressure when standing on the force plate with eyes open. The present findings suggest that tDCS can potentiate the effects of virtual reality training on static and functional balance among children with CP.     

Stress and Coping: A Comparison of Self-Report Measures of Functioning in Families of Young Children with Cerebral Palsy or No Medical Diagnosis

We analyzed data from 87 mothers of children ages 15 to 44 months with cerebral palsy (CP) or no diagnosis, who completed the Dyadic Adjustment Scale, Parenting Stress Index, Support Functions Scale, and Inventory of Social Support. Principal components analysis of the 15 subscales from the 5 measures revealed few cross-measure loadings. Mothers of children with CP (severe or mild) reported higher levels of parenting stress than did mothers of controls. However, cluster analysis of self-report measures yielded a 5-cluster solution, with no diagnostic group differences across clusters. That is, there were no overall differences in self-reported family functioning according to presence or severity of the child's disability. The results are discussed in terms of the organization of family systems and their relationship to child diagnosis. Clinical implications for assessing and working with families are noted.     

Influence of Visual Dependence on Inter-Segmental Coordination during Upright Stance in Cerebral Palsy

Abstract

The presence of visual dependence as an influential factor on the development of functional stability in ambulatory individuals with cerebral palsy (CP) was studied in 22 adults with spastic bilateral CP, 11 of whom were considered visually dependent, and 18 healthy adults. Participants stood upright during pitch plane disturbances of the visual field and support surface. Intersegmental coordination behaviors were assessed by fitting trajectories of adjacent body segments to an ellipse. Mixed-model repeated measures ANOVAs were performed on ellipse orientation angle and area. Dissimilar stabilizing strategies adopted by the two groups with CP imply that visual dependence impacts postural control. Postural reorganization in response to visual flow in all groups indicates that we cannot ignore perceptual aspects of postural control when designing therapeutic interventions.     

Effects of Backpack Carriage on Dual-Task Performance in Children During Standing and Walking

Primary school children perform parts of their everyday activities while carrying school supplies and being involved in attention-demanding situations. Twenty-eight children (8–10 years old) performed a 1-legged stance and a 10 m walking test under single- and dual-task situations in unloaded (i.e., no backpack) and loaded conditions (i.e., backpack with 20% of body mass). Results showed that load carriage did not significantly influence children's standing and walking performance (all p > .05), while divided attention affected all proxies of walking (all p < .001). Last, no significant load by attention interactions was detected. The single application of attentional but not load demand negatively affects children's walking performance. A combined application of both did not further deteriorate their gait behavior.     

Strength Training Effects on Muscle Forces and Contributions to Whole-Body Movement in Cerebral Palsy

Strength training is often prescribed for children with cerebral palsy (CP); however, links between strength gains and mobility are unclear. Nine children (age 14?±?3?years; GMFCS I-III) with spastic CP completed a 6-week strength-training program. Musculoskeletal gait simulations were generated for four children to assess training effects on muscle forces and function. There were increases in isometric joint strength, but no statistical changes in fast-as-possible walking speed or endurance after training. The walking simulations revealed changes in muscle forces and contributions to body center of mass acceleration, with greater forces from the hip muscles during walking most commonly observed. A progressive strength-training program can result in isometric and dynamic strength gains in children with CP, associated with variable mobility outcomes.     

The Disability Paradox Revisited: Quality of Life and Family Caregiving in Pediatric Cerebral Palsy

Parents who have children with cerebral palsy (CP) have been reported to have a more impaired QL and higher levels of burden than parents of typically developing children; however, little is known about the positive dimensions of their caregiving experience. In this study, WHOQOL-Bref and The Revised Burden Measure were administered to a sample of 105 parents of children/adolescents with CP (clinical group) and 117 parents of children/adolescents with no disabilities (control group). Despite the fact that parents of children with CP reported more Subjective Burden and less caregiving Uplifts, there were more similarities than differences in the variables compared between clinical and control groups. For parents of children with CP, the associations between Burden dimensions and QL, and between caregiving Uplifts and QL, were respectively moderate and weak. Caregiving Uplifts were found to moderate the links between Objective Burden and Psychological QL, and between Relationship Burden and Social QL. In addition, differential main effects of Burden dimensions and caregiving Uplifts were verified for Physical, Psychological and Social QL domains. These results highlight the adaptation variability of parents who have children with CP, as well as the importance of acknowledging caregiving uplifts as a resource that may attenuate the impact of burden on their QL.     

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

Encoding and Retrieval Processes in Learning-Disabled,Head-Injured,and Nondisabled Young Adults

Using a multi-trial, free-recall paradigm (Rey Auditory-Verbal Learning Test; Lezak, 1983), the acquisition and retention by learning disabled (LD) young adults with a Halstead Impairment Index less than or equal to 0.3 (low LD) or greater than or equal to 0.4 (high LD) was compared with that of nondisabled and head-injured (HI) young adults. Significant group differences, particularly during the last three acquisition trials, confirmed the effectiveness of this method in revealing subtle learning and retention deficits. Analyses of Trial 1 recall showed group differences in the prerecency but not the recency portion of the serial position curve, thus implicating long-term but not short-term memory differences between the groups. Analyses of pair frequency (Sternberg & Tulving, 1977) data showed that the three clinical groups had difficulty organizing the to-be-learned material for effective retrieval. Following an interpolated task, retention was poorer for the clinical groups than for the nondisabled and varied inversely with the degree of neuropsychological impairment. Finally, during retention, the nondisabled and low LD groups retained and used the list organization established during acquisition whereas the high LD and HI groups did not.     

Verbal and Nonverbal Metaphor With Children in Counseling

The metaphor is typically viewed as a verbal form of expression in traditional talk therapies. However, this definition excludes nonverbal metaphors that children use when they express themselves through play. In this article, the authors examine the use of therapeutic metaphors, both verbal and nonverbal, with children. The roles of the child, counselor, and family in treatment are discussed, along with the benefits and limitations of using therapeutic metaphors with children. The use of quantitative, qualitative, and integrated methods for studying children's use of verbal and nonverbal metaphors in counseling is also examined.