Influence of gait analysis on decision-marketing for lower extremity surgery

Relationship between upper limb function and neuroradiological findings in children with hemiplegic cerebral palsy

H FEYS PT PHD A, M EYSSEN MD B, E JASPERS MSC PT A, K KLINGELS
MSC PT A, C HUENAERTS MSC PT C, K DESLOOVERE PHD A,C,
G MOLENAERS PHD MD D, P DE COCK MD PHD D

  1. 1. Department of Rehabilitation Science, Catholic University Leuven;
  2. 2. Department of Pediatrics;
  3. 3. Clinical Movement Laboratory, University Hospital Leuven;
  4. 4. Faculty of Medicine, Catholic University Leuven, Belgium

Objectives: Although some studies have been published on the relation between lesion type and clinical findings, results have not always been convergent. The objective of this study was to examine the relationship between neuroradiological findings and upper extremity function in children with hemiplegic cerebral palsy (CP).

Design: Cohort study.

Setting: Clinical motion analysis laboratory, University Hospital, Pellenberg.

Participants: Fifty-four participants out of 85 children (age 5-15y) with hemiplegic CP and magnetic resonance images (MRI) available, consecutively referred to the clinical motion analysis laboratory were included in the study.

Method: MRI were independently reviewed by a neuropediatrician and neuroradiologist, who were blind to the clinical results. Children were classified into four groups: (1) congenital brain malformations (CBM); (2) periventricular lesions (PVL; (3) cortical-subcortical pre- or perinatal brain lesions (CSC); and (4) acquired brain lesions (ACQ), which correspond to different types of structural pathologies, depending mainly on the stage of brain development. Also, the involvement of the different neuroanatomical structures was cored (absence or presence of a lesion). Clinical assessments included measures of upper limb function (Melbourne Assessment for Unilateral Upper Limb Function, House Classification) and motor impairments (passive range of motion, modified Ashworth scale, manual muscle strength, and grip strength). Comparative statistics and correlation analysis were used.

Results: According to the classification groups, three children had a CBM, 29 a PVL, 14 a CSC, and eight an ACQ lesion. Comparison between the PVL, CSC, and ACQ groups revealed a highly significant difference for the Melbourne Assessment (p<0.003) and House Classification (p<0.001). Post-hoc tests showed significant difference between the PVL versus CSC and ACQ groups (p<0.05), in favor of the children with PVL lesions. Difference between CSC and ACQ lesions were not significant, although trends towards worse results in the ACQ group were found. Comparison of motor impairments between lesion groups revealed a significant difference for muscle tone (p=0.04) and muscle strength (p=0.002). Within the group with PVL, significantly better results were also found for most outcome measures in children with pure lesions in comparison to mixed lesions (p<0.05). Correlation analysis additionally showed that middle cerebral artery infractions and basal ganglia/thalamic lesions were significantly correlated to a worse performance (coefficients values between 0.31 and 0.54).

Conclusions: The type of brain lesions distinguish children with hemiplegic CP with regard to upper limb function. This is important for prognosis and may contribute to a better delineation of interventions in the future.

 
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