ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<109::AID-MRDD1>3.0.CO;2-M

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractPremature infants, who now survive in greater numbers than ever before, are at increased risk for motor and other neurologic disabilities. Risk is highest at the lowest extremes of birthweight and gestational age. This article focuses on children born weighing less than 1500 g (those of very low birthweight [VLBW]), almost all of whom are very premature. Maternal infection, especially intrauterine infection, is associated with preterm delivery, increased risk of cerebral palsy (CP), and neonatal brain imaging findings related to CP risk. Administration of magnesium sulfate prenatally, for maternal preeclampsia or for tocolysis, has been associated with reduced risk of CP. Multiple births tend to be low in birthweight, but whether and to what degree VLBW twins and triplets are at additional risk of unfavorable neurologic outcome compared with VLBW singletons of similar birthweight and gestational age is not yet clear. Potential causes and indicators of birth asphyxia are apparently not major factors in CP among VLBW infants. Many but not all the predictors of low birthweight are also predictors of neurologic morbidity among VLBW infants. For example, maternal smoking is related to low or very low birthweight (but not prematurity) and is not related to risk of CP and preeclampsia has been observed in recent studies to be associated with lower CP risk. MRDD Research Reviews 3:112‐117, 1997. Published 1997 Wiley‐Liss, Inc.This article is a US Government work and, as such, is in the public domain in the United States of Amer

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<112::AID-MRDD2>3.0.CO;2-T

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractImaging studies, particularly magnetic resonance (MR) imaging, can be extremely helpful in cerebral palsy. Both the cause of insult and the age of the fetus at the time of the insult are important factors in determining the signal intensity and pattern of abnormality detected on MR imaging. As a result, MR studies can provide information regarding both the cause and timing of the cerebral damage or malformation. Additionally, MR studies are capable of determining the extent or severity of cerebral involvement, which can affect prognosis. This article presents imaging findings associated with the most common causes of cerebral palsy. MRDD Research Reviews 3:118‐128, 1997. © 1997 Wiley‐Liss,

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<118::AID-MRDD3>3.0.CO;2-N

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractCerebral palsy (CP) is an often severe disability associated with abnormal growth, body composition, physical activity, and food intake as well as malnutrition. Children with severe CP have linear growth that is often reduced to less than 3rd centile with progressively delayed growth with age. Milder CP is characterized by somewhat reduced growth (near 25th to 50th centiles). A primary contributor to growth retardation is malnutrition associated with poor feeding skills and oromotor dysfunction. Disease severity and the complex of other associated abnormalities (e.g., abnormal stress on bones, endocrine abnormalities) also appear to contribute to poor growth. Body composition in children with CP is also abnormal. As expected, fat free mass is reduced due to poor linear growth, muscle mass depletion, and disuse atrophy. Fat mass is also reduced, at least in part secondary to malnutrition. Dietary intake in most children is less than normal for age, although sometimes appropriate for body size. Resting energy expenditure is decreased in the most severely affected children, particularly among those who are most severely malnourished. Total energy expenditure is also reduced due to lack of physical activity and malnutrition. Reported dietary intake appears to be a poor indicator of actual energy needs when compared with information from total energy expenditure. Clinical evaluation of growth, body composition, and nutritional status should be performed using a specialized measurement to replace body height. In addition, fat mass should be assessed using skinfold thicknesses to detect malnutrition. When possible, measurements of energy expenditure should be used to estimate dietary requirements. MRDD Research Reviews 3:129‐137, 1997. © 1997 Wiley‐Liss,

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<129::AID-MRDD4>3.0.CO;2-M

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractThe goals of motor intervention for children with cerebral palsy have shifted over the past decade from an emphasis on isolated components of movement and developmental milestones to a focus on demonstrating functional skills as a part of meaningful activities. Recent theoretical development and research focused on understanding the development of motor skills in very young children support the position that function and repetition facilitate the acquisition and expression of early motor skills. These advances suggest that learning, social interaction, and experience are integrally involved in the process of motor development in both typically and atypically developing children. Taken together, these issues support the need for developing interventions that combine the strengths of multiple approaches. This article describes the evolution of an intervention approach termed neurobehavioral. A brief review of the literature that forms the foundation of the approach is provided. This is followed by a description of the intervention and a summary of empirical work to date. MRDD Research Reviews 3:138‐144, 1997. © 1997 Wiley‐Liss,

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<138::AID-MRDD5>3.0.CO;2-N

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractDevelopmental therapies in children with cerebral palsy have been a traditional mainstay of treatment. Their use is part of mandated intervention programs in every state. Until recently, however, research into the effects of these interventions has been limited both in scope and quality. This paper reviews the status of research into the effects of developmental therapies, using physical therapy in cerebral palsy as the model. Recent studies have not demonstrated consistent treatment effects in cerebral palsy, but the quantity and scope of the research is insufficient to make global statements about treatment effect. Directions for future research should include multi‐center clinical trials incorporating no‐treatment control groups as well as single‐subject studies to generate hypotheses for larger studies. A wide variety of parameters of the subject–treatment interaction may affect treatment outcome and should be investigated. These include treatment timing, intensity, parent involvement, treatment combinations, and the profile of the child's associated disabilities. Study cohorts at extreme risk for cerebral palsy can be identified through neuroimaging and may allow evaluation of very early treatment effects. Studies evaluating a wide range of measures, including functional and economic outcomes, are necessary if decisions about program support are to based on treatment effectiveness as well as cost. MRDD Research Reviews 3:145‐152, 1997. © 1997 Wiley

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<145::AID-MRDD6>3.0.CO;2-Q

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractMotor disability is the cardinal symptom of cerebral palsy. Based on the nature of motor dysfunction, cerebral palsy can be subdivided into three major types: 1) spastic cerebral palsy associated with damage to cortical motor areas and/or underlying white matter, 2) choreoathetotic cerebral palsy associated with damage to the basal ganglia, and 3) ataxic cerebral palsy associated with damage to cerebellar structures. People with cerebral palsy often exhibit a wide range of motor symptomatology representing a mix of these three basic conditions. Common motor disorders in cerebral palsy that may appear in different combinations include co‐contraction of antagonist muscles, spasticity and related signs such as clonus and reflex irradiation, mirror movements, impaired ability for rapid and selective voluntary activation of muscles, increased muscle tone often appearing as sustained involuntary contractions at rest, chorea, athetosis, dystonia, impaired balance control, and ataxia. This paper focuses on recent neurophysiological developments in understanding the nature of motor impairments in cerebral palsy, particularly with reference to co‐contraction of antagonist muscles, mirror movements, and basal ganglia circuit dysfunction that may underlie choreoathetotic disorders. MRDD Research Reviews 3:153‐167, 1997. © 1997 Wiley‐L

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<153::AID-MRDD7>3.0.CO;2-S

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractSelective dorsal rhizotomy (SDR) is performed for relief of severe spasticity in patients with cerebral palsy (CP). The surgical procedure is designed to ablate a select portion of dorsal spinal root segments that are contributing to abnormal tone and interfering with appropriate function. The surgery is reported to reduce spasticity, improve independent mobility, facilitate activities of daily living, and reduce the risk of common complications of spasticity in CP. Optimistic, uncontrolled studies with largely subjective outcome measures were responsible for increased enthusiasm and expanded use of the procedure during the last decade. Evaluation of the functional benefits of the procedure using prospective, randomized, controlled trials has only recently been undertaken. Without a valid test for efficacy, the independent effect of SDR cannot be separated from the effects of other interventions, such as physical therapy, the considerable power of parental expectations, the increasing maturity in developing children with CP, and placebo effect. Scientific studies of the neurophysiologic and functional benefits of SDR are in progress at several centers at the present time and will likely yield valuable information about the efficacy of the procedure. MRDD Research Reviews 3:168‐174, 1997. © 1997 Wiley‐Liss,

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<168::AID-MRDD8>3.0.CO;2-N

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractThe delay in developmental milestones in cerebral palsy (CP) is presumed to result from a nonprogressive insult to the developing central nervous system (CNS). In CP, the site(s), type, duration, and magnitude of CNS insult(s) may never be defined, and a single focus of damage may not be revealed by standard brain imaging methods. The neurological examination (i.e., assessment of reflexes, tone, and motor coordination) generally does not define the insult with precision, nor can it predict the delays in motor skill development. The CNS damage may only be suspected from the medical history during the prenatal or perinatal period; confirmation of CNS insult may be deferred until the child misses developmental milestones in the first few months or years of life. In CP, patterns of motor incoordination and delay emerge gradually over time during development. While the original CNS injury is presumed to be a nonprogressive insult to higher motor centers (e.g., cerebral motor cortex), the damage probably causes significant modulation of functional neural connections during maturation of the brain and spinal cord. Such aberrant communication in motor pathways may be caused by, or result in, motor incoordination. In turn, repetition of uncoordinated movements may reinforce aberrant neural connections with, or at, the spinal cord. In this paper, we review neural responses to stimulation of sensory and motor systems and compare data for healthy neonates and children, and children and adults with CP. Age‐related differences are identified in measured onset latencies of responses, computed central conduction delays, and relative levels of excitatory drive. Differences in muscle responses are shown among subject groups for myotatic reflex activation of agonist, antagonist, and more distant limb muscles. From these data, inferences have been made that, in CP, impairments in CNS circuitry may include descending corticospinal pathways and/or spinal reflex pathways (e.g., “reciprocal excitation”). Data from a number of investigators support the theory that changes in spinal reflex pathways are likely to play a fundamental role in the development of motor control. MRDD Research Reviews 3:175‐183, 1997. © 1997 Wiley

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<175::AID-MRDD9>3.0.CO;2-Q

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY

摘要:

AbstractThis paper discusses the definition and subclassification of cerebral palsy, its ascertainment, birth prevalence, and aetiology. Cerebral palsy is a description defined by clinical observation rather than a diagnosis informative about aetiology, pathology, or prognosis. As a disease entity it is aetiologically and pathologically diverse. The cerebral palsy grouping is useful for management and service planning but the combining of several individually rare congenital and early childhood conditions creates an epidemiological challenge. The birth prevalence of cerebral palsy in the developed world has not declined since the mid‐1950s, in contrast to perinatal mortality. The proportion of children with cerebral palsy that are born very preterm has increased with the advent of neonatal intensive care, and refinement of the techniques of neonatal intensive care may be necessary before its benefits can be fully realised. Since cerebral palsy is, by definition, incurable, epidemiology strives to elucidate causation as a necessary step towards prevention. Definitive allocation of cause before the post‐neonatal period is usually impossible and a large proportion of all cases of cerebral palsy are not adequately explained. Recognised risk factors may be single or multiple and can occur at any stage from before conception to infancy. In developed countries, the majority of aetiological paths are likely to commence before labour and delivery. Approximately 10% of cases are believed to now be causally associated with adverse intrapartum events, less than either the proportion traditionally assumed or the proportion caused post‐neonatally. The proportions of children with cerebral palsy resulting from an intrapartum cause and from a post‐neonatal cause are both believed to be higher in developing countries. Since post‐neonatally acquired brain damage has the most easily recognised and understood causes, post‐neonatally acquired cerebral palsy should be the most preventable. MRDD Research Reviews 3:184‐193, 1997. © 1997 W

ISSN:1080-4013    

DOI:10.1002/(SICI)1098-2779(1997)3:2<184::AID-MRDD10>3.0.CO;2-R

出版商:John Wiley&Sons, Inc.    

年代:1997

数据来源: WILEY