This free weekly bulletin lists the latest research on cerebral palsy (CP), as indexed in the NCBI, PubMed (Medline) and Entrez (GenBank) databases. These articles were identified by a search using the key term "cerebral palsy". To subscribe, please email Robyn Cummins [email protected] with ‘Subscribe to CP Research News’ in the subject line, and your name and email address in the body of the email. You may unsubscribe at any time by emailing Robyn with your ‘unsubscribe’ request. Interventions

1. Disabil Rehabil Assist Technol. 2011 Feb 11. [Epub ahead of print]
Predicting equipment needs of children with cerebral palsy using the Gross Motor Function Classification
System: a cross-sectional study.

Novak I, Smithers-Sheedy H, Morgan C.
Cerebral Palsy Institute, Sydney, Australia.
Background. Children with cerebral palsy (CP) routinely use assistive equipment to improve their independence.
Specialist equipment is expensive and therefore not always available to the child when needed. Aim. The aim of
this study was to determine whether the assistive equipment needs of children with CP and the associated costs
could be predicted. Method. A cross-sectional study using a chart audit was completed. Two hundred forty-two
children met eligibility criteria and were included in the study. Data ed from files pertained to the child's CP, associ-
ated impairments and assistive equipment prescribed. The findings were generated using linear regression model-
ling. Results. Gross Motor Function Classification System (GMFCS) level [B?=?3.01 (95% CI, 2.36-3.57), p?=?
0.000] and the presence of epilepsy [B?=?2.35 (95% CI, 0.64-4.06), p?=?0.008] predicted the prescription of as-
sistive equipment. The more severely affected the gross motor function impairment, the more equipment that was
required and the more the equipment cost. Interpretation. The equipment needs of children with CP can be pre-
dicted for the duration of childhood. This information may be useful for families and for budget and service plan-
PMID: 21314294 [PubMed - as supplied by publisher]
2. J Clin Neurosci. 2011 Feb 10. [Epub ahead of print]
Myositis ossificans of bilateral hip joints in a patient with diplegic cerebral palsy.

Juneja M, Jain R, Mishra D, Gautam VK.
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India; Lok Nayak Hospital, Delhi Gate,
Daryaganj, New Delhi, India.
Myositis ossificans (MO) occurs in association with musculoskeletal trauma, traumatic and non-traumatic neu-
rologic conditions, joint surgery and rarely as a hereditary disorder. We report a 6-year-old boy with diplegic cere-
bral palsy who developed MO of his bilateral hip joints after initiating physiotherapy. He responded well to conser-
vative management.
Copyright 2010 Elsevier Ltd. All rights reserved.
Research Institute of Cerebral Palsy Alliance
PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au
CP Research News ~ Monday 21 February 2011
PMID: 21316244 [PubMed - as supplied by publisher] 3. J Neurophysiol. 2011 Feb 16. [Epub ahead of print]

Con tributors to excess antagonist activity during movement in children with secondary dystonia due to
cerebral palsy.

Children with secondary dystonia due to cerebral palsy exhibit abnormal upper extremity postures and slow volun- tary movement. However, the interaction between abnormal postures and abnormal movement in dystonia is still uncl ear. Some mechanisms by which postures are maintained in dystonia include stretch reflexes, overflow of mus- cle activation to other muscles, and direct coactivation of antagonist muscles. This study explores the independent
contributions of each of these postural mechanisms to abnormal biceps brachii (antagonist) activity during elbow
extension, which slows movement. A linear model of biceps activation as a function of velocity-dependent reflexes,
triceps-dependent overflow and direct drive to the biceps was fitted to experimental data from eleven children and
young adults with secondary dystonia due to cerebral palsy and eleven age-matched control subjects. Subjects per-
formed elbow extension movements against each of four levels of resistance without perturbations or in each of two
perturbation conditions. Results show that biceps activity in children with dystonia consists of significant contribu-
tions of reflex activation, overflow from triceps and direct muscular drive. Additionally, stretch reflexes during move-
ment are shown to be elevated at three latencies after stretch. These findings suggest that there are postural
mechanisms involved in stabilizing the elbow along its slow trajectory during movement and provide a quantitative
basis for the selection of treatments targeting specific impairments in children with secondary dystonia due to cere-
bral palsy.
PMID: 21325680 [PubMed - as supplied by publisher]

4. J Oral Pathol Med. 2011 Feb 16. doi: 10.1111/j.1600-0714.2011.01008.x. [Epub ahead of print]
Autonomic nervous system in individuals with cerebral palsy: a controlled study.

Ferreira MC, Pastore C, Imada R, Guaré R, Leite M, Poyares D, Santos MT.
Universidade Cruzeiro do Sul Universidade Paulista Instituto do Coração, Hospital das Clínicas, Universidade de
São Paulo Universidade Cruzeiro do Sul Psychobiology Department, Universidade Federal de Sao Paulo Persons
with Disabilities Division, Universidade Cruzeiro do Sul, Sao Paulo, SP, Brazil.
Background: Disturbances in homeostatic functions have been observed in individuals with cerebral palsy (CP),
possibly resulting from autonomic dysfunction. Salivary flow rate and saliva composition are controlled by the auto-
nomic nervous system, and CP individuals exhibit alterations in salivary parameters that suggest autonomic impair-
ment. This study aimed to investigate cardiac parameters as indicative of autonomic disturbances, possibly associ-
ated with salivary changes observed in CP individuals. Methods: Ninety individuals with CP were compared with 35
sibling volunteers with no neurological damage (CG). Twenty-four-hour ECG/Holter monitoring (SEER(®) Light; GE
Medical Systems, Milwaukee, WI, USA) and 12-lead electrocardiographic recordings were performed on the CP
and control groups. Total saliva was collected, and the salivary flow rate and total protein concentration were deter-
mined. Results: Cerebral palsy (CP) individuals presented a significant reduction in salivary flow rate (P < 0.01)
and increased protein concentrations (P < 0.01) compared to CG. Twenty-four-hour Holter ECG analysis showed
differences for high frequency (HF), low frequency (LF) and LF/HF ratio between the groups, with the CP group pre-
senting higher HF and LF values and lower LF/HF. Electrocardiographic parameters showed a statistically signifi-
cant difference for heart rate, and its correlates, and mean corrected QT interval between the groups studied (P <
0.05). Snoring was frequent among CP patients. ECG and autonomic changes were independently associated with
CP. Conclusion: Individuals with cerebral palsy present cardiovascular changes principally manifested as disturbed
sympathovagal balance. These autonomic dysfunctions could contribute to the salivary changes observed.
2011 John Wiley & Sons A/S.
Research Institute of Cerebral Palsy Alliance
PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au 2
CP Research News ~ Monday 21 February 2011
PMID: 21323740 [PubMed - as supplied by publisher] 4. Nurs N Z. 2010 Dec-2011 Jan;16(11):18-9.

Young man with cerebral palsy knows his own mind.

PMID: 21329062 [PubMed - in process]

5. Twin Res Hum Genet. 2011 Feb;14(1):79-87.
Monozygotic Twins Concordant and Discordant for DCD: Two Sides to the Story.

Pearsall-Jones JG, Piek JP, Steed L, McDougall MR, Levy F.
1 School of Psychology and Speech Pathology, Curtin Health Innovation Research Institute, Curtin University, Aus-
tralia; The Centre for Cerebral Palsy, Perth, Australia.
Being an identical twin does not necessarily mean having identical perceptions of family functioning, nor of the twin
relationship. Using the co-twin control design, the aim of this study was to explore perceptions of family dynamics
and the twin relationship in monozygotic (MZ) twins discordant and concordant for Developmental Coordination Dis-
order (DCD). It was hypothesized that, as has been found in twins discordant for cerebral palsy, twins without DCD
would perceive family functioning as less healthy than would their co-twins with DCD. It was also hypothesized that
the twin relationship would be regarded generally as mutually supportive. Questionnaire data on 866 sets of MZ
twins aged 6 to 17 years were used to identify seven sets discordant, and two sets concordant for DCD. Quantita-
tive (General Functioning Scale of the Family Assessment Device - FAD), and qualitative (semi-structured inter-
view) measures were used to assess family dynamics and the twin relationship. In discordant sets, six of seven
twins without DCD rated family functioning at a less healthy level than did their co-twins with DCD. All twins in the
DCD concordant sets rated their family functioning at a healthy level. From the semi-structured interviews, emer-
gent themes included friendship, support, minimal sibling rivalry, and minor difficulties. It was concluded that, over-
all, the twin relationship was regarded as close and mutually supportive, with an ambivalent polarity between the
best and most difficult aspects of being an identical twin. Implications for research, policy and clinical practice are
PMID: 21314259 [PubMed - in process]
Epidemiology / Aetiology / Diagnosis & Early Treatment
6. Early Hum Dev. 2010 Nov;86(11):675-82.
Outcomes after central grey matter injury in term perinatal hypoxic-ischaemic encephalopathy.

Martinez-Biarge M, Diez-Sebastian J, Rutherford MA, Cowan FM.
Department of Paediatrics and Imaging Sciences, Imperial College London, UK. [email protected]
Central grey matter damage following perinatal hypoxia-ischaemia frequently leads to death or motor abnormality
often with deficits in other developmental domains. Predicting these different outcomes is difficult yet very important
for early management, planning and providing for needs on discharge and later and not least for parents to know
how their children will be affected. The best single predictor of the pattern of outcomes for an individual infant is an
early MRI scan. We present a guide for predicting outcome at 2 years in different developmental domains based on
the severity of injury seen in the basal ganglia and thalami (BGT) on neonatal MRI.
Research Institute of Cerebral Palsy Alliance
PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au 3
CP Research News ~ Monday 21 February 2011
Copyright 2010 Elsevier Ltd. All rights reserved. PMID: 20864278 [PubMed - indexed for MEDLINE] 7. Gait Posture. 2011 Feb 15. [Epub ahead of print]

Gait analysis may help to distinguish hereditary spastic paraplegia from cerebral palsy.

Wolf SI, Braatz F, Metaxiotis D, Armbrust P, Dreher T, Döderlein L, Mikut R. Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, Ger-
Hereditary spastic paraplegia (HSP) designates a group of genetic disorders typically leading to spasticity in the
lower limbs and consequently to gait disorders. Although the symptoms are similar to those of cerebral palsy (CP),
the correct diagnosis is important for treatment recommendations as one condition is progressive in nature whereas
the other is not. Due to the heterogeneity of HSP, genetic testing is complex and in some genetic forms still not
possible. The aim of this study was, therefore, to investigate if instrumented 3D-gait analysis could help distinguish
between these two conditions. The gait pattern of 29 patients with HSP was compared with that of 29 patients with
CP who were matched in age, sex, and the extent of gait disturbance and also to 29 typically developing subjects
for reference. More than 3000 gait parameters were evaluated for their relevance to classify patients into diagnostic
groups. Cluster analysis revealed that these gait features may classify only subgroups of symptoms as the gait pat-
tern is very heterogeneous within each diagnosis group. However, prolonged hip extension, knee extension, and
ankle plantar flexion were identified as indicators for HSP. In addition, large trunk tilt velocities appear unique in
some cases of HSP. These indicators in gait pattern may contribute in establishing the diagnosis of HSP, which is
important in predicting outcome when planning surgical treatment for functional improvements in these patients.
Copyright 2011 Elsevier B.V. All rights reserved.
PMID: 21330136 [PubMed - as supplied by publisher]
8. Indian J Pediatr. 2011 Feb 12. [Epub ahead of print]
Indomethacin Tocolysis and Neurodevelopmental Outcome.

Soraisham AS, Sauve R, Singhal N.
Division of Neonatology, Department of Pediatrics, Institute for Child and Maternal Health, University of Calgary,
Calgary, Alberta, Canada, [email protected].
OBJECTIVE: To compare the neurodevelopmental outcomes, at 30-42 months adjusted age, between infants ex-
posed to antenatal indomethacin and those unexposed to antenatal indomethacin. METHODS: This was a retro-
spective cohort study. The study cohort consisted of all nonanomalous infants with birth weight =?1250 g and/or
gestational age =?28 wks born between 2000 and 2003, who completed neurodevelopmental assessments be-
tween 30-42 months adjusted age. The authors compared the neurodevelopmental outcomes of infants exposed
and unexposed to antenatal indomethacin. RESULTS: Of the 321 infants, 75 infants (23%) exposed to antenatal
indomethacin were lower in gestational age (26.4 vs 27.8 wks). In univariate analysis, infants exposed to antenatal
indomethacin had significantly increased incidence of patent ductus arteriosus (PDA) (60% vs. 39%), surgical PDA
ligation (40% vs. 18%) and bronchopulmonary dysplasia (81% vs. 60%). There was no significant difference in
cerebral palsy, cognitive delay, deafness, blindness and major disability between the two groups. In multivariable
logistic regression analysis, antenatal indomethacin exposure was not associated with cerebral palsy (OR, 0.70;
95% CI, 0.22-2.18), cognitive delay (OR, 0.56; 95% CI, 0.28-1.12) or neurodevelopmental disability (OR, 0.50; 95%
CI, 0.21-1.19). CONCLUSIONS: Neurodevelopmental outcome of preterm infants exposed to antenatal indometha-
cin is equivalent to those unexposed to antenatal indomethacin, despite being born earlier.
PMID: 21318396 [PubMed - as supplied by publisher]
Research Institute of Cerebral Palsy Alliance
PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au 4
CP Research News ~ Monday 21 February 2011
9. Int J Nurs Stud. 2011 Feb 15. [Epub ahead of print]

The health of children and young people with cerebral palsy: A longitudinal, population-based study.

McC ullough N, Parkes J, Kerr C, McDowell BC. School of Nursing and Midwifery, Queen's University Belfast, 10 Malone Road, Belfast, Northern Ireland, BT9 5BN, BACKGROUND: Cerebral palsy (CP) is a chronic condition about which little is known in relation to the long term stability of and factors influencing health. OBJECTIVES: To describe the health status of 4-17 year olds with ambu- lant CP, compare with the general population and identify factors predicting change in health over time. DESIGN: A
longitudinal, clinical survey. SETTING: A regional hospital-based Gait Analysis Laboratory. PARTICIPANTS: Those
aged 4-17 years and able to walk at least 10m independently were identified from a case register of people with
CP. A total of 184 subjects took part (38% of all eligibles in the region); 154 (84%) returned for a second assess-
ment on average 2.5 years later. METHODS: The Child Health Questionnaire (Parent-form-50) was completed by
184 parents at time 1, and 156 at time 2. RESULTS: Children and young people with CP have significantly poorer
health across a number of domains when compared to children in the general child population. Over time improve-
ments occurred in behaviour (p=0.01), family activities (p<0.001) and physical functioning (p=0.05). Linear regres-
sion showed that gross motor function (p<0.001) and cerebral palsy subtype (p<0.05) were associated with
changes in physical functioning; age was associated with changes in behaviour (p=0.007) and family activities
(p=0.01); and communication ability was significantly associated with changes in family activities (p=0.005). CON-
CLUSIONS: Children and young people with CP have poorer health than their able bodied peers but relatively sta-
ble health over 2.5 years. Where change occurred, it was for the better.
Copyright 2011 Elsevier Ltd. All rights reserved.
PMID: 21329925 [PubMed - as supplied by publisher]
10. Neonatal Netw. 2011 Jan-Feb 1;30(1):29-35.
Induced hypothermia for neonatal hypoxic-ischemic encephalopathy: pathophysiology, current treatment,
and nursing considerations.

Cooper DJ.
Hypoxic-ischemic encephalopathy (HIE) can lead to devastating neurodevelopmental consequences such as cere-
bral palsy, seizure disorders, and significant developmental delays. HIE in the newborn is often the result of a hy-
poxic event, such as uterine rupture, placental abruption, or cord prolapse. Biphasic brain injury occurs in HIE. The
first phase involves activation of the sympathetic nervous system as a compensatory mechanism. The second
phase, known as reperfusion brain injury, occurs hours later. Induced hypothermia, a neuroprotective strategy for
treating HIE, targets the second phase to prevent reperfusion injury. NICU nurses are in a unique position to detect
patient instability and to maintain the therapeutic interventions that contribute to the healing process. This article
highlights the significant role nurses play in the management of infants diagnosed with HIE who are treated with
induced hypothermia.
PMID: 21317095 [PubMed - in process]

11. Conn Med. 2010 Nov-Dec;74(10):623-5.
Connecticut and its cerebral palsied children. 1960.

Fuldner RV.
PMID: 21189721 [PubMed - indexed for MEDLINE]
Research Institute of Cerebral Palsy Alliance
PO Box 184 Brookvale NSW 2100 Australia | T +61 2 9479 7200 | www.cerebralpalsy.org.au 5
CP Research News ~ Monday 21 February 2011
12. Pediatrics. 2011 Feb 14. [Epub ahead of print]

Prediction of Neurodevelopmental and Sensory Outcome At 5 Years in Norwegian Children Born Extremely

Leversen KT, Sommerfelt K, Rønnestad A, Kaaresen PI, Farstad T, Skranes J, Støen R, Elgen IB, Rettedal S, Eide Obje ctive: To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm. Methods:
This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational
ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the
Wechsler Preschool and Primary Scale of Intelligence-Revised, motor function with the Movement Assessment Bat-
tery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Dis-
abilities were described as mild, moderate, or severe. Results: Of 371 eligible children, 306 (82%) were examined
at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) chil-
dren had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and
1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values
given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7-13.4]), preeclamp-
sia (-7.7 [-12.7 to -2.7]), and retinopathy of prematurity higher than grade 2 (-17.5 [-27.1 to -8.0]). Movement As-
sessment Battery for Children scores were positively associated with gestational age and prenatal steroids and
negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity.
Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of
87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P
= .001). Conclusions: The outcome was poorer for children with gestational ages of 25 weeks or less compared
with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deaf-
ness, however, gestational age had a limited association with cognitive and motor function.
PMID: 21321031 [PubMed - as supplied by publisher]
13. Afr Health Sci. 2010 Sep;10(3):218-25.
Epilepsy in rural Ugandan children: seizure pattern, age of onset and associated findings
Duggan M.
Springview Cottage, More Hall Lane, Bolsterstone, Sheffield S36 3ST, UK.
INTRODUCTION: Much information on childhood epilepsy in sub Saharan Africa is hospital based. A survey was
considered necessary before integrating epilepsy management into a Ugandan community programme. METHOD:
Using an 'outreach' method, children with recurrent seizures were offered assessment at 19 sites in Rukungiri Dis-
trict. A brief history and neurological and developmental assessment was carried out on each child. A clinical diag-
nosis of epilepsy, including seizure type, was given to 440 of 618 children <18 years with 178 exclusions.
RESULTS: The age-specific prevalence of epilepsy in children < 15 years was 2.04‰ (95% CI 1.94‰ to 2.24 ‰)
based on 395 cases in an <15 years population of 193,126. Percentage distribution by seizure type was:-
generalised tonic-clonic (53%), complex partial seizures CPS (27%), simple partial and miscellaneous seizures (6%
each), with some diagnostic overlap between seizure types. Cerebral palsy, evident or evolving, was most strongly
associated with CPS. A positive perinatal or infantile history was noted in 12 and 6% respectively, and 50.2% of
seizures began in infancy. CONCLUSIONS: The prevalence of epilepsy is similar in Gambian children. The high
contribution from early-onset CPS, resembles Kenyan reports of malaria-associated CPS, suggesting a causal as-
sociation with malaria.
PMID: 21327131 [PubMed - in process]

Source: http://cpresearch.org.au/pdfs/2011_cpresearch_news/cpresearchnews02212011.pdf

Microsoft word - position paper 2.docx

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