| 1. |
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| 2. |
- Ahlin, Kristina, et al.
(författare)
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Non-infectious risk factors for different types of cerebral palsy in term-born babies: a population-based, case-control study.
- 2013
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:6, s. 724-731
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify non-infectious antenatal and perinatal risk factors for cerebral palsy (CP) and its subtypes in children born at term. DESIGN: A population-based, case-control study. SETTING: The western healthcare region of Sweden. POPULATION: A population-based series of children with CP born at term during 1983-94 (n=309) was matched with a control group (n=618). METHODS: A total of 62 variables, maternal characteristics, and prepartal, intrapartal and postpartal variables were retrieved from obstetric records. Both univariate and multivariate analyses were performed for spastic and dyskinetic CP, and for the total CP group. MAIN OUTCOME MEASURES: Cerebral palsy (CP) and subtypes. RESULTS: Univariate analysis resulted in 26 significant risk factors for CP. Birthweight (OR0.54, 95%CI0.39-0.74), not living with the baby's father (OR2.58, 95%CI 1.11-5.97), admittance to a neonatal intensive care unit (NICU) (OR 4.43, 95% CI 3.03-6.47), maternal weight at 34weeks of gestation (OR1.02, 95%CI 1.00-1.03) and neonatal encephalopathy (OR69.2, 95%CI 9.36-511.89) were found to be risk factors for CP in the totalCP group in our multivariate analysis. Factors during the periods before, during and after delivery were all shown to increase the risk of spastic diplegia and tetraplegia, whereas mostly factors during the period before delivery increased the risk of spastic hemiplegia, and only factors during delivery increased the risk of dyskinetic CP. Admittance to an NICU was a risk factor for all CP subtypes. CONCLUSIONS: The risk factor pattern differed by CP subtype. The presented risk factors may be useful indicators for identifying children at risk of developing CP, and helpful for targeting individuals for early intervention programmes.
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| 3. |
- Dahlseng, Magnus O, et al.
(författare)
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Gastrostomy tube feeding of children with cerebral palsy: variation across six European countries.
- 2012
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Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622. ; 54:10, s. 938-944
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Tidskriftsartikel (refereegranskat)abstract
- Aim To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries. Method Data on 1295 children (754 males, 541 females; mean age 5y 11mo, range 11y 2mo, min 6mo, max 11y 8mo) with CP born from 1999 to 2001 were collected from geographically defined areas in six European countries; four of the areas covered the whole country. Distribution of CP was unilateral 37%, bilateral 51%, dyskinetic 8%, and ataxic 4%. Sixty children were classified in Gross Motor Function Classification System (GMFCS) levels I and II, 6 in level III and 34 in levels IV and Vas Outcome measures were GTF, age at placement, feeding difficulties and the children's height and weight for age standard deviation scores (z-scores). Results The use of GTF among all children with CP was highest in western Sweden (22%, 95% confidence interval [CI] 16-29), and lowest in Portugal (6%, 95% CI 3-10), northern England (6%, 95% CI 3-9) and in Iceland (3%, 95% CI 0-13; p<0.001). The difference between areas was greater among children in GMFCS levels IV and V (non-ambulant); in this group, lower height z-scores were more prevalent in the areas with lower prevalence of GTF. The children's age at placement of gastrostomy also varied between areas (p<0.002). Interpretation The observed differences in the use of GTF may reflect differences in access to treatment or clinical practice, or both. Our results suggest that the use of GTF may improve growth in height and weight among children with more severely affected gross motor function - the group most likely to have associated feeding difficulties.
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| 4. |
- Himmelmann, Kate, 1959
(författare)
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Cerebral palsy - patterns and patchwork.
- 2011
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Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 53:10
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Tidskriftsartikel (refereegranskat)
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| 5. |
- Himmelmann, Kate, 1959, et al.
(författare)
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Communication ability in cerebral palsy: A study from the CP register of western Sweden.
- 2013
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Ingår i: European journal of paediatric neurology. - : Elsevier BV. - 1090-3798. ; 17:6, s. 568-574
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Communication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support. AIM: To study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden. METHODS: Sixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded. RESULTS: Half the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I-II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p=0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p<0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p<0.01). CONCLUSION: Communication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester.
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| 6. |
- Himmelmann, Kate, 1959, et al.
(författare)
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Function and neuroimaging in cerebral palsy: a population-based study.
- 2011
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Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 53:6, s. 516-21
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this population-based study was to describe function in cerebral palsy (CP) in relation to neuroimaging. Method Motor function, accompanying impairments, and neuroimaging (86 by magnetic resonance imaging, 74 by computed tomography) were studied in 186 children born in western Sweden between 1999 and 2002 (96 males, 90 females; age range at data collection 4-8y). Results Forty per cent of the children had unilateral spastic CP, 39% bilateral, 16% dyskinetic CP, and 5% ataxia. Fifty-one per cent were in level I of the Gross Motor Function Classification System (GMFCS), 14% in level II, 3% in level III, 11% in level IV, and 22% level V. Forty per cent of the children were in level I of the Manual Ability Classification System 19% were in II, 9% at III, 8% in IV, and 24% in level V. Seventy-six per cent of the children with white-matter lesions were in GMFCS levels I and II, whereas 67% with basal ganglia lesions were in levels IV and V. Learning disability* (45%), epilepsy (44%), and visual impairment (17%) were most common in children with brain maldevelopment, and cortical/subcortical or basal ganglia lesions. Speech was impaired in 49% of the children, absent in 30%, and 6% had a neuropsychiatric diagnosis. Compared with children born between 1991 and 1998, the numbers of those in GMFCS level I increased (p=0.007), as did those with epilepsy (p=0.015). Interpretation Neuroimaging improves the understanding of the neuroanatomical basis for function in CP. Type and severity of motor impairment and accompanying impairments are related to the timing of lesions.
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| 7. |
- Himmelmann, Kate, 1959, et al.
(författare)
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Risk factors for cerebral palsy in children born at term.
- 2011
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To provide an overview of current research on risk factors for cerebral palsy (CP) in children born at term and hypothesize how new findings can affect the content of the CP registers worldwide. Data Source. A systematic search in PubMed for original articles, published from 2000 to 2010 regarding risk factors for CP in children born at term was conducted. Methods of study selection. Factors from the prenatal, perinatal and neonatal period considered as possible contributors to the causal pathway to CP in children born at term were regarded as risk factors. Full text review was made of 266 articles. Results. Sixty-two articles met the criteria for an original report on risk factors for CP in children born at term. Perinatal adverse events including stroke were the focus of most publications, followed by genetic studies. Malformations, infections, perinatal adverse events and multiple gestation were risk factors associated with CP. The evidence regarding for example thrombophilic factors and non-CNS abnormalities was inconsistent. Conclusion. Information on maternal and neonatal infections, umbilical cord blood gases at birth, mode of delivery and placental status should be collected in a standardized way in CP registers. Information on social factors such as education level, family income and area of residence is also of importance. More research is needed to understand the risk factors of CP and specifically of how they relate to causal pathways of cerebral palsy.
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| 8. |
- Himmelmann, Kate, 1959, et al.
(författare)
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The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002.
- 2010
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Ingår i: Acta paediatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 99:9, s. 1337-1343
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Aim: The aim of the study was to describe the prevalence and origin of cerebral palsy (CP), which is the tenth report from the western Swedish study. Methods: A population-based study covering 85 737 live births in the area in 1999-2002. Birth characteristics and neuroimaging findings were recorded, prevalence of CP was calculated and aetiology was analysed. Results: CP was found in 186 children. The crude prevalence was 2.18 per 1000 live births. The gestational age-specific prevalence for <28 gestational weeks was 55.6 per 1000 live births, whereas it was 43.7 for 28-31 weeks, 6.1 for 32-36 weeks and 1.43 per 1000 for >36 weeks. There was a female majority among children born at term and a male predominance in children born preterm. Hemiplegia accounted for 38%, diplegia for 32%, tetraplegia for 7%, whereas 17% had dyskinetic CP and 5% ataxia. Neuroimaging showed white-matter lesions in 31% and cortical/subcortical lesions in 29%. The aetiology was considered to be prenatal in 36%, peri/neonatal in 42%, whereas it remained unclassified in 21%. Conclusion: The decrease in CP prevalence observed since the 1980s had ceased. An increase in children born at term and in dyskinetic CP was found. In children born before 28 weeks of gestation, the prevalence decreased significantly. White-matter and cortical/subcortical lesions dominated on neuroimaging.
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| 9. |
- Himmelmann, Kate, 1959, et al.
(författare)
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The panorama of cerebral palsy in Sweden. XI. Changing patterns in the birth-year period 2003-2006.
- 2014
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 103:6, s. 618-624
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe the epidemiology of cerebral palsy (CP) in western Sweden. Methods: A population-based study covering 94466 live births in the area in 2003-2006. Birth characteristics and neuroimaging findings were recorded, prevalence was calculated and aetiology was analysed. Results: CP was found in 206 children, including postneonatal cases, corresponding to a crude prevalence of 2.18 per 1000 live births. The gestational age-specific prevalence for <28 gestational weeks was 71.4 per 1000 live births, while it was 39.6 for 28-31weeks, 6.4 for 32-36weeks and 1.41 per 1000 for >36weeks. Hemiplegia accounted for 44%, diplegia for 29% and tetraplegia for 6%, while 16% had dyskinetic CP and 5% had ataxia. Neuroimaging was available in 95% of the children. This showed maldevelopment in 13%, white matter lesions in 36%, cortical/subcortical lesions in 23% and basal ganglia lesions in 14%. The aetiology was considered to be prenatal in 36% and perinatal/neonatal in 46% and remained unclassified in 18%. Conclusion: The overall prevalence of CP in western Sweden was stable. However, the distribution of CP types changed and the term hemiplegia increased significantly. Among children with CP born extremely preterm, the percentage born before 26weeks of gestation had increased.
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| 10. |
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| 11. |
- Nordberg, Ann, et al.
(författare)
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Speech problems affect more than one in two children with cerebral palsy: Swedish population-based study.
- 2013
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 102:2, s. 161-166
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe speech ability in a population-based study of children with cerebral palsy (CP), in relation to CP subtype, motor function, cognitive level and neuroimaging findings. METHODS: A retrospective chart review of 129 children (66 girls, 63 boys) with CP, born in 1999-2002, was carried out. Speech ability and background information, such as type of CP, motor function, cognitive level and neuroimaging data, were collected and analysed. RESULTS: Speech disorders were found in 21% of the children and were present in all types of CP. Forty-one per cent of the children with speech disorders also had mental retardation, and 42% were able to walk independently. A further 32% of the children were nonverbal, and maldevelopment and basal ganglia lesions were most common in this group. The remaining 47% had no speech disorders, and this group was most likely to display white matter lesions of immaturity. CONCLUSION: More than half of the children in this CP cohort had a speech disorder (21%) or were nonverbal (32%). Speech ability was related to the type of CP, gross motor function, the presence of mental retardation and the localization of brain maldevelopment and lesions. Neuroimaging results differed between the three speech ability groups.
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| 12. |
- Pennington, Lindsay, et al.
(författare)
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Development of The Viking Speech Scale to classify the speech of children with cerebral palsy.
- 2013
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Ingår i: Research in developmental disabilities. - : Elsevier BV. - 1873-3379 .- 0891-4222. ; 34:10, s. 3202-10
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Tidskriftsartikel (refereegranskat)abstract
- Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k>.58 for all comparisons). Test-retest reliability was substantial to almost perfect for all groups (k>.68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review.
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| 13. |
- Smithers-Sheedy, Hayley, et al.
(författare)
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What constitutes cerebral palsy in the twenty-first century?
- 2014
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Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 56:4, s. 323-328
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Tidskriftsartikel (refereegranskat)abstract
- Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed.
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