Università degli studi di Modena e Reggio Emilia

A group of diplegic cerebral palsied (CP) children presents six precise signs that can be easily observed during clinical examinations, physiotherapy sessions and everyday activities. These signs are: startle reaction, upper limbs in startle position, averted-eye gaze, grimaces, eye blinking and posture freezing.

Physical function is crucial to participation in life activities and must always be accurately assessed in children with cerebral palsy (CP)1. The Activities Scale for Kids performance (ASKp) is currently used for this purpose, but its psychometric properties have not yet been completely verified in children with CP2, the principal cause of disability in industrialized countries3. Recently, the reliability of the Italian version of the scale was confirmed in this population and initial proof of validity was collected. However, there is no gold standard that can serve as a criterion. We verified the ASKp convergent validity with respect to the Gross Motor Function Measure-66 (GMFM-66), the gold standard in the assessment of gross motor abilities in this population

Aims: This study collects evidence of construct convergent validity of the Activity Scale for Kids performance (ASKp), comparing its results with the 66-item Gross Motor Function Measure (GMFM-66) and with the Gross Motor Function Classification System (GMFCS) and testing the ASKp’s ability to discriminate between individuals with different functional capabilities. Methods: This cross-sectional study involved 60 children with spastic cerebral palsy (CP) assessed with the GMFM-66 who self-administered the Italian version of the ASKp. Results: Children were 10.9 (±3) years old with GMFCS Level I–III. Moderate correlations were found between GMFM and ASKp scores (r = 0.577; p < .001), and between GMFCS levels and ASKp score (rs = −0.541, p < .001). The ASKp discriminated between children with different functional capabilities, determined by the GMFCS (F = 18.2, p < .001). Conclusions: ASKp is valid to assess physical functioning, a crucial domain in rehabilitation of children with spastic CP. Trial registration: ClinicalTrials.gov Identifier: NCT03325842.

Hemiplegia is the most common form of Cerebral Palsy. Upper Limb is generally more affected than lower one. In fact, hemiplegic children can spontaneously acquire standing and walking ability, while manipulation remains uncertain, with severe limitations in activity and participation, which define child's functional status (International Classification of Functioning - ICF). Several non-surgical tools are currently available to approach upper limb impairments. Studies regarding upper limb multilevel surgery in Hemiplegic Cerebral Palsy are relatively few and inhomogeneous.

La paralisi cerebrale infantile (PCI) è la più comune causa di disabilità dell’infanzia; i bambini con PCI sperimentano spesso difficoltà nelle ADL e il miglioramento della perfomance in questi compiti diviene un aspetto prioritario dell’intervento riabilitativo. Al fine di individuare obiettivi di trattamento appropriati e misurare gli effetti del proprio intervento, gli operatori della riabilitazione devono disporre di strumenti di valutazione validi nel contesto di applicazione. Nell’ambito della riabilitazione pediatrica sono state sviluppate numerose scale di valutazione, la maggior parte delle quali non sono formalmente tradotte e validate nel contesto italiano; una di queste è la Activities Scale for Kids (ASKp) che, ad oggi, è l’unico questionario di autovalutazione in abito pediatrico creato per indagare la percezione che il bambino ha in merito alla sua disabilità o limitazione nelle ADL; la validità della ASKp nella sua versione originale, in lingua inglese, è stata testata attraverso opportuni studi su bambini con disabilità di natura muscolo-scheletrica conseguente a varie patologie. Essa non è mai stata validata nella popolazione di bambini con PCI. Lo scopo di questo studio è quello di testare la versione italiana culturalmente adattata della scala ASKp nella popolazione con PCI. MATERIALI E METODI In questo studio con disegno trasversale viene testata l’affidabilità della ASKp attraverso la sua somministrazione ad un campione di bambini e adolescenti italiani, tra i 5 e i 15 anni, nelle diverse forme cliniche di emiplegia e di diplegia dovute a PCI. Trattandosi di una scala autosomministrata, sono esclusi i bambini e gli adolescenti con ritardo mentale moderato o grave. RISULTATI Ad oggi sono stati inclusi nello studio 83 bambini e adolescenti (47 maschi e 36 femmine), con un’età media di 10 anni e 6 mesi, nella maggior parte diplegici (49 pazienti). Nell’89% dei casi il livello cognitivo dei bambini è risultato nella norma. Un quarto dei pazienti necessita di ausili per spostarsi all’esterno, mentre una proporzione quasi analoga necessita di ausili per spostarsi intra–extramoenia. Il punteggio minimo ottenuto nella ASKp è 26, quello massimo 100 e il punteggio medio 78,4. L’affidabilità, testata tramite l’α di Cronbach, è pari a 0.93 (IC 0.90-0.96). La ASKp si è dimostrata in grado di discriminare livelli diversi di autonomia tra pazienti con livello cognitivo nella norma e pazienti con lieve ritardo mentale e tra pazienti che utilizzano ausili per spostarsi negli ambienti chiusi e pazienti che non li utilizzano o vi fanno ricorso solo per gli spostamenti in spazi aperti. I risultati parziali ad oggi ottenuti non ci hanno permesso di rilevare altre capacità discriminative. CONCLUSIONI La misura della performance dei bambini con PCI nelle attività quotidiane è un outcome importante per il team riabilitativo, che può indirizzare il team verso obiettivi concreti e funzionali. È fondamentale avere a disposizione scale di valutazione delle ADL robuste e focalizzate sui bambini. La versione italiana della ASKp è affidabile nella popolazione con PCI.

The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p= .025) and functional goals achievement (GAS) was also slightly better in the same group (p= .033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment. © 2014 Elsevier Ltd.

Nel panorama della riabilitazione infantile, il metodo Doman ha occupato e continua ad occupare un ruolo di primo piano. Le ragioni di questo successo sono legate soprattutto ai messaggi che Doman ha saputo indirizzare ai genitori ai quali ha parlato apertamente di possibilità di miglioramento, se non di piena guarigione. Per giudicare onestamente la veridicità delle affermazioni di Doman, è giusto confrontarle con quanto le neuroscienze sostenevano ai tempi in cui Doman scriveva le sue proposte. Molte ricerche avvenute all’epoca o successivamente hanno confutato le affermazioni di Doman sulla quantità e qualità del recupero, dimostrandone l’infondatezza dei presupposti e delle procedure. Poche sono state le voci a favore e tutte su settori limitati del linguaggio. Le famiglie che nonostante i tanti giudizi negativi espressi sul metodo volessero praticare comunque la cura Doman, attratte per lo più dalla concretezza dei percorsi terapeutici in termini di quantità, progressione e durata, riceverebbero risposte economiche difformi nelle diverse regioni italiane per una differente legislazione regionale

In over thirty years of clinical observation of cerebral palsied (CP) children, especially among premature babies with bilateral motor damage, we have repeatedly found a group of patients with a unique combination of clinical characteristics which, we believe, could represent a specific group within the CP categorization. For convenience, we have termed them dysperceptive and we have been studying their behavior in a fairly large group of patients in order to see if some phenomena, unmistakably observed in single cases, were recognizable, also in different degrees, in larger groups. We have maintained the term perceptual disturbance or dysperception for the first and most interesting hypothesis that the errors performed by these children could happen during the collection, interpretation, and re-elaboration of information, especially of the sense of movement, even if other fascinating theories can be found especially in the field of psychology. These complex behaviors, for example fear, can be observed during clinical examination or physiotherapeutic treatments. In addition, parents and older children often describe some specific situations, which are recurrent and typical, that take place in everyday life in different settings (at school, on holiday, with friends, etc.), often underlining the limitations produced by these phenomena regarding motor independence and quality of life. These signs can be observed in CP children with diverse motor damage (diplegia, tetraplegia, but not hemiplegia) and at different development levels. In order to explore consistency and recurrence of the more important or frequent dysperceptive signs, describe them in detail and collect evidence by suitable instruments, we have been and are still employing video recording sessions (natural history of these signs). © 2010 Springer-Verlag Milan.

The term cerebral palsy in English, paralisi cerebrale infantile in Italian, infirmité motrice cérébrale in French, paralisis cerebral in Spanish and Zerebral Bewegung Störung in German de fines a persistent but not unchangeable disorder of posture and motion, due to an organic and not progressive alteration of the cerebral function, determined by preperi- and post natal causes, before its growth and development are completed (Bax, 1964; Spastic Society Berlin, 1966, Edinburgh, 1969). © 2010 Springer-Verlag Milan.

The classification systems for cerebral palsy (CP) need to be continuously updated, according to specific aims and to significant changes observed over the years in the panorama of CP. A simplification of CP categories, abandoning the use of the term diplegia, has been recently suggested. Conversely, in this paper a new proposal for classification of CP is briefly presented, where special attention is given to diplegia which is suggested to be divided into four main clinical forms, according to the patterns of walking observable in these subjects. The proposed classification was applied to a large population of 213 subjects with diplegia, among 467 cases of CP admitted to two reference centres for this disorder. The relative incidence of the four forms is reported. The adopted classification criteria, based on a primary ability of professionals working in rehabilitation, i.e. observation capacity, makes this approach simple and easy to use at all levels of the rehabilitation services for CP.

AIM: The aim of this study was to validate a recent classification of gait in children with the spastic diplegic form of cerebral palsy (CP) by checking the reliability of different scorers in assigning subject walking performance to one of the four specific patterns described in the classification. METHODS: The gait patterns of 50 children and adolescents with CP (23 males, 27 females; age range 3-17 years) were selected among patients whose videos were stored in the archives of the Pisa and Reggio Emilia Hospitals. Only video recordings of gait with homogeneous features (duration of at least 90 s, simultaneous recordings on sagittal and frontal views, and other criteria) were taken for examination. The videos were blindly scored using an observational gait scale, at first by two of the authors of the classification system (defined as ''maximum experts''), then by ten expert observers, and finally by 206 professionals of rehabilitation after a one-day training on the classification. Cohen's kappa statistics (k) and intra class correlations (ICC) were calculated. RESULTS: Kappa and ICC indicate an almost perfect agreement both between the two maximum experts and among the ten expert observers. Good results were also obtained in the group of one-day trained scorers. Only a few cases were assigned to the ''unclassified'' category. The profession of the observer (doctor or therapist) and previous knowledge of the classification had no significant influence on reliability scores. CONCLUSION: The results suggest that the proposed classification can be reliably applied, even utilizing short video recordings, to arrange diplegic children into different patterns. Further studies are needed to validate the use of this classification system for clinical and research aims.