S Schroeder

Anisotropy of transcallosal motor fibres indicates functional impairment in children with periventricular leukomalacia.

Aim  In children with bilateral spastic cerebral palsy (CP), periventricular leukomalacia (PVL) is commonly identified on magnetic resonance imaging. We characterized this white matter condition by examining callosal microstructure, interhemispheric inhibitory competence (IIC), and mirror movements.

Safety of robotic-assisted treadmill therapy in children and adolescents with gait impairment: A bi-centre survey

Objective: The aim of the present study was to report on adverse events encountered with robotic-assisted treadmill therapy in children and adolescents with gait disorders. Methods: Eighty-nine patients who underwent a trial of robotic assisted treadmill therapy in the two participating centres were analysed. Demographic data and safety data of the patients were analysed using descriptive statistics. Results: In 38 (42.7%) out of 89 patients, adverse events were documented. Most commonly, mild skin erythema at the sites of the cuffs of the device and muscle pain were encountered. In five patients (5.6%), open skin lesions (n = 2), joint pain (n = 2) or tendinopathy (n = 1) limited the continuation of the therapy with the Lokomat. No severe side-effects emerged. Conclusions: Robotic assisted treadmill therapy is a safe method to enable longer periods of gait therapy in children and adolescents with gait disorders.

Muscle ultrasound in classic infantile and adult Pompe disease: A useful screening tool in adults but not in infants

A cohort of 4 infantile and 15 adult Pompe patients has been investigated regarding correlation between strength and ultrasound of skeletal musculature. In adults, muscle ultrasound is useful to assess clinical and subclinical involvement of muscles. In this study, visible sonographic changes were found in every clinically affected muscle, using a modified Heckmatt scale. In some muscles morphologic changes preceded weakness. Regarding the anatomical pattern of involvement, our findings do not support the hypothesis of a specific pattern with a higher vulnerability of vastus intermedius than rectus femoris, which has been postulated before. A frequent sparing of triceps brachii could be confirmed. Intramuscular abnormalities occurred in a focal, a diffuse, or an intermediate pattern, with characteristics of both. In contrast to muscular dystrophies, bone echogencity was not markedly decreased in Pompe disease even in an advanced stage. In infants, muscle ultrasound showed no distinct pathology even in clinically severely affected children and should not be used as a screening method for infantile Pompe disease.

Does hip displacement influence health-related quality of life in children with cerebral palsy?

Abstract Objective: To evaluate the association of hip lateralisation with health-related quality of life (HRQL) in children with cerebral palsy (CP) using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD®) questionnaire. Methods: We assessed n = 34 patients (mean age: 10.2 years, SD: 4.7 years; female: n = 16) with bilateral CP and Gross Motor Function Classification System (GMFCS) Level III–V using the CPCHILD® questionnaire. Hip lateralisation was measured by Reimer`s migration percentage (MP). Results: There was an association between both, MP and GMFCS with CPCHILD® total score. Stratified analyses did not suggest interaction of the association between MP and CPCHILD® total score by GMFCS level. After adjustment for GMFCS level, we found a significant linear decrease of CPCHILD® total score of −0.188 points by 1% increment in MP. Conclusions: There was an association between MP and HRQL, which could not be explained by the GMFCS level.

Six-minute walk test versus two-minute walk test in children with Duchenne muscular dystrophy: Is more time more information?

BACKGROUND/PURPOSE The six minute walk test is a widely accepted primary outcome parameter in most studies in Duchenne muscular dystrophy (DMD). To compare information obtained by the six minute walk distance (6MWD) test and the two minute walk distance (2MWD) in patients with DMD, a cohort of 13 voluntary DMD boys did a repeated six minute walking test. METHODS Patients had to be ambulatory with a physical disability according to Levels 1-3 on the Vignos-Scale for lower extremity. Measurements were taken at one minute intervals. Reliability was measured by intraclass correlation. RESULTS Test-retest reliability for 6MWD and 2MWD in two different age classes was very good for both subgroups. Test-retest-reliability was lower in patients with more advanced disability in both tests. Walking speed remained completely stable from time points 1-6 minutes in the whole study patient collective, which indicates that physical exhaustion is not reached after six minutes even in more disabled patients. CONCLUSION Thus the 6MWD in DMD patients does not give additional information as compared to a 2MWD.

Childhood stroke: Awareness, interest and knowledge among the pediatric community

Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke. The acronym FAST (Face-Arm-Speech-Time-Test) was correctly cited in 27% of the questionnaires. Most commonly quoted symptoms of childhood stroke were hemiparesis (90%), speech disorder (58%), seizure (44%), headache (40%), and impaired consciousness (33%). Migraine (63%), seizure (39%), and infections of the brain (31%) were most frequently named as stroke mimics. Main diagnostic measures indicated were magnetic resonance imaging (MRI) (96%) and computer tomography (CT) (55%). Main therapeutic strategies were thrombolysis (80%), anticoagulation (41%), neuroprotective measures, and thrombectomies (15% each). Thirty-nine percent of participants had taken part in training sessions, 61% studied literature, 37% discussed with colleagues, and 25% performed internet research on childhood stroke. Ninety-three percent of participants approve skill enhancement, favoring training sessions (80%), publications (43%), and web based offers (35%). Consent for offering a flyer on the topic to caregivers in facilities was given in 49%. Conclusion: Childhood stroke constitutes a topic of clinical importance to pediatricians. Participants demonstrate a considerable level of comprehension concerning the subject, but room for improvement remains. A multi-modal approach encompassing an elaborate training program, regular educational publications in professional journals, and web based offers could reach a broad range of health care providers. Paired with a public adult and childhood stroke awareness campaign, these efforts could contribute to optimize the care for children suffering from stroke.

Jumping Mechanography as a Complementary Testing Tool for Motor Function in Children with Hereditary Motor and Sensory Neuropathy

Objective This study aims to compare mechanography, measuring force in jumping, and rising, with the 6‐minute walk test (6MWT) and time function tests in pediatric patients with hereditary motor and sensory neuropathies. Methods A cohort of 23 patients performed the 6MWT and time function tests (time to run 10 m, to rise from a supine position, and to climb four stairs), as well as the chair rising test (CRT) and the single two‐legged jump (S2LJ) on a mechanography ground reaction force platform. Results were correlated calculating linear regression. Results Correlation revealed high or moderate correlation between mechanography and the 6MWT and the time function tests: S2LJ/6MWT = 0.64; CRT/6MWT = 0.52; S2LJ/rising from floor = 0.63; CRT/rising from floor = 0.67; S2LJ/10 m run = 0.74; CRT/10 m run = 0.66; S2LJ/climb four stairs = 0.56; CRT/climb four stairs = 0.47. Conclusion Jumping mechanography is a good additional tool for the assessment of pediatric patients with Charcot‐Marie‐Tooth disease and might be used for primary outcome measures. It was not feasible in more advanced stages of the disease. In less disabled children, the S2LJ, which quantifies force generated by proximal and distal muscles, might be superior to other tests.

Which covariates influence effectiveness of intensified robotic-assisted treadmill therapy in children with cerebral palsy

Aims: In children with cerebral palsy (CP), intensified robotic-assisted treadmill therapy (iRobAT) has been shown to improve ICF domains of function, activity, and participation. Yet the influencing covariates on effectiveness of this expensive and time-consuming intervention remain unclear. The purpose of this study is to look for improvement in gros motor function in children with CP in correlation to the following covariates: gender, age, GMFCS level, combination with botulinum toxin (BoNT), therapy intensity, and repetitive iRobAT blocks.