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What early clinical signs should prompt referral for diagnosis of cerebral palsy? A scoping review
Author(s) -
A GAHUKAMBLE
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.17_13225
Subject(s) - cerebral palsy , referral , medicine , pediatrics , physical therapy , physical medicine and rehabilitation , family medicine
Background and Objective(s): Bilateral spastic cerebral palsy (BSCP) accounts for about 70% of children with spastic cerebral palsy. The clinical presentation with regards to gait is complex. In the context of orthopaedic interventions for cerebral palsy, the concept of a surgical dose has been advocated. This emphasizes the importance of individualizing treatment including the surgical prescription while planning care. Asymmetric involvement in BSCP furthermore highlights the need to tailor treatment. In this study, our aim was to investigate the difference in severity of involvement of the two sides in ambulant children with bilateral spastic cerebral palsy. Study Design: Cross sectional study. Study Participants & Setting: A total of 50 consecutive children with BSCP, GMFCS I to III, treated in the Cerebral palsy clinic of a tertiary care hospital between September 2014 and December 2015 were included. Materials/Methods: The Edinburgh visual gait score (EVGS) was used to score the gait deviations on each side using video recordings taken as part of the management protocol. The severity of involvement of the sides was considered asymmetric if a difference of more than 3 existed between the scores of the sides. Parametric data was reported as means, standard deviations and t-test used for between group comparisons. Statistical analysis was carried out using SPSS v15.0. Results: The mean age was 9.3 years (SD 3.8, range 4–17). There were 34 boys and 16 girls. GMFCS distribution was 1 GMFCS I, 18 GMFCS II and 31 GMFCS III. The mean total EVGS and difference between EVGS of each side were GMFCS II: 23.0 (SD 5.2), 3.2 (SD 2.8) and GMFCS III: 33.2 (SD 7.3) and 2.4 (SD 2.3) respectively. 16 of the 50 children (32%) had a difference in the EVGS of each side of 4 or more, these comprised the asymmetric group. The mean age, total EVGS and mean difference in EVGS in the asymmetric group was 8.4 years (SD 3.9), 27.2 (SD 6.8) and 5.6 (2.3) respectively and in the symmetric group were 9.6 years (SD 3.7), 29.8 (SD 9.6) and 1.3 (0.8) respectively. We were unable to demonstrate a significant difference between the asymmetric and symmetric group based on GMFCS or age. Of the 50 children we identified 13 who demonstrated a crouch gait pattern as a result of the natural history of cerebral palsy. The mean difference in EVGS in this group was 1.3 (SD 1.2) as compared to 3.1 (SD 2.7) for the rest of the cohort; this difference was statistically significant (p=0.021). Conclusions/Significance: Thirty two percent of ambulant children with bilateral spastic cerebral palsy have asymmetry in the severity of involvement as per the EVGS. Children with a primary crouch gait pattern are more likely to have symmetric EVGS scores on both sides. This study demonstrates that a large proportion of children with BSCP are likely to require different doses of treatment for each side. This data will also be useful in sample size calculation while planning future research.