The Chinese Guideline for Rehabilitation of Cerebral Palsy (hereinafter referred as Guideline) is the first evidence-based guideline for rehabilitation of cerebral palsy, which was compiled by Chinese experts from different fields in 2015. The Guideline suggests that the diagnosis of cerebral palsy needs to meet four essential conditions and two reference conditions. Although the cerebral palsy can be diagnosed according to the Guideline, there is still the question that whether there is a clear age definition and standardized prediction methods for early diagnosis and accurate prediction of cerebral palsy. The Guideline does not give a clear definition of age and standardized prediction methods. There is no international unified understanding or specific recommendations as well. Recently, Dr Iona Novak and other experts have pointed out that the historical viewpoint of the latent or silent period (before the age of 12-24 months) has already been outdated, because cerebral palsy or " high risk of cerebral palsy” can be accurately predicted before the corrected age of 6 months and it is possible to accurately predicte whether it is cerebral palsy or " high risk of cerebral palsy” before the corrected age of 6 months. They proposed a standardized assessment program for early diagnosis. This article introduces and discusses the relevant descriptions of the Guideline and the latest international understanding of early diagnosis and intervention of cerebral palsy.
Mirror therapy is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving non-affected limb gives the illusion of normal movement in the affected limb. As a simple, safe, and low-cost treatment, mirror therapy has been widely used. By summarizing and analyzing the literature about mirror therapy at home and abroad, this article summarizes its mechanism and clinical application in pain, stroke, cerebral palsy and so on, so as to provide reference for research and application on mirror therapy.
Objectives To analyze the effect of sling exercise therapy on the walking ability of children with spastic hemiplegia and cerebral palsy, and to provide a scientific basis for clinical treatment. Methods Children with spastic hemiplegia and cerebral palsy who were treated in the Department of Rehabilitation of Children’s Hospital of Shanghai from July 2018 to July 2019 were selected as the research subjects. The children were divided into conventional treatment group and sling exercise therapy group by random number table method. The routine treatment group was given routine rehabilitation training, and the sling exercise therapy group was given combined sling exercise therapy on the basis of routine treatment. The Gross Motor Function Measure (GMFM)-88-item E functional area score, Clinical Spasticity Index (CSI) and Berg Balance Scale (BBS) score were compared between the two groups. Results A total of 36 children were included, with 18 cases in each group. There was no significant difference in gender, age and hemiplegia side between the two groups (P>0.05). All children completed the trial without adverse reactions. Before treatment, there was no significant difference in BBS, CSI and GMFM-88 E functional area scores between the two groups (P>0.05). After 3 months of treatment, the above scores of the two groups were improved compared with those before treatment (P<0.05). The improvement of the above scores in the sling exercise therapy group after treatment was better than that in the conventional treatment group. The difference of BBS, CSI, and GMFM-88 E functional area scores in the sling exercise therapy group before and after treatment was 8.94±4.15, 2.44±0.71, and 7.28±3.23, respectively, the difference of the above scores before and after treatment in the conventional treatment group was 4.50±4.15, 1.83±0.79, and 2.89±1.64, respectively, and the differences were statistically significant (P<0.05). Conclusion Combined use of sling exercise therapy can better improve the walking ability of children with spastic hemiplegia and cerebral palsy, which is worthy of clinical promotion and application.
ObjectiveTo observe whether multipoint target muscle injection of botulinum toxin type A (BTX-A) in the treatment of spastic cerebral palsy in children is better than non-multipoint target muscle injection. MethodsFrom February to October 2013, 42 children with spastic cerebral palsy were treated in our hospital. According to the treatment sequence, the children were numbered. Those with an odd number were designated into multipoint target muscle injection group (group A), and those with an even number were put into non-multipoint target muscle ordinary injection group (group B). Each group had 21 children, and all of them were treated with the injection of BTX-A. Modified Ashworth Scoring (MAS) was performed for all the children before treatment, and 2 weeks, one month, and three months after treatment. The change of dorsiflexion range of motion with knee flexion and extension was recorded and compared. The analysis was done by using multilevel statistical method. ResultsBoth groups of children had significantly improved their ankle range and modified Ashworth score (P<0.05). No interaction between measurement time and group was detected, and the differences between the two groups had no statistical significance (P>0.05). ConclusionLower muscle tone, greater ankle mobility and better motor function can be achieved after Botulinum toxin A treatment. For now, we cannot draw the conclusion that the effect of multipoint target muscle injection is better than that of non-multipoint target muscle injection in the treatment of spastic cerebral palsy in children.
ObjectiveTo explore the surgical technique and effectiveness of limited bone and soft tissue surgery combined with Ilizarov technique in the treatment of adolescents severe cerebral palsy with flattened valgus foot and lower leg external rotation deformity. MethodsA retrospective analysis was conducted on 12 patients with severe cerebral palsy with flattened valgus foot and external rotation deformity of the lower leg, totaling 16 feet, admitted between January 2022 and January 2025. There were 5 males with 7 feet and 7 females with 9 feet, the age ranged from 12 to 18 years, with an average of 15 years. There were 10 cases on the left foot, 6 cases on the right foot, and 4 cases on both feet. The preoperative external rotation angle of the lower leg ranged from 20° to 35°, with an average of 26°. The preoperative visual analogue scale (VAS) score was 4.9±0.9, the American Orthopaedic Foot & Ankle Society (AOFAS) score was 68.7±12.0, the calcaneal tilt angle was (12.69±1.78)°, and the hindfoot angle was (18.69±3.55)°. Patients with bilateral lower leg deformities underwent surgery in two phases, with an interval of 3-6 months between surgeries. Select soft tissue surgery (Achilles tendon elongation, release or transposition of joint capsule and ligaments) and bone surgery (joint fusion, calcaneal osteotomy, medial wedge osteotomy, etc.) combined with tibiofibular internal rotation osteotomy and Ilizarov external fixation were selected according to the patient’s condition. At 1 week after operation, the external fixators of the lower leg and ankle were slowly adjusted, and the deformities that were not completely solved in the three-dimensional correction operation were corrected. Postoperative pain relief and functional recovery were evaluated by VAS and AOFAS scores, and the improvement of foot deformity was evaluated by calcaneal tilt angle and hindfoot angle on radiographic data, and the postoperative effctiveness was evaluated according to the International Clubfoot Study Group (ICFSG). Results At 2 weeks after operation, the foot deformity of the patient was basically adjusted. All patients were followed up 6-36 months, with an average of 18 months. The incisions healed by first intention without nerve injury, infection, or other complications. At last follow-up, the patients recovered satisfactorily, the osteotomy sites healed, and the external rotation of the lower leg was corrected. The VAS score was 1.2±0.1 and AOFAS score was 86.7±6.8, which were significantly different from those before operation (P<0.05). The calcaneal tilt angle was (18.38±1.15)° and the hindfoot angle was (10.06±2.93)°, which were significantly different from those before operation (P<0.05). According to the ICFSG scoring standard, 13 feet were excellent and 3 feet were good, and the excellent and good rate was 100%. ConclusionThe combination of bone and soft tissue limited surgery and Ilizarov technique is a safe, minimally invasive, and effective method for treating severe cerebral palsy in adolescents with flattened valgus foot and external rotation deformity of the lower leg. It conforms to biological principles and follows the concept of natural bone reconstruction.
Objective To assess the effectiveness of T1 nerve root transection for treating spastic hand contracture in patients with cerebral palsy. Methods A clinical data of 12 patients with spastic hand contracture caused by cerebral palsy, who admitted between March 2024 and February 2025 and treated with T1 nerve root transection, was retrospectively analyzed. There were 7 males and 5 females, with a mean age of 35.6 years (range, 13-67 years). Before operation, muscle tone was grading 3-4 according to the Modified Ashworth Scale (MAS); muscle strength of the affected hand was grading 2-4 for flexor muscles and grading 0-4 for extensor muscles according to the Medical Research Council (MRC) scale; hand function was grading 0-4 according to the modified House Functional Classification (HFC); upper limb function scoring was 5.5 (0.5, 10.3) according to the Action Research Arm Test (ARAT) score. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 6-18 months (mean, 12.6 months). At last follow-up, the spastic contracture of the affected hand obviously reduced, the muscle tone decreased, and hand function improved. The MAS grade, HFC grade, and ARAT score all showed significant improvement when compared with preoperative values (P<0.05). However, there was no significant improvement in flexor or extensor muscle strength of the affected limb, and no significant difference in MRC grade between pre- and post-operation (P>0.05). Conclusion T1 nerve root transection is a safe and effective treatment for spastic hand contracture in patients with cerebral palsy. It can significantly reduce muscle tone, relieve flexion contracture, and improve hand function. However, it does not appear to improve muscle strength.