• Humans
• Muscle Spasticity/therapy
• Muscle Spasticity/diagnosis
• Muscle Spasticity/rehabilitation
• Muscle Spasticity/etiology
• Muscle Spasticity/physiopathology
• Consensus
• Physical and Rehabilitation Medicine/standards
• Physical and Rehabilitation Medicine/methods
• United States
• Delphi Technique
• Practice Guidelines as Topic

• American Academy of Physical Medicine and Rehabilitation

• cerebral palsy
• contracture
• functional physiotherapy
• muscle strength
• passive range of motion
• selective percutaneous myofascial lengthening

• PRISMA (Preferred reporting items for systematic reviews and meta-analysis)
• cerebral palsy
• forearm (MeSH)
• pediatric
• surgery
• systematic review & meta-analysis
• upper extremity
• wrist (MeSH)

• Male
• Child
• Humans
• Adolescent
• Cerebral Palsy/complications
• Cerebral Palsy/surgery
• Gait
• Orthopedic Procedures
• Outcome Assessment, Health Care

Cerebral palsy (CP) is a complex neuromuscular condition that may negatively influence gross motor function. Children diagnosed with CP often exhibit spasticity, weakness, reduced motor control, contracture, and bony malalignment. Despite many previous association studies, the causal impact of these impairments on motor function is unknown.

In this study, we proposed a causal model which estimated the effects of common impairments on motor function in children with spastic CP as measured by the 66-item Gross Motor Function Measure (GMFM-66). We estimated both direct and total effect sizes of all included variables using linear regression based on covariate adjustment sets implied by the minimally sufficient adjustment sets. In addition, we estimated bivariate effect sizes of all measures for comparison.

We retrospectively evaluated 300 consecutive subjects with spastic cerebral palsy who underwent routine clinical gait analysis. Model data included standard information collected during this analysis.

The largest causal effect sizes, as measured by standardized regression coefficients, were found for selective voluntary motor control and dynamic motor control, followed by strength, then gait deviations. In contrast, common treatment targets, such as spasticity and orthopedic deformity, had relatively small effects. Effect sizes estimated from bivariate models, which cannot appropriately adjust for other causal factors, substantially overestimated the total effect of spasticity, strength, and orthopedic deformity.

Understanding the effects of impairments on gross motor function will allow clinicians to direct treatments at those impairments with the greatest potential to influence gross motor function and provide realistic expectations of the anticipated changes.

• Cerebral Palsy
• Child
• Disability Evaluation
• Gait
• Humans
• Motor Skills
• Muscle Spasticity
• Retrospective Studies

• Cerebral Palsy/surgery
• Child
• Databases, Factual
• Humans
• Medicine
• Young Adult

The objective of the study is to identify and evaluate possible factors that influence the ability to run before and after single event multi-level surgery (SEMLS). Young patients (6–25 years) with spastic cerebral palsy (GMFCSI-II) were retrospectively included. Type and number of surgical procedures, time for recovery and 3D gait analysis variables were analyzed with respect to the ability to run. In total, 98 patients (38 females; 60 males) who received SEMLS (12 years, SD 3.4) were included and compared to a control group of 71 conservatively treated patients. Of 60 runners pre-surgery, 17 (28%) lost the ability, while gained in 8 of 38 (21%) non-runners. The number of surgical procedures was a significant predictor and those who lost their ability to run had significantly more (mean = 5.9, SD = 1.7), compared to the patients who gained the ability (mean = 3.5, SD = 0.9). Further, pre-surgical function (e.g., gait speed) was significantly different (p < 0.001). Pre-surgical function and the number of surgical procedures seem to play an important role for the gain or loss of the ability to run after surgery. Caution is warranted in patients with lower pre-surgical function and the ability to run, as they seem at a higher risk to lose the ability.

• 3D gait analysis
• SEMLS
• cerebral palsy
• locomotion
• running

This study evaluated the effects of whole-body vibration (WBV) com-bined with action observation on gross motor function, balance, and gait in children with spastic cerebral palsy. The participants were randomized into the WBV combined with action observation (WBVAO) group (n=7) and the WBV group (n=7). The WBVAO group received WBV combined with action observation training, and the WBV group received WBV training for 4 weeks. Both groups received 30 min of training a day, 3 times a week. All participants completed the 5 times sit to stand (FTSTS) test, Timed Up and Go (TUG) test, pediatric reach test, 10-m walk test, 6-min walk test (6MWT), and timed up and down stair (TUDS) test before and after the training intervention. Moreover, the participant’s Gross Motor Function Measure (GMFM) and Pediatric Balance Scale (PBS) scores were assessed. Both the WBVAO and WBV groups demonstrated significant increases in the scores of FTSTS test, GMFM (D and E dimensions), PBS, TUG test, 6MWT, and TUDS test. The WBVAO group improved more significantly compared to the WBV group based on the scores of the FTSTS test, GMFM (D dimension), PBS, 6MWT, and TUDS test. WBV combined with action observation improved lower extremity functional strength, gross motor function, and balance and gait in children with cerebral palsy. These results suggest that WBV combined with action observation is both feasible and suitable for individuals with cerebral palsy.

• Balance
• Cerebral palsy
• Gait
• Gross motor function
• Whole-body vibration

• Cerebral Palsy/physiopathology
• Child
• Female
• Gait/physiology
• Humans
• Joints/physiopathology
• Male
• Muscle Spasticity/physiopathology
• Muscle Weakness/physiopathology
• Range of Motion, Articular/physiology
• Statistics as Topic

• Agentschap voor Innovatie door Wetenschap en Technologie
• Fonds Wetenschappelijk Onderzoek (BE)
• Onderzoeksraad, KU Leuven (BE)

Hereditary spastic paraplegias (HSPs) refer to a group of heterogeneous neurodegenerative diseases characterized by lower limbs spasticity and weakness. So far, over 72 genes have been found to cause HSP (SPG1-SPG72). Among autosomal dominant HSP patients, spastic paraplegia 4 (SPG4/SPAST) gene is the most common pathogenic gene, and atlastin-1 (ATL1) is the second most common one. Here we reported a novel ATL1 mutation in a Chinese spastic paraplegia 3A (SPG3A) family, which expands the clinical and genetic spectrum of ATL1 mutations.

A 9-year-old boy with progressive spastic paraplegia accompanied by right hearing loss and mental retardation for five years was admitted to our hospital. Past history was unremarkable. The family history was positive, and his grandfather and mother had similar symptoms. Neurological examinations revealed hypermyotonia in his lower limbs, hyperreflexia in knee reflex, bilateral positive Babinski signs and scissors gait. The results of blood routine test, liver function test, blood glucose test, ceruloplasmin test and vitamin test were all normal. The serum lactic acid level was significantly increased. The testing for brainstem auditory evoked potential demonstrated that the right side hearing was impaired while the left was normal. Magnetic resonance imaging showed mild atrophy of the spinal cord. The gene panel test revealed that the proband carried an ATL1 c.752A>G p.Gln251Arg (p.Q251R) mutation, and Sanger sequencing confirmed the existence of family co-segregation.

We reported a novel ATL1 Q251R mutation and a novel clinical phenotype of hearing loss in a Chinese SPG3A family.

• Hereditary spastic paraplegia
• SPG3A
• Atlastin-1 (ATL1) gene
• Hearing loss
• Case report

In this issue of the Biomedical Journal, we learn about a novel are still largely mysterious mechanism of cell death that is challenging classification systems of cell death pathways and could have important implications for future cancer therapy. We also learn of a promising biomarker to stratify patients into risk groups after stroke. Finally, this issue also includes two studies investigating factors that influence outcome after heart surgery.

• Cell death
• Entosis
• Neutrophil to lymphocyte ratio
• Stroke