Spasticity of the gastrosoleus muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy: A registry analysis of 2,796 examinations in 355 children

Background and purpose Spasticity and muscle contracture are two common manifestations of cerebral palsy (CP). A spastic muscle may inhibit growth in length of the muscle, but the importance of this relationship is not known. In 1994, a register and a healthcare program for children with CP in southern Sweden were initiated. The child's muscle tone according to the Ashworth scale and the ankle range of motion (ROM) is measured annually during the entire growth period. We have used these data to analyze the relationship between spasticity and ROM of the gastrosoleus muscle. Patients and methods All measurements in the total population of children with CP aged 0-18 years during the period January 1995 through June 2008 were analyzed. The study was based on 2,796 examinations in 355 children. In the statistical analysis, the effect of muscle tone on ROM was estimated using a random effects model. Results The range of dorsiflexion of the ankle joint decreased in the total material by mean 19 (95% CI: 14-24) degrees during the first 18 years of life. There was a statistically significant association between the ROM and the child's level of spasticity during the year preceding the ROM measurement. Interpretation Spasticity is related to the development of muscle contracture. In the treatment of children with CP, the spasticity, contracture, and strength of the gastrosoleus muscle must be considered together

Development of spasticity with age in a total population of children with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy.</p> <p>Methods</p> <p>All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995–2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0–1 were gathered in one category and levels 2–4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion.</p> <p>Results</p> <p>In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2–4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15.</p> <p>Conclusion</p> <p>In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.</p

Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children

<p>Abstract</p> <p>Background</p> <p>The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy.</p> <p>Methods</p> <p>365 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden were included in the study. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four.</p> <p>Results</p> <p>GMFCS levels were available in all 365 children, MACS levels in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels.</p> <p>Conclusion</p> <p>Gross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. To give a complete clinical picture when evaluating these children, both aspects have to be described. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.</p

Characteristics of children with hip displacement in cerebral palsy

<p>Abstract</p> <p>Background</p> <p>Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.</p> <p>Methods</p> <p>In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9–16 years of age.</p> <p>Results</p> <p>Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement.</p> <p>The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V.</p> <p>Conclusion</p> <p>Hip displacement in CP often occurs already at 2–3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted.</p> <p>We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child's age and GMFCS level.</p

Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

<p>Abstract</p> <p>Background</p> <p>The decreasing range of joint motion caused by insufficient muscle length is a common problem in children with cerebral palsy (CP), often worsening with age. In 1994 a CP register and health care programme for children with CP was initiated in southern Sweden. The aim of this study was to analyse the development of the passive range of motion (ROM) in the lower limbs during all the growth periods in relation to gross motor function and CP subtype in the total population of children with CP.</p> <p>Methods</p> <p>In total, 359 children with CP born during 1990-1999, living in the southernmost part of Sweden in the year during which they reached their third birthday and still living in the area in the year of their seventh birthday were analysed. The programme includes a continuous standardized follow-up with goniometric measurements of ROM in the lower limbs. The assessments are made by each child's local physiotherapist twice a year until 6 years of age, then once a year. In total, 5075 assessments from the CPUP database from 1994 to 1 January 2007 were analysed.</p> <p>Results</p> <p>The study showed a decreasing mean range of motion over the period 2-14 years of age in all joints or muscles measured. The development of ROM varied according to GMFCS level and CP subtype.</p> <p>Conclusion</p> <p>We found a decreasing ROM in children with CP from 2-14 years of age. This information is important for both the treatment and follow-up planning of the individual child as well as for the planning of health care programmes for all children with CP.</p

Sensitivity of Colding tool life equation on the dimensions of experimental dataset

In this work, 22 sets of cutting data and tool life for longitudinal turning of steel are analyzed using the Colding equation. When modeling tool life with a limited number of tool performance data points, the model error may be low for these points. Evaluating the model for test points not used when computing the model coefficients may give larger errors for these points. This work proves that the Colding model also provides sufficient precision when modelling data points not being used to create the model, and is therefore a well-functioning instrument for tool life modelling. The results also prove that for the selected data, the precision of the model can be greatly improved when the dimension of the data set is increased from 5 to 10 data points. Above 13 data points the precision improvements are negligible.Проаналізовано 22 набору режимів різання і стійкість інструменту при поздовжньому точінні стали при застосуванні моделі Колдінга. При моделюванні стійкості інструменту при обмеженій кількості даних про робочі характеристики помилка моделі може бути незначною в заданих точках. Оцінка моделі для тестових точок, які не використовуються при обчисленні коефіцієнтів моделі, може показати більші помилки в цих точках. Доведено, що модель Колдінга забезпечує достатню точність при моделюванні даних, що не використовуються для створення моделі, і тому може бути застосована для моделювання періоду стійкості інструменту. Результати також доводять, що для даних, що використовуються, точність моделі може бути значно поліпшена при збільшенні набору точок з 5 до 10, а при збільшенні понад 13 точок поліпшення точності моделювання незначні.Проанализированы 22 набора режимов резания и стойкость инструмента при продольном точении стали с применением модели Колдинга. При моделировании стойкости инструмента при ограниченном количестве данных о рабочих характеристиках ошибка модели может быть незначительной в заданных точках. Оценка модели для тестовых точек, не используемых при вычислении коэффициентов модели, может показать бóльшие ошибки в этих точках. Доказано, что модель Колдинга обеспечивает достаточную точность при моделировании данных, не используемых для создания модели, и поэтому может быть применена для моделирования периода стойкости инструмента. Результаты также доказывают, что для используемых данных точность модели может быть значительно улучшена при увеличении набора точек с 5 до 10, а при увеличении более 13 точек улучшения точности моделирования незначительны

When Is a Principal Charged With an Agent’s Knowledge?

Question: Detecting species presence in vegetation and making visual assessment of abundances involve a certain amount of skill, and therefore subjectivity. We evaluated the magnitude of the error in data, and its consequences for evaluating temporal trends. Location: Swedish forest vegetation. Methods: Vegetation data were collected independently by two observers in 342 permanent 100-m2 plots in mature boreal forests. Each plot was visited by one observer from a group of 36 and one of two quality assessment observers. The cover class of 29 taxa was recorded, and presence/absence for an additional 50. Results: Overall, one third of each occurrence was missed by one of the two observers, but with large differences among species. There were more missed occurrences at low abundances. Species occurring at low abundance when present tended to be frequently overlooked. Variance component analyses indicated that cover data on 5 of 17 species had a significant observer bias. Observer-explained variance was &lt; 10% in 15 of 17 species. Conclusion: The substantial number of missed occurrences suggests poor power in detecting changes based on presence/absence data. The magnitude of observer bias in cover estimates was relatively small, compared with random error, and therefore potentially analytically tractable. Data in this monitoring system could be improved by a more structured working model during field work.Original publication: Milberg, P., Bergstedt, J., Fridman, J., Odell, G & Westerberg, L., Systematic and random variation in vegetation monitoring data, 2008, Journal of Vegetation Science, (19), 633-644. http://dx.doi.org/10.3170/2008-8-18423. Copyright: Opulus Press, http://www.opuluspress.se/index.ph

Influence of radial depth of cut on entry conditions and dynamics in face milling application

In this study, acceleration of the workpiece is measured for different radial depths of cut and cutting edge geometries. The influence of the radial depth of cut on the dynamical behavior is evaluated in time and frequency domains. The results for different radial depths of cut and cutting geometries are quantified using the root mean square value of acceleration. The outcome of this research study can be used both for the better cutting data recommendations and improved tool design.У даному дослідженні прискорення оброблюваної деталі вимірювали для різних радіальних глибин різання і геометрії ріжучої кромки фрези. Вплив радіальної глибини різання на динамічну поведінку оцінювали в часових і частотних інтервалах. Отримано кількісні результати для різних радіальних глибин і геометрії різання з використанням середньоквадратичного значення прискорення. Результати цього дослідження можуть бути використані для рекомендацій як покращення процесу різання, так і конструкції інструменту.В данном исследовании ускорение перемещения заготовки измеряли для разных радиальных глубин резания и геометрии режущей кромки фрезы. Влияние радиальной глубины резания на динамическое поведение оценивали во временных и частотных интервалах. Получены количественные результаты для различных радиальных глубин и геометрии резания с использованием среднеквадратичного значения ускорения. Результаты этого исследования могут быть использованы для рекомендаций по улучшению как процесса резания, так конструкции инструмента

The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study

Background:  An increased Head Shaft Angle (HSA) has been reported as a risk factor for hip displacement in children with cerebral palsy (CP) but opinions differ in the literature. The purpose of this study was to re-evaluate the relationship between HSA and hip displacement in a different population of children with CP. Methods:  The Cerebral Palsy Integrated Pathway Scotland surveillance programme includes 95% of all children with CP in Scotland. The pelvic radiographs from 640 children in GMFCS levels III-V were chosen. The most displaced hip was analysed and the radiographs used were those taken at the child’s first registration in the database to avoid the potential effects of surveillance on subsequent hip centration. A logistic regression model was used with hip displacement (migration percentage [MP] ≥40%) as outcome and HSA, GMFCS, age and sex as covariates. Results: The MP was ≥40% in 118 hips with a mean HSA of 164° (range 121–180°) and < 40% in 522 hips with a mean HSA of 160° (range 111–180°). The logistic regression analysis showed no significant influence of age and sex on MP in this population but a high GMFCS level was strongly associated with hip displacement. An increased HSA was also associated with hip displacement, a 10° difference in HSA for children adjusted for age, sex, and GMFCS gave an odds ratio of 1.26 for hip displacement equal or above 40% (p = 0.009) and hips with HSA above 164.5 degrees had an odds ratio of 1.96 compared with hips with HSA below 164.5 degrees (p = 0.002). Conclusion:  These findings confirm that HSA is associated with hip displacement in children in GMFCS levels III-V.Publisher PDFPeer reviewe