Predictors of the Effectiveness of Medical Rehabilitation of Patients with Cerebral Palsy

Abstract

INTRODUCTION: Cerebral palsy (CP) is one of the most common causes of disability in children. The use of clinical tools that will allow the prediction of results is necessary for the medical rehabilitation of children with CP. Although clinical and socio-economic factors that determine the prognosis of rehabilitation and further social adaptation of patients with CP are being actively investigated, predictors that help predict the effectiveness of medical rehabilitation measures are not yet identified.

AIM: To determine the predictors of the effectiveness of medical rehabilitation in children with CP using anamnesis, scales, and questionnaire data.

MATERIALS AND METHODS: The study involved 29 children (average age, 5.4 ± 1.1 years) with various forms of CP who underwent medical rehabilitation in inpatient and outpatient conditions within 12 months. Before and after rehabilitation courses, all patients, apart from general somatic-clinical and neurological examinations, underwent tests that use specialized questionnaires and scales and evaluation using the International Classification of Functioning, Disability and Health (ICF) Core Sets for children and adolescence with cerebral palsy. The patients were arranged into groups depending on the presence of improvement determined using the author-developed criterion: reduction of the determinant level relative to “function” and “activity and participation” components of ICF by a minimum of at least one point in three domains. Various uni- and multivariate logistic regression models were used to evaluate the prognostic significance of history, scales, and questionnaire data. Receiver operating characteristic curves were constructed to determine the threshold values of quantitative parameters optimal for predicting a certain treatment outcome.

RESULTS: The Gross Motor Function Measure 88 score of >82.1% before the rehabilitation measures indicated a positive rehabilitation prognosis. ICF domains b760 “control of voluntary movement functions”, d415 “maintaining a body position”, and d710 “basic interpersonal relations” are predictors of the effectiveness of rehabilitation in patients with a CP with determinant level ≤ 1.

CONCLUSION: The results demonstrated that higher parameters of motor and coordination functions and higher levels of interpersonal interactions of children with ICP are significant predictors of the effectiveness of rehabilitation.

Keywords

infantile cerebral palsy / medical rehabilitation / efficiency / predictors / rehabilitation prognosis / international classification of functioning / ICF

References

[1] Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology. 2007;109:8–14.

[2] Rosenbaum P., Paneth N., Leviton A., et al. A report: the definition and classification of cerebral palsy April 2006 // Developmental Medicine & Child Neurology. 2007. Vol. 109. Р. 8–14.

[3] Castelli E, Fazzi E, SIMFER-SINPIA Intersociety Commission. Recommendations for the rehabilitation of children with cerebral palsy. European Journal of Physical and Rehabilitation Medicine. 2016; 52(5):691–703.

[4] Castelli E., Fazzi E., SIMFER-SINPIA Intersociety Commission. Recommendations for the rehabilitation of children with cerebral palsy // European Journal of Physical and Rehabilitation Medicine. 2016. Vol. 52, № 5. Р. 691–703.

[5] Semyonova EV, Klochkova EV, Korshikova-Morozova AE, et al. Reabilitatsiya detey s DTsP: obzor sovremennykh podkhodov v pomoshch’ reabilitatsionnym tsentram. Moscow: Lepta Kniga; 2018. (In Russ).

[6] Семёнова Е.В., Клочкова Е.В., Коршикова-Морозова А.Е., и др. Реабилитация детей с ДЦП: обзор современных подходов в помощь реабилитационным центрам. М.: Лепта книга; 2018.

[7] Wimalasundera N, Stevenson VL. Cerebral palsy. Practical Neurology. 2016;16(3):184–94. doi: 10.1136/practneurol-2015-001184

[8] Wimalasundera N., Stevenson V.L. Cerebral palsy // Practical Neurology. 2016. Vol. 16, № 3. P.184–194. doi: 10.1136/practneurol-2015-001184

[9] Klinicheskiye rekomendatsii. Detskiy tserebral’nyy paralich u detey. Moscow: Union of Pediatricians of Russia; 2016. (In Russ). https://nasdr.ru/wp-content/uploads/2019/06/kr_dcp.pdf.

[10] Клинические рекомендации. Детский церебральный паралич у детей. М.: Союз педиатров России; 2016. Доступно по: https://nasdr.ru/wp-content/uploads/2019/06/kr_dcp.pdf.

[11] Verschuren O, Peterson MD, Balemans ACJ, et al. Exercise and physical activity recommendations for people with cerebral palsy. Developmental Medicine & Child Neurology. 2016;58(8):798–808. doi: 10.1111/dmcn.13053

[12] Verschuren O., Peterson M.D., Balemans A.C.J., et al. Exercise and physical activity recommendations for people with cerebral palsy // Developmental Medicine & Child Neurology. 2016. Vol. 58, № 8. Р. 798–808. doi: 10.1111/dmcn.13053

[13] Sheiko GE, Belova AN, Kuznetsov AN, et al. Application of the International Classification of Functioning, Disability and Health (Children and Youth Version) in the Evaluation of Rehabilitation Measures of Patients with Cerebral Palsy. Bulletin of Rehabilitation Medicine. 2020;99(5):38-45. (In Russ). doi: 10.38025/2078-1962-2020-99-5-38-45

[14] Шейко Г.Е., Белова А.Н., Кузнецов А.Н., и др. Применение Международной классификации функционирования, ограничения жизнедеятельности и здоровья детей и подростков в оценке реабилитационных мероприятий у пациентов с детским церебральным параличом // Вестник восстановительной медицины. 2020. Т. 99, № 5. С. 38–45. doi: 10.38025/2078-1962-2020-99-5-38-45

[15] Andrade PMO, Haase VG, Oliveira–Ferreira F. An ICF-based approach for cerebral palsy from a biopsychosocial perspective. Developmental Neurorehabilitation. 2012;15(6):391–400. doi: 10.3109/17518423.2012.700650

[16] Andrade P.M.O., Haase V.G., Oliveira–Ferreira F. An ICF-based approach for cerebral palsy from a biopsychosocial perspective // Developmental Neurorehabilitation. 2012. Vol. 15, № 6. Р. 391–400. doi: 10.3109/17518423.2012.700650

[17] Almasri NA, O’Neil ME, Palisano RJ. Predictors of needs for families of children with cerebral palsy. Disability and Rehabilitation. 2014;36(3):210–9. doi: 10.3109/09638288.2013.783123

[18] Almasri N.A., O’Neil M.E., Palisano R.J. Predictors of needs for families of children with cerebral palsy // Disability and Rehabilitation. 2014. Vol. 36, № 3. Р. 210–219. doi: 10.3109/09638288.2013.783123

[19] Schiariti V, Selb M, Cieza A, et al. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: A consensus meeting. Developmental Medicine & Child Neurology. 2015;57(2):149–58. doi: 10.1111/dmcn.12551

[20] Schiariti V., Selb M., Cieza A., et al. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: a consensus meeting // Developmental Medicine & Child Neurology. 2015. Vol. 57, № 2. P. 149–158. doi: 10.1111/dmcn.12551

[21] Schiariti V, Sauve K, Tatla S. Which Measure Should I Use?: Content Analysis Using the ICF Core Sets for Children and Youth with Cerebral Palsy. Paediatrics & Child Health. 2015;20(5):e41-2. doi: 10.1093/pch/20.5.e41

[22] Schiariti V., Sauve K., Tatla S. Which Measure Should I Use?: Content Analysis Using the ICF Core Sets for Children and Youth with Cerebral Palsy // Paediatrics & Child Health. 2015. Vol. 20, № 5. Р. e41–e42. doi: 10.1093/pch/20.5.e41

[23] Belova AN, Sheiko GE, Shaklunova NV, et al. Medical Rehabilitation of Children with Cerebral Palsy: Application of the International Classification of Functioning, Disability and Health (Children & Youth Version). Bulletin of Rehabilitation Medicine. 2019;(1):2-9. (In Russ).

[24] Белова А.Н., Шейко Г.Е., Шаклунова Н.В., и др. Медицинская реабилитация при детском церебральном параличе: применение Международной классификации функционирования, ограничений жизнедеятельности и здоровья детей и подростков // Вестник восстановительной медицины. 2019. № 1. С. 2–9.

[25] Russell DJ, Rosenbaum PL, Avery LM, et al. Gross Motor Function Measure (GMFM-66 & GMFM-88): User's Manual. London : Mac Keith, distributed by Cambridge University Press; 2002.

[26] Russell D.J., Rosenbaum P.L., Avery L.M., et al. Gross Motor Function Measure (GMFM-66 & GMFM-88): User's Manual. London: London: Mac Keith, distributed by Cambridge University Press; 2002.

[27] Schiariti V, Mahdi S, Bölte S. International Classification of Functioning, Disability and Health Core Sets for cerebral palsy, autism spectrum disorder, and attention-deficit-hyperactivity disorder. Developmental Medicine & Child Neurology. 2018;60(9):933-41. doi: 10.1111/dmcn.13922

[28] Schiariti V., Mahdi S., Bölte S. International Classification of Functioning, Disability and Health Core Sets for cerebral palsy, autism spectrum disorder, and attention-deficit-hyperactivity disorder // Developmental Medicine & Child Neurology. 2018. Vol. 60, № 9. Р. 933–941. doi: 10.1111/dmcn.13922

[29] Jeevanantham D. Application of the International Classification of Functioning, Disability and Health ― Children and Youth in Children With Cerebral Palsy. Indian Pediatrics. 2016;53(9):805–10. doi: 10.1007/s13312-016-0935-8

[30] Jeevanantham D. Application of the International Classification of Functioning, Disability and Health ― Children and Youth in Children With Cerebral Palsy // Indian Pediatrics. 2016. Vol. 53, № 9. Р. 805–810. doi: 10.1007/s13312-016-0935-8

[31] Shoshmin AV, Ponomarenko GN, Besstrashnova YaK, et al. The application of the International Classification of functioning, disability and health for the evaluation of the effectiveness of rehabilitation: methodology, practical experience, results. Voprosy Kurortologii, Fizioterapii, i Lechebnoi Fizicheskoi Kultury. 2016;93(6):12–20. (In Russ). doi: 10.17116/kurort2016612-20

[32] Шошмин А.В., Пономаренко Г.Н., Бесстрашнова Я.К., и др. Применение международной классификации функционирования, ограничений жизнедеятельности и здоровья для оценки эффективности реабилитации: методология, практика, результаты // Вопросы курортологии, физиотерапии и лечебной физической культуры. 2016. Т. 93, № 6, С. 12-20. doi: 10.17116/kurort2016612-20

[33] Weigl M, Cieza A, Andersen C, et al. Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise. Journal of Rehabilitation Medicine. 2004;(44 Suppl):12–21. doi: 10.1080/16501960410015443

[34] Weigl M., Cieza A., Andersen C., et al. Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise // Journal of Rehabilitation Medicine. 2004. № 44 Suppl. Р. 12–21. doi: 10.1080/16501960410015443

[35] Yun YN, Choi GE, Lim H. Assessment Using the ICF-core set for Children and Youth with Cerebral Palsy: A Single Case Study. The Journal of Korean Physical Therapy. 2019;31(2):103-10. doi: 10.18857/JKPT.2019.31.2.103

[36] Yun Y.N., Choi G.E., Lim H. Assessment Using the ICF-core set for Children and Youth with Cerebral Palsy: A Single Case Study // The Journal of Korean Physical Therapy. 2019. Vol. 31, № 2. Р.103-110. doi: 10.18857/JKPT.2019.31.2.103

[37] Van Gorp M, Roebroeck ME, van Eck M, et al. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study. Disability and Rehabilitation. 2020;42(22):3162-71. doi: 10.1080/09638288.2019.1585971

[38] Van Gorp M., Roebroeck M.E., van Eck M., et al. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study // Disability and Rehabilitation. 2020. Vol. 42, № 22. Р. 3162-3171. doi: 10.1080/09638288.2019.1585971