Object In this descriptive study the authors evaluated medical outcomes, interventions, satisfaction with life, and subjective impressions about selective dorsal rhizotomy (SDR) in older adolescents and adults who had undergone the procedure as children. Methods A survey was administered to older adolescents (16–20 years old) and adults with CP who had undergone SDR between 1986 and 2000 at two academic centers. The patients or their caregivers participated in telephone or clinic interviews. Subjective impressions about the SDR and a history of post-SDR medical interventions were obtained. Current functional status, history and ratings of pain, educational achievement, living situation, and subjective health status were also recorded. The Diener Satisfaction with Life Scale (SWLS) was administered. Results Eighty-eight participants, mean age 25.6 ± 4.8 years (mean ± standard deviation), were interviewed at a mean of 19.6 ± 3.0 years after surgery. The distribution of current reported Gross Motor Function Classification System levels was as follows: I, 7%; II, 18%; III, 23%; IV, 36%; and V, 16%. Moreover, 56% of respondents were living with parents and 25% were living alone. Thirty-five percent were employed, and 39% were still in school. The mean overall SWLS score was 26.0 ± 7.3, indicating a high level of satisfaction with life. According to 65% of the patients, the SDR was helpful; 31% were uncertain about the procedure's efficacy. Sixty-five percent would recommend the procedure to others. Fifty-eight percent reported excellent to very good health. Forty-four percent reported pain in the past week. Fifty-one percent reported chronic back pain in general. Logistic regression analysis suggested that an increased satisfaction with life was a predictor (p = 0.01) of an affirmative response to the question about recommending the procedure to others and that better overall health showed a trend toward being such a predictor (p = 0.08). Additional interventions were frequently performed after the SDR. Seventy-four percent of participants underwent orthopedic surgery. Thirty-eight percent were currently taking oral medications for tone, and 53% had received botulinum toxin injections for spasticity treatment. Thirteen patients (15%) had an intrathecal baclofen pump placed. Conclusions The majority of adults who had undergone SDR as children would recommend the procedure to others. Very few reported negative impressions of the procedure. Levels of satisfaction with life were generally high. Pain prevalence was similar to what has been reported in the literature for adults with cerebral palsy. Despite the SDR, further interventions, both surgical and nonsurgical, were used in the majority of patients.

Objective The purposes of this study were to examine differences in adipose tissue distribution, lumbar vertebral bone mineral density (BMD), and muscle attenuation in adults with and without cerebral palsy (CP), and to determine the associations between morphological characteristics. Design Cross-sectional, retrospective analyses of archived computed tomography (CT) scans. Setting Clinical treatment and rehabilitation center for persons with CP. Participants Adults with CP with a mean ± SD age of 38.8 ± 14.4 years; body mass: 61.3 ± 17.1 kg; Gross Motor Function Classification level of I-V, and a matched cohort of neuro-typical adults. Of the 41 adults with CP included in the study, 10 were not matchable due to low body masses. Interventions Not applicable Main Outcome Measure(s) Computed tomography scans were assessed for visceral and subcutaneous adipose tissue (VAT and SAT areas), psoas major area and attenuation in Hounsfield units (HU), and cortical and trabecular BMDs. Results Adults with CP had lower cortical (β=−63.41 HU, p<0.001) and trabecular (β=−42.24 HU, p<0.001) BMDs, as well as psoas major areas (β=−374.51 mm2, p<0.001) and attenuation (β=−9.21 HU, p<0.001), after controlling for age, sex, and body mass. Adults with CP had greater VAT (β=3914.81 mm2, p<0.001) and SAT (β=4615.68 mm2, p<0.001). Muscle attenuation was significantly correlated with trabecular (r=0.51, p=0.002) and cortical (r=0.46, p<0.01) BMD; whereas VAT was negatively associated with cortical BMD (β=−0.037 HU/cm2; r2=0.13; p=0.03). Conclusions Adults with CP had lower BMDs, smaller psoas major area, greater intermuscular adipose tissue, and greater trunk adiposity than neuro-typical adults. VAT and cortical BMD were inversely associated.

Objective The purpose of this study was to determine the agreement between actual height or segmental length, and estimated height from segmental measures among individuals cerebral palsy (CP). Design A convenience sample of 137 children and young adults with CP (age 2–25 years) was recruited from a tertiary care center. Height, body mass, recumbent length, knee height, tibia length and ulna length were measured. Estimated height was calculated using several common prediction equations. Agreement between measured and estimated height was determined using the Bland-Altman method. Results Limits of agreement were wide for all equations, usually in the range of ± 10 cm. Repeatability of the individual measures was high, with a coefficient of variation of 1–2% for all measures. The equation using knee height demonstrated a non-uniform difference where height estimation worsened as overall height increased. Conclusions Accurate measurement of height is important, but very difficult in individuals with CP. Segmental measures are highly repeatable, and thus may be used on their own to monitor growth. However, when an accurate measure of height is needed to monitor nutritional status (i.e. for body mass index calculation), caution is warranted as there is only fair to poor agreement between actual height and estimated height.

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BACKGROUND: Adults with cerebral palsy (CP) have an increased risk for polypharmacy, premature mortality, and early development of several morbidities, including conditions associated with excess medication exposure, such as chronic kidney disease (CKD) and liver disease. To date, very little is known about the consequence of polypharmacy for adults with CP. OBJECTIVE:To determine if polypharmacy is associated with an increased risk for mortality, severe CKD, and liver disease among adults with CP, before and after adjusting for comorbid neurodevelopmental disabilities (NDDs) and multimorbidity. METHODS:This is an exploratory treatment effectiveness study. Data from the Optum Clinformatics Data Mart were used for this retrospective cohort study. Adults aged 18 years or older with a diagnosis of CP and without severe CKD (stages IV+) and liver disease were identified from the calendar year 2013 and were subsequently followed from January 1, 2014, to death, severe CKD, liver disease, loss to follow-up, or end of study period (December 31, 2017). Diagnosis codes were used to identify NDDs (intellectual disabilities, epilepsy, autism spectrum disorders, spina bifida) and 24 relevant morbidities at baseline (i.e., calendar year 2013). Polypharmacy was defined as ≥ 5 medications and hyperpolypharmacy was defined