Diaphragmatic mobility in children with spastic cerebral palsy and differing motor performance levels

Bennett, Surussawadi; Siritaratiwat, Wantana; Tanrangka, Nittaya; Bennett, Michael J.; Kanpittaya, Jaturat

doi:10.1016/j.resp.2019.05.010

Cited by 9 publications

(10 citation statements)

References 35 publications

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“…Most (64%) studies included participants over 50 years of age [5, 7, 9, 10, 18-20, 23, 25, 27-29, 31-38]. Two articles included children [4, 12]. The studies commonly included: people with chronic obstructive pulmonary disease (COPD) (23% of all included articles) [5, 7, 23, 29, 33, 35, 36], healthy individuals – 23% articles [9, 11, 14, 21, 26, 28, 39], and people with neuromuscular disease – 23% articles [10, 19, 20, 25, 27, 31, 40].…”

Section: Resultsmentioning

confidence: 99%

“…Diaphragm excursion amplitude (DE a ) was collected in 58% of articles, and diaphragm excursion velocity (DE v ) was collected in three articles. With regards pulmonary parameters, the investigators mainly used parameters such as MIP (48% of articles) [7, 10-12, 14, 20, 24, 26, 28, 31, 34, 36, 37, 39, 40], FVC (45% of articles) [4, 7, 10-12, 14, 20, 25, 27, 32, 33, 35, 40, 41] and FEV 1 (32% of articles) [4, 7, 11, 12, 23, 29, 32, 33, 35, 41].…”

Section: Resultsmentioning

confidence: 99%

“…Spirometry and plethysmography are the most commonly used tools in the evaluation of respiratory system function [1][2][3][4][5][6][7][8][9]. These instruments require the use of dynamic functional trials [1,8], potentially limiting their application.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review

et al. 2022

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Introduction: The purpose of this study was to evaluate the potential utility of respiratory muscles ultrasound (US) imaging for assessing respiratory function and identify US variables that best correlate with pulmonary parameters. Materials and Methods: A search of 5 databases was conducted. Initially, there was no language, study design, or time frame restrictions. All studies assessing the relationship between pulmonary and US parameters were included. Two reviewers independently extracted and documented data regarding to examined population, age, gender, health condition, methodology, US, and pulmonary function measurements. All studies were qualitative synthesis. Results: A total of 1,272 participants from 31 studies were included. Diaphragm thickness, diaphragm thickening ratio, and diaphragm excursion amplitude were mainly used as US parameters. Forced vital capacity, forced expiratory volume1sec, and maximal inspiratory pressure were mainly used as pulmonary parameters. The relationships between pulmonary and US parameters varied from negligible to strong (depend on examined population and methodology used). Data were not quantitatively synthesis due to high heterogeneity in terms of study design, population examined, and various pulmonary and US parameters. Conclusion: A strong relationship between US measurements and pulmonary parameters was demonstrated in some studies but not others. This review confirmed that US measurements can complement spirometry, but the exact role of the US remains to be confirmed. Further studies using standardized methodology are needed to obtain more conclusive evidence on the usefulness of US for assessing respiratory function.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review

et al. 2022

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“…Sleep-disordered breathing in CP may also be caused by muscular weakness. Children with CP have reduced diaphragmatic mobility, respiratory muscle strength and chest expansion ( 134 ). Sleep disorders in general have a significant impact on quality of life in CP ( 107 , 135 ) and therefore, treatment should be strongly considered for sleep disordered breathing.…”

Section: Respiratory Dysfunctionmentioning

confidence: 99%

Multi-Organ Dysfunction in Cerebral Palsy

et al. 2021

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Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.

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“…The hypoxemia and vascular bed restriction can cause pulmonary hypertension and cor pulmonale ( 80 ). Patients with hypertonia have a weaker diaphragm ( 81 ).…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

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Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.

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Diaphragmatic mobility in children with spastic cerebral palsy and differing motor performance levels

Cited by 9 publications

References 35 publications

Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review

Ultrasonography in Assessment of Respiratory Muscles Function: A Systematic Review

Multi-Organ Dysfunction in Cerebral Palsy

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

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