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Vol.1 No.2 2012

Scientific Research Journal of India

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Growth in Cerebral Palsy Children between 3-13 years in Urban Dharwad, India

Parmar Sanjay T.*. MPT (Paediatrics).

Nayana A. Khobre**. MPT (Paediatrics).

Abstract: Background & Objective- Cerebral palsy is defined as a group of non-progressive disorders of movement or posture due to a defect or lesion of the immature brain. The incidence of cerebral palsy is 2-2.5 cases in every 1000 live births. Cerebral palsy is frequently associated with poor growth and children with cerebral palsy tend to be shorter and lighter than their normal counterparts. Our objective of the study is to find out growth in cerebral palsy children. Method - A sample size of 100 children with cerebral palsy of either gender from 3-13 years were assessed for body mass index, growth of children with cerebral palsy was found out. The outcome measures Child Developmental Care/National Health Center Statistics growth charts (CDC/NHCS). Results - Statistical analysis was done with statistical software (n Master 1.0). Data analysis and results showed no statistical significance growth found in children with cerebral palsy. The study showed that clinically all the children with cerebral palsy had low growth when assessed on CDC/NHCS growth charts. Interpretation and conclusion - The children with cerebral palsy had low growth compared with the other counterparts of same age group.

Key words- Growth, Cerebral Palsy.

INTRODUCTION

Cerebral palsy (CP) is defined as

“umbrella term covering a group of non-

progressive, but often changing, motor

impairment syndromes secondary to

lesions or anomalies of the brain arising in

the early stages of its development”.

Cerebral palsy is in variably associated

with many deficits such as mental

retardation, speech and language and oral-

motor problems. The etiology of CP is

very diverse and multi-factorial. The

causes are congenital, genetic,

inflammatory, infectious, anoxic, traumatic

and metabolic. The injury to the

developing brain may be prenatal, natal or

postnatal 1 . The incidence of cerebral palsy http://www.srji.co.cc

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is 2-2.5 cases in every 1000 live births. There are an estimated 4-5 million children and people in India with cerebral palsy 2 . The incidence of malnutrition in individuals with cerebral palsy is a combination of factors, which directly or indirectly result in reduced food and nutrient intake 3 . Feeding problems are not easily recognizable in children and in order to optimally utilize the impaired feeding potential in these children, early identification of the incidence of malnutrition in individuals with cerebral palsy is necessary. It also requires regular assessment of feeding and nutritional status and appropriate nutritional rehabilitation 4 . While the prevalence of growth disorders among these children is unknown, certain observations have been made. Growth failure has been related to the type of cp-spastic or athetoid and to topographical distribution, and oral-motor dysfunction also has been associated with poorer growth 5 A study done on percent body fat, muscle area and oral motor functions are important factors for weight gain and linear growth of children with cerebral palsy. The identification of the nutritional problem has a great potential to help improve weight, muscle mass, decrease irritability and circulation in order to halt

the incidence of malnutrition in children with cerebral palsy 6 . A study done on incidence of malnutrition in children with cerebral palsy tells about feeding problem are usually complicated by the lack of awareness of parents of incidence of malnutrition in cerebral palsy children. The main reasons for lack of awareness in parents were illiteracy, misconception about the disease and associated complications in cerebral palsy. The psychological impact of having child with severe chronic neurological disease is so deep that parents do not appreciate the feeding problems to the extent they should. The study done on Growth and nutrition disorders is common secondary health conditions in children with cerebral palsy (CP). Poor growth and malnutrition in CP merit study because of their impact on health, including psychological and physiological function, healthcare utilization, societal participation, motor function, and survival. Understanding the etiology of poor growth has led to a variety of interventions to improve growth. Increased recognition and understanding of neurological, endocrinal, and environmental factors have begun to shape care for children with CP, as well. The investigation of these factors relies on advances made in the assessment methods available to address the challenges

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inherent in measuring growth in children with CP. Descriptive growth charts and norms of body composition provide information that may help clinicians to interpret growth and intervene to improve growth and nutrition in children with CP. Linking growth to measures of health will be necessary to develop growth standards for children with CP in order to optimize health and well-being.

METHOD A sample size of 100 children with cerebral palsy with either gender from 3- 13 years of age was assessed for body mass index. The study was conducted for 1 year in Physiotherapy OPD of SDM medical hospital Dharwad Karnataka India. Ethical clearance is obtained from the Institutional Ethical Committee, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, prior to the commencement of the study. The children included in the study were diagnosed cerebral palsy cases, who were able to stand on stadiometer and weighing machine. Children who were un-conscious, unco-operative, who were not able to stand and unstable Patients were excluded. Parents of the subjects willing to participate were briefed about the study and how the study would help their children.A written consent was obtained from the parents of the children.

Children diagnosed with cerebral palsy were assessed for BMI by taking the height and weight of the children. The child was made to stand on the Stediometer with the consideration of physical disabilities to measure the height and Weight was measured by making the children stand on weighing machine. The outcome measures was CDC/NHCS growth charts. The growth was assessed by height in meters and weight in kilograms and BMI (Body Mass Index) is calculated in weight (in kgs) by height square (in meters). And BMI percentiles were calculated on CDC/NHCS growth charts.

DATA ANALYSIS Statistical analysis was done with statistical software (n Master 1.0). descriptive analysis was carried out using mean and standard deviation of mean age, height, weight, BMI, BMI percentile. Comparison between variables is done using unpaired t-test. The p-value is 0.5693 which shows that there is no significant difference between boys and girls.

RESULTS The table1 depicts the distribution of study subjects according to gender and different types of cerebral palsy children. It shows mainly spastic cerebral palsy

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cases more in the present study which

includes 3-13years of age group. The table

2 depicts the mean and standard deviation

age of both boys and girls.

The table 3, 4, 5 depicts that the

mean and standard deviation (SD) values

of height, weight, BMI and BMI percentile

for different diagnosis of cerebral palsy in

which dystonic and diplegic type have less

mean values. And by different age groups

of 3-5years, 6-8 years, 9-11 years, and 12+

years have increasing mean values as per

the age increases. The mean values of

height, weight and BMI is less in boys

than girls which was not significant. The

table 5 depicts the children in our study are

underweight with 86%.

The table 6 shows that comparison

of boys and girl children with respect to

BMI scores by t-test with mean and

standard deviation where there was no

significant difference between boys and

girls.

ILLUSTRATIONS FOR DIFFERENT POSITIONS

Table 1: Distribution of study subjects according to gender by different diagnosis

Diagnosis

Boys

%

Girls

%

Total

Ataxic CP

5

71.43

2

28.57

7

Dystonic CP

5

83.33

1

16.67

6

Hemiplegic CP

11

64.71

6

35.29

17

Hypotonic CP

6

100.00

0

0.00

6

Diplegic CP

17

60.71

11

39.29

28

Quadri CP

21

80.77

5

19.23

26

Triplegic CP

8

80.00

2

20.00

10

Total

73

73.00

27

27.00

100

The above table depicts Distribution of study subjects according to gender by different diagnosis

Table2: Mean and SD total oral motor scores and its dimensions by diagnosis

 

BMI

BMI%

Diagnosis

Means

Std.Dev.

Means

Std.Dev.

Ataxic CP

18.1857

4.9878

63.8571

36.0159

Dystonic CP

14.3333

3.2629

35.1667

47.2035

Hemiplegic CP

15.5706

2.0784

41.0000

34.6717

Hypotonic CP

16.0500

4.2646

42.1667

46.2100

Diplegic CP

15.5429

3.0375

30.5357

35.6282

Quadri CP

16.7615

4.2477

48.6154

39.3732

Triplegic CP

17.3800

2.8197

65.5000

32.2154

All Grps

16.1910

3.5160

43.8200

38.2515

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Table 3: Mean and SD total oral motor scores and its dimensions by diagnosis

   

BMI

   

BMI%

 

Diagnosis

 

Means

Std.Dev.

Means

 

Std.Dev.

Ataxic CP

 

18.1857

4.9878

63.8571

 

36.0159

Dystonic CP

 

14.3333

3.2629

35.1667

 

47.2035

Hemiplegic CP

 

15.5706

2.0784

41.0000

 

34.6717

Hypotonic CP

 

16.0500

4.2646

42.1667

 

46.2100

Diplegic CP

 

15.5429

3.0375

30.5357

 

35.6282

Quadri CP

 

16.7615

4.2477

48.6154

 

39.3732

Triplegic CP

 

17.3800

2.8197

65.5000

 

32.2154

All Grps

 

16.1910

3.5160

43.8200

 

38.2515

Table 4: Mean and SD of Wt, Ht and BMI by age groups

 

Variables

Summary

3-5yrs

 

6-8yrs

9-11yrs

12+yrs

Total

Height

Means

97.0000

 

115.7500

130.1481

145.1250

119.6500

Std.Dev.

10.1612

 

7.6031

10.5492

7.0887

18.6917

Weight

Means

13.2120

 

21.5031

28.5185

41.5563

24.5330

Std.Dev.

3.2447

 

5.2859

8.3176

12.2666

11.7800

BMI

Means

13.7760

 

16.1719

16.5222

19.4438

16.1910

Std.Dev.

2.0765

 

3.0619

2.6963

4.6381

3.5160

The above table depicts Mean and SD of Wt, Ht and BMI by age groups

Table 5: Distribution of samples by BMI category and gender

BMI

Male

%

Female

%

Total

%

Under weight

61

70.93

25

29.07

86

86.00

Normal

9

90.00

1

10.00

10

10.00

Over weight

3

75.00

1

25.00

4

4.00

Total

73

73.00

27

27.00

100

100.00

The above depicts that Distribution of samples by BMI category and gender

DISCUSSION

In our study the mean age group of

boys population is 7.794 and of girls

population is 8.266 out of the total score

which showed the mean value more in age

group of 9-11years in total score which

depicts there is no significant difference in

BMI in both male and female population.

As in 9-11yrs age group 30 children were

there and in 12+yrs age group were 15

children may be because of number of

children more in 9-11yrs group mean

value was more as comparative to other

groups.

The mean values in the different

variable of our study show different mean

values of each type of cerebral palsy

relatively quadriplegic and hypotonic

having lower mean as compared to others

due to smaller sample size in them for

which no statistical analysis was been

carried out.

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Studies have documented that growth patterns for patients with cerebral palsy (CP) are different from those in the general population. Patients with CP have below average weight, linear growth, and muscle mass and fat stores compared with their peers in the general population. Bone mass density is also reduced, especially among patients who are non-ambulatory Poor growth in children with CP may be related to nutritional factors, physical factors or factors related to the brain lesion itself. Nutritional factors include inadequate dietary intake, secondary to impaired oral motor and swallowing competence and poor nutritional status and may impact directly on growth. Physical factors result in decreased mechanical stress on bones due to immobility or lack of weight bearing. Bone growth studies have suggested that immobilization decreases bone formation and longitudinal bone growth and increases bone resorption, which suppresses certain growth- stimulating hormones. Factors related to the brain lesion itself may impact on growth either directly (via a negative neurotrophic effect on linear growth) or indirectly (via the endocrine system). Growth differences between impaired and unimpaired limbs in children with

References

hemiplegic, support the hypothesis that non-nutritional factors play a significant role in reducing growth in children with CP.

A study done on Identification of malnutrition in children with cerebral palsy: poor performance of weight-for- height percentiles where explained, undernourished children with CP have changes in body composition and proportion compared with normally developing peers. Alterations include increased total body water, severely depleted fat stores, minimally depleted muscle stores, severe short stature, and decreased bone density.

CONCLUSION All the children with cerebral palsy had lower growth than other peer groups, when they were assessed on CDC/NHCS growth charts, which may be due to oral motor dysfunction and other factors such as neurological factors and the further studies can be carried out by considering different types of cerebral palsy with various other scales and their growth pattern to find out what oral motor dysfunction has effect on growth.

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CORRESPONDENCE

*Assistant Prof, SDM College of Physiotherapy Dharwad India. **Post graduate student, SDM College of Physiotherapy, Dharwad India.

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