Thesis (M.S.)--University of Wisconsin--Madison, 1968. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.Med.Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 43-47). Also available in print.

Thesis (M.A.)--University of Wisconsin--Madison, 1980. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 47-51).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1975. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 126-136.

No description available.

Cerebral palsy (CP) is the most common cause of physical disability in childhood. Today, most children with CP survive into adulthood with life expectancies similar to typically developing (TD) adults. One of the biggest challenges during the lifespan of individuals with CP is healthy aging; to prevent or minimize the secondary effects of CP on the musculoskeletal system (e.g. bone deformities due to spasticity) as well as to improve functional status and quality of life. There is currently no treatment that is able to cure the brain damage which causes CP, but a variety of options exist to address spasticity, the most prevalent primary condition which is estimated to be present in 80% of people with CP. One of these options is the neurosurgical procedure of Selective Dorsal Rhizotomy (SDR) which entails selective sectioning of dorsal rootlets in the lumbosacral area, diminishing spasticity through reducing muscle tone. SDR gained increasing acceptance following the work of Peacock and Arens in the 1980s, and although a large number of studies have demonstrated the benefits of this procedure, they largely comprise relatively short-term follow-up assessments in children and adolescents. There is thus a need for long-term follow-up studies focussed on all facets of daily living (International Classification of Function, Disability and Health (ICF) model domains: body structure and function, activity and participation) and quality of life in adults with CP who underwent SDR in their childhood. The aim of this doctoral thesis was to address this need, and provide information that might help guide parents, caregivers and clinicians in their clinical decision-making process for a child with CP. This aim was addressed through three key investigations. First, the status of adults with CP and spastic diplegia - related to all domains of the ICF-model and health-related quality of life - was determined more than 25 years after SDR. Second, changes in gait pattern, spinal deformities and level of activities and participation in adults with CP were determined nine years after a similar assessment. Third, associations between results in the different ICFmodel domains along with personal and environmental context factors. This PhD thesis forms part of a longitudinal investigation tracking the health and wellness of adults with CP. The former studies were performed in 2008 and consequently a recent follow-up was conducted in 2017 in the same CP cohort. All participants underwent SDR according to the Peacock method (strict selection criteria were adhered) at Red Cross War Memorial Children’s Hospital in Cape Town, South Africa, between 1981 and 1991. This PhD thesis is based on four studies, with the first being a cross-sectional study conducted in 2017 (Chapter 2) and the other three are nine-year follow-up studies (comparing findings in 2017 with studies conducted in 2008 (Chapter 3 - 5). Each study included a matched TD group, except for the spine study (Chapter 4). Participants were observed and assessed for functioning, health, disability and quality of life based on a physical examination, gait analysis, functional mobility tests, spine radiographs and several questionnaires. With respect to the ICF-model Body structure and function domain, adults with CP showed sustained reduction in muscle tone and minimal signs of spasticity in their gait pattern, with no increased prevalence of scoliosis, hyperkyphosis or hyperlordosis, and did not experience limitation of daily activities due to pain. Some challenges were found regarding ROM, muscle strength, selectivity and back pain but they were comparable with what would be expected in adults with CP who did not undergo SDR. Concerning, the Activity domain, the majority of the cohort was independent in functional mobility and the accomplishment of daily activities with no increased risk for falls. They were as satisfied with accomplishing daily activities as the TD adults, though as might be expected, they were found to be less content with their level of mobility. Regarding Participation domain, the adults with CP greater than 25 years post-SDR were independent and satisfied with their attainment of social roles. Most were married or had a relationship, lived independently (with or without partner), finished higher education and were engaged in paid employment. The perceived health-related quality of life was similar to that of TD adults in most of the health concepts (physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning and mental health), except for physical functioning. No increased prevalence of anxiety and depression was found, which was in line with the reported mental health findings of the health-related quality of life questionnaire. This suggests that while adults with CP have on-going physical challenges following SDR, this might not directly impact their mental health and levels of anxiety and depression. The majority of the cohort viewed the SDR they had undergone as worthwhile due to mobility and functional walking gains. Importantly, no changes were found over the nine-year interval in overall gait, functional mobility, spinal deformities, pain and level of accomplishment and satisfaction in daily activities and social participation. This indicates stability of function which is remarkable since functional decline might be expected in adults with CP while aging. However, correlations were found between functional mobility and daily activities and social participation as well as between functional mobility and strength. This highlights the possible importance of resistance training and maintaining walking ability to enable daily activities and social participation and prevent functional deterioration in the future.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to compare the maxillary dental arch form and palatal vault form between 98 cerebral palsied and 76 normal children. All subjects were divided into three categories based on their dental eruption. The cerebral palsy subjects were further divided into the regional classifications of diplegia, paraplegia, hemiplegia, and quadriplegia, and the descriptive classifications of spasticity, athetosis, and mixed. The maxillary dental arch form was described by an index number which reflected intercuspid width, intermolar width, anterior-posterior length, and degree of divergence of the posterior segments. The palatal vault form v1as described by the angle of divergence of the palatal walls at an established reference point from a cross-sectional view. All measurements were made from study models and Xerox photocopies of study model cross-sections. In addition, those occlusal discrepancies that were thought to influence arch form, i.e., posterior unilateral and bilateral crossbite, anterior crossbite, anterior open bite, and posterior dental asymmetry were tabulated. Statistical analysis of the results revealed no significant difference in maxillary dental arch form between the cerebral palsied and normal children. The same held true for palatal vault form. Significant differences did occur between primary, mixed, and permanent dentitions for both cerebral palsied and non-handicapped groups. The results suggest that the neuromuscular handicap has little effect on the form of the maxillary dental arch. On the basis of this study, it appears that there is no particular type of maxillary arch form that is peculiar to cerebral palsy.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to provide information concerning occlusion and related problems in cerebral palsied children. A group of 124 cerebral palsied children between the ages of 6 and 12 years were examined at the Cerebral Palsy Dental Clinic, Indiana University. The occlusion was evaluated according to Angle's classification. In addition, a recording was made of overjet, over-bite, open bite, cuspid relationships, crossbite and midline discrepancies. The examination included a clinical evaluation of the swallowing pattern of each child. The cerebral palsy classification and I.Q. scores were recorded for each cerebral palsied child after a comprehensive review of his medical record. These findings were compared with a control group of 141 similar aged non-cerebral palsied children examined at Indiana University, Pedodontic department. The cerebral palsied group had an average increased overjet of 0.8 mm. and an average decreased overbite of 0.5 mm., representing an upward and outward positioning of the maxillary anterior segment. Anterior open bite was present in a similar percentage of both groups, but in the cerebral palsied group the measurement recorded was more than twice as great as that recorded in the control group. Forty-four per cent of the cerebral palsied children exhibited bruxism, more than twice the percentage of cases recorded in the control group. The cerebral palsied children exhibited bruxism most frequently in the day time, and was most common in the athetoid group. Other measurements recorded were not significantly different between the two groups. From this study one can conclude that malocclusion and factors affecting occlusion are not found with greater frequency in cerebral palsied children.

Indiana University-Purdue University Indianapolis (IUPUI) / The orbicularis oris muscle of fourteen individuals including seven cerebral palsied spastic hemplegics and seven normal individuals with Class I occlusion was examined electro-myographically to determine any differences in muscle activity on the right and left side of the lips. The age range was between eight years and seventeen years. No limitations were placed on age, sex, or race since the purpose of the study was to determine any differences in activity between the right and left sides of the orbicularis oris muscle. A six channel Polygraph Grass Model 5A was used with paired surface electrodes attached to each quadrant of the lips and connected to four channels of the Polygraph. When the lips were at rest, no muscle activity was detected for either group. When the lips were tested during voluntary swallowing, involuntary swallowing associated with straw drinking and holding the lips together, the activity was fairly equal and symmetrical in the normal group. However, in the cerebral palsied spastic hemiplegics, there was increased muscle activity in the orbicularis oris muscle on the hemiplegic side.

Indiana University-Purdue University Indianapolis (IUPUI) / Dietary habits of 30 cerebral palsied children were investigated in this study using seven-day intake records obtained from their parents. Each child was classified in terms of physiological and topographical involvement, functional capacity, and mental retardation. All food records were evaluated in terms of the four food groups, and the nutritional adequacy and consistency of the diet were analyzed. The average number of meals per day and the frequency and types of between-meal snacks were evaluated. The cerebral palsied children, as a group, showed pronounced deficiency in all four food groups being most deficient in the vegetable-fruit group and least deficient in the bread-cereals group. In terms of nutrients, the children showed deficiencies of iron, calories, niacin, ascorbic acid, and calcium, in the order listed. The children generally consumed soft food, ate their meals at surprising regularity, and snacked approximately three items per day. Their snacks consisted of items of high nutritional value. Dietary habits did not vary significantly when they were evaluated according to types of affliction. Some effects on the consumption of milk and fruits and vegetables were observed, but because each type of cerebral palsy was not well represented, results did not warrant definite conclusions.