Placental vessels and the umbilical circulatory network function to carry oxygen and nutrients to the fetus. It is at this level that placental lesions such as villitis, obliterative vasculopathy, and thrombotic vasculopathy have been observed in association with fetal inflammatory response syndrome (FIRS) and cerebral palsy. We used human umbilical vein endothelial cells (HUVECs) as a model to study the regulation of inflammation and thrombosis in fetal vessels by microbial products. In this thesis we measured interleukin-8 (IL-8) and tissue factor (TF) expression by HUVECs treated with lipopolysaccharide (LPS), poly (I:C) (PIC), and peptidoglycan (PG). Our results show a profound induction of IL-8 by PIC, a TLR-3 ligand. We also show a moderate induction of tissue factor expression in PIC-treated HUVECs. These results show that HUVECs are exquisitely sensitive to PIC and suggests an important role for viral infection in umbilical vessel inflammation. We additionally treated HUVECs with dexamethasone (DEX), an anti-inflammatory steroid, and melatonin (MT), a pineal gland product with immunomodulatory and anti-oxidant properties. DEX reduced the level of both IL-8 and TF expression in PIC-treated cells. MT, however, further enhanced IL-8 expression in PIC-treated cells. Our results indicate a potential role for glucocorticoid therapy in reducing placental vessel inflammation and thrombosis. Thus, intervention with GC in pregnancies with FIRS may reduce the severity of placental lesions associated with cerebral palsy.

A research review of eleven studies pertaining to receptive language performance among nonverbal, school-age children with cerebral palsy was completed. The purpose of this review was to identify components and predictor variables of receptive language growth among the target population. The studies were analyzed to further explore how limited verbal output related to comprehension level and to determine appropriate expectations for receptive abilities within the target population. Results suggested that language performances within the domains of verbal and written comprehension were generally lower compared to children matched for chronological age. However, performances were also highly variable among the target population, indicating the potential for typical receptive language development despite impaired expressive abilities. In addition, the following variables demonstrated predictive patterns across subjects: type of cerebral palsy, home literacy environment, and reading status. Clinical implications, including assessment and treatment planning considerations that are sensitive to unique developmental patterns demonstrated in the target population, are discussed. The empirical focus on language output and the use of mixed age groups in current studies on cerebral palsy warrant future research. Additional investigations of receptive language growth as it relates to specific age groups within this clinical population are needed. / text

Children with cerebral palsy that have severe motor impairments, and often co-occurring visual impairments, may often have an impaired ability in prelinguistic forms of communication. In order for children to establish intentional communication, research suggests that prelinguistic communicative competence must be in place. Access to alternative and augmentative communication (AAC) is not sufficient to enhance interaction if motivation to communicate intentionally does not exist. The purpose of this literature review is to discuss the important aspects of early assessment and intervention for children with cerebral palsy who have severe motor impairment. There is a wealth of information about the development, assessment, and intervention of prelinguistic communication in typically developing children and children with developmental delays; however, limited empirical research focuses on children with severe physical impairments. The aim of this project will be to draw conclusions from the available research in order to formulate a protocol for speech-language pathologists to use in assessment and intervention of prelinguistic communication in young children with cerebral palsy. / text

This thesis investigates coordination of the lower limb joints within the limb during walking. The researcher was motivated by her clinical experience as a paediatric physiotherapist. She observed that the pattern of lower limb coordination differed between normal children and those with cerebral palsy. Many of the currently used interventions did not appear to influence this patterning. As a precursor to evaluating the effectiveness of treatments in modifying coordination, a tool to measure coordination was required. The researcher initially investigated qualitative and then quantitative methods of measuring within limb coordination. A technique was developed that used relative angular velocity of two joints to determine when joints were in-phase, antiphasic or in stasis. The phasic parameters of hip/knee, knee/ankle and hip/ankle joints coordination were quantified. There were some significant differences between normal children and children with cerebral palsy. Asymmetry of these phasic parameters was identified, with children with cerebral palsy being more asymmetrical than normal children. The clinical utility of this technique was tested by comparing 2 groups of children before and after 2 surgical procedures. This showed some significant differences in phasic parameters between pre and post-operative data for one procedure. Low samples sizes mean that further work is required to confirm these findings. Data from this work has been used to calculate sample sizes to give an a priori power of 0.8 and further research is proposed and potential applications discussed. It is hoped that this technique will raise awareness of abnormal intra-limb coordination and allow therapists to identify key interactions between joints that need to be facilitated during walking training.

Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents. Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of  exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used. Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life. Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.

General aim of the study: to identify the main social factors, which have negative effect on quality of life of 10-16 years old children with cerebral palsy, and to formulate recommendations for the elimination or reduction of these factors. Objectives: 1. To estimate the social �� economical status of the families, having healthy or disabled children. 2. To evaluate some social integration aspects of healthy or disabled children: the access to health care, education and social services. 3. To find out differences in incidence of some social factors which have negative effect on quality of life in study populations. 4. To formulate the recommendations for the reduction of social factors, which have negative effect on quality of life of children. Research method: The study was performed in Kaunas County (Kaunas, Jonava, Kedainiai, Raseiniai) in 2005. 154 families which have healthy children, and 150 families which have children with cerebral palsy aged from 10 to 16, were interviewed. For the data collection anonymous questionnaire was structured by the author of the study and tested in pilot study. Results: The results of the study showed that the quality of life of Lithuanian disabled children and their families in the social and economic aspects is worse than in families which raise healthy children. It was estimated that the disabled children more often than healthy children grow with one of the parents (21%), in orphanage (10%) or at foster care (4, 4%). Disabled... [to full text]

Object: children with cerebral palsy. Problem: Cerebral palsy (CP) is frequent cause of children’s motor disorder. It affects person’s relationship with environment and limits his participation. Motor disorder and motor development in cerebral palsy depends on form and level of impairment and is very individual. Persons with cerebral palsy achieve different level of mobility. It is very important to choose properly responsible Gross Motor Function Measure scale. It should be clinically informative and be able to reflect changes in gross motor development. Besides, it should show effect of applied treatment method and help to formulate concrete goals of physical therapy. Physical therapy is an important part of any treatment plan for cerebral palsy patients. Treatment plan should be organized considering functional level and abilities of the children. There should be formulated goals and indicated means for reaching these goals in the treatment plan. Motor development will improve if treatment plan is purposeful. It should protect from developing contractures and deformations. In general treatment plan should increase cognitive skills and social integration. Purpose: to evaluate characteristics of application of Gross Motor Function Measure (GMFM) Scale for children with cerebral palsy. Tasks: to compare results of children with cerebral palsy evaluated according Gross Motor Function Measure Scale in both (88 and 66) versions; to determine aims of physiotherapy for 6 month... [to full text]

Darbo objektas: vaikai, sergantys cerebrinio paralyžiaus forma ─ spastine diplegija. Tyrimo problema: vaikų, sergančių spastine diplegija, stambiosios motorikos funkcijų gerinimas, spastikos ir kontraktūrų mažinimas, plaštakos raumenų funkcijos stiprinimas. Hipotezė: kineziterapija, vaikams, sergantiems spazmine diplegija, turėtų padėti pasiekti kuo geresnių rezultatų stiprinant raumenų jėgą, mažinant spastiką ir kontraktūras bei tobulinant stambiosios motorikos funkcijas. Tyrimo tikslas: nustatyti kineziterapijos efektyvumą vaikams, sergantiems cerebrinio paralyžiaus forma ─ spastine diplegija. Tyrimo uždaviniai: 1. Išanalizuoti išrašus iš tiriamųjų medicininių dokumentacijų. 2. Įvertinti vaikų plaštakos raumenų jėgą amžiaus ir lyties aspektu prieš kineziterapiją ir po jos. 3. Įvertinti stambiosios motorikos funkcijų, pagal „Ėjimo, bėgimo ir šokinėjimo“, „Stovėjimo“ ir „Šliaužimo ir klūpėjimo“ testų parametrų dinamiką, taikant kineziterapiją amžiaus ir lyties aspektu. 4. Įvertinti vaikų kojų spastiškumą ir išmatuoti pėdos tiesimo amplitudę prieš kineziterapiją ir po jos. Išanalizavus tyrimo rezultatus padarytos šios išvados: 1. Išanalizuota, kad daugiausiai iš visų tiriamųjų cerebrinio paralyžiaus forma ─ spastine diplegija susirgo dėl gimdymo metu ištiktos hipoksijos ir pasireiškus infekcijai, tik vienas atvejis dėl auglio sukeltų padarinių. Tyrime dalyvavo daugiau berniukų nei mergaičių. 2. Nustatyta, kad po kineziterapijos tiriamųjų plaštakų raumenų jėga padidėjo... [toliau žr. visą tekstą] / Object of the study: children with cerebral palsy ─ spastic diplegic form. Problem of the study: development of spastic diplegic children’s gross motor function, decreasing of spasticity and contractures, strengthening of palms’ muscles. Purpose of the study: to define efficiency of physiotherapy of spastic diplegic children. Tasks of the study: 1. To analyze extracts from medical documentation. 2. To evaluate strength of palms’ muscles of spastic diplegic children in sex and age aspects before and after physiotherapy. 3. To measure dynamics of gross motor function tests’– “Walking, running and jumping”, “Standing”, “Crawling and kneeling” parameters according gender and age before and after physiotherapy. 4. To evaluate spasticity of legs and measure range of passive dorsi-flexion of feet before and after physiotherapy. Conclusions: 1. Analyzed, that in the majority of studied cases the reason of getting sick with cerebral palsy – spastic diplegia – is suffering of a child from hypoxia or catching infection during bearing, only one case - aroused growth. In the survey took part more boys than girls. 2. Defined, that after physiotherapy strength of palms’ muscles of tested children increased. The best result was showed by boys of 8-9 years old and the worse ─ by girls and boys of 4-5 years old. 3. Having measured parameters of Gross Motor function tests’ – “Walking, running and jumping”, “Standing”, “Crawling and kneeling”, it was found out that dynamics of tests’... [to full text]

Tyrimo objektas: vaikų, sergančių cerebriniu paralyžiumi, Dauno sindromu ir autizmu, rankų judesių funkcijos rodikliai ir jų kaitos ypatumai. Tyrimo problema: vaikų, sergančių cerebriniu paralyžiumi, Dauno sindromu ir autizmu, priežiūra labai įtakoja šeimos gyvenimą, skatina prisitaikyti prie vaiko poreikių. Dirbant su šiais vaikais ne visuomet galima pritaikyti įprastinius metodus jų motorikos funkcijai atkurti ar stiprinti. Vaikams, turintiems fizinę ir psichinę negalią, judėjimas yra neišsenkanti saviraiškos, savirealizacijos ir supančio pasaulio pažinimo priemonė. Dėl bendrosios ir smulkiosios motorikos nepakankamumo gali sutrikti judesių koordinacija. Neįgalusis vaikas negali arba ribotai gali atlikti judesius, keičiant padėtį erdvėje. Daugelio autorių nuomone, kineziterapijos užsiėmimai yra veiksminga priemonė lengvinanti fizinę negalią, padedanti integruoti šiuos vaikus į visuomenę. Šiam magistriniam darbui parinkta tokia kineziterapijos programa, kuri būtų efektyvi ir veiksminga šių vaikų rankų judesiams pagerinti. Nes tik įvairių motorikos ugdymo metodų taikymas didina vaikų gebėjimą atlikti taisyklingą judesį ir aktyvina vaiko dalyvavimą savitarnos, bendravimo bei pažinimo veikloje. Todėl kuo ilgiau nekreipiamas pakankamas dėmesys į šias problemas, tuo sunkesnių pasekmių galime tikėtis. Tyrimo tikslas: nustatyti kineziterapijos poveikį vaikų, sergančių cerebriniu paralyžiumi, Dauno sindromu ir autizmu, rankų judesiams. Tyrimo uždaviniai: 1. Nustatyti vaikų... [toliau žr. visą tekstą] / The object of research: indicators of hand movement functions and the specific features of their change among the children suffering from cerebral paralysis, Down's sindrome and autism. The problem of research: The care of the children with cerebral paralysis, Down's sindrome and autism has a great influence upon family life and makes it adapt to the needs of the child. While working with these children it is not always possible to employ conventional methods for the recreation of their motoric function and find the ways of how to strengthen it. Movement is an inexhaustible means of self realization, self expression and the way of learning about the surrounding world for the children with physical and psychic disability. Due to the lack of general and small motoric movements, a child‘s coordination can be impaired. A disabled child cannot or is limited to make movements changing his position in space. According to the opinion of many authors, kinesitherapy exercises are an effective way of making physical disability more bearable and help to integrale the children into the life of the society. Only the use of different methods of movement increases a child‘s ability to make correct movements and makes him more active in taking care of himself, in communication and in the course of gaining knowledge. For this reason, if the problems are neglected, more serious outcomes can be expected. This Master‘s degree thesis deals with such a program of kinesitherapy which could... [to full text]

Darbo objektas: vaikai, sergantys cerebrinio paralyžiaus forma ─ spastine diplegija. Tyrimo problema: vaikų, sergančių spastine diplegija, stambiosios motorikos funkcijų gerinimas, spastikos ir kontraktūrų mažinimas, plaštakos raumenų funkcijos stiprinimas. Hipotezė: kineziterapija, vaikams, sergantiems spazmine diplegija, turėtų padėti pasiekti kuo geresnių rezultatų stiprinant raumenų jėgą, mažinant spastiką ir kontraktūras bei tobulinant stambiosios motorikos funkcijas. Tyrimo tikslas: nustatyti kineziterapijos efektyvumą vaikams, sergantiems cerebrinio paralyžiaus forma ─ spastine diplegija. Tyrimo uždaviniai: 1. Išanalizuoti išrašus iš tiriamųjų medicininių dokumentacijų. 2. Įvertinti vaikų plaštakos raumenų jėgą amžiaus ir lyties aspektu prieš kineziterapiją ir po jos. 3. Įvertinti stambiosios motorikos funkcijų, pagal „Ėjimo, bėgimo ir šokinėjimo“, „Stovėjimo“ ir „Šliaužimo ir klūpėjimo“ testų parametrų dinamiką, taikant kineziterapiją amžiaus ir lyties aspektu. 4. Įvertinti vaikų kojų spastiškumą ir išmatuoti pėdos tiesimo amplitudę prieš kineziterapiją ir po jos. Išanalizavus tyrimo rezultatus padarytos šios išvados: 1. Išanalizuota, kad daugiausiai iš visų tiriamųjų cerebrinio paralyžiaus forma ─ spastine diplegija susirgo dėl gimdymo metu ištiktos hipoksijos ir pasireiškus infekcijai, tik vienas atvejis dėl auglio sukeltų padarinių. Tyrime dalyvavo daugiau berniukų nei mergaičių. 2. Nustatyta, kad po kineziterapijos tiriamųjų plaštakų raumenų jėga padidėjo... [toliau žr. visą tekstą] / Object of the study: children with cerebral palsy ─ spastic diplegic form. Problem of the study: development of spastic diplegic children’s gross motor function, decreasing of spasticity and contractures, strengthening of palms’ muscles. Purpose of the study: to define efficiency of physiotherapy of spastic diplegic children. Tasks of the study: 1. To analyze extracts from medical documentation. 2. To evaluate strength of palms’ muscles of spastic diplegic children in sex and age aspects before and after physiotherapy. 3. To measure dynamics of gross motor function tests’– “Walking, running and jumping”, “Standing”, “Crawling and kneeling” parameters according gender and age before and after physiotherapy. 4. To evaluate spasticity of legs and measure range of passive dorsi-flexion of feet before and after physiotherapy. Conclusions: 1. Analyzed, that in the majority of studied cases the reason of getting sick with cerebral palsy – spastic diplegia – is suffering of a child from hypoxia or catching infection during bearing, only one case - aroused growth. In the survey took part more boys than girls. 2. Defined, that after physiotherapy strength of palms’ muscles of tested children increased. The best result was showed by boys of 8-9 years old and the worse ─ by girls and boys of 4-5 years old. 3. Having measured parameters of Gross Motor function tests’ – “Walking, running and jumping”, “Standing”, “Crawling and kneeling”, it was found out that dynamics of tests’... [to full text]