Vol.1 No.

2 2012

Scientific Research Journal of India

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 nonprogressive, 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 oralmotor problems. The etiology of CP is very diverse and multi-factorial. The causes and are congenital, The injury genetic, to the inflammatory, infectious, anoxic, traumatic metabolic. developing brain may be prenatal, natal or postnatal1. The incidence of cerebral palsy http://www.srji.co.cc

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Scientific Research Journal of India with cerebral palsy6.

is 2-2.5 cases in every 1000 live births. There are an estimated 4-5 million children and people in India with cerebral palsy2. The incidence of malnutrition in individuals with cerebral palsy is a combination of factors, which directly or indirectly result in reduced food and nutrient intake3. Feeding problems are not easily recognizable in children and in order to optimally utilize the impaired feeding potential in these of the children, incidence early of identification

the incidence of malnutrition in children 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. and Increased recognition and understanding of neurological, endocrinal, 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

malnutrition in individuals with cerebral palsy is necessary. It also requires regular assessment of feeding and nutritional status and
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appropriate

nutritional

rehabilitation . 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
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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

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Scientific Research Journal of India

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.

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.

METHOD A sample size of 100 children with cerebral palsy with either gender from 313 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

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.

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.

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 http://www.srji.co.cc

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Scientific Research Journal of India

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% Means Std.Dev. Means Diagnosis Ataxic CP 18.1857 4.9878 63.8571 Dystonic CP 14.3333 3.2629 35.1667 Hemiplegic CP 15.5706 2.0784 41.0000 Hypotonic CP 16.0500 4.2646 42.1667 Diplegic CP 15.5429 3.0375 30.5357 Quadri CP 16.7615 4.2477 48.6154 Triplegic CP 17.3800 2.8197 65.5000 All Grps 16.1910 3.5160 43.8200

Std.Dev. 36.0159 47.2035 34.6717 46.2100 35.6282 39.3732 32.2154 38.2515

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Vol.1 No.2 2012

Scientific Research Journal of India

Table 3: Mean and SD total oral motor scores and its dimensions by diagnosis BMI BMI% Diagnosis Means Std.Dev. Means Ataxic CP 18.1857 4.9878 63.8571 Dystonic CP 14.3333 3.2629 35.1667 Hemiplegic CP 15.5706 2.0784 41.0000 Hypotonic CP 16.0500 4.2646 42.1667 Diplegic CP 15.5429 3.0375 30.5357 Quadri CP 16.7615 4.2477 48.6154 Triplegic CP 17.3800 2.8197 65.5000 All Grps 16.1910 3.5160 43.8200 Table 4: Mean and SD of Wt, Ht and BMI by age groups Variables Summary 3-5yrs 6-8yrs 9-11yrs 12+yrs Height Means 97.0000 115.7500 130.1481 145.1250 Std.Dev. 10.1612 7.6031 10.5492 7.0887 Weight Means 13.2120 21.5031 28.5185 41.5563 Std.Dev. 3.2447 5.2859 8.3176 12.2666 BMI Means 13.7760 16.1719 16.5222 19.4438 Std.Dev. 2.0765 3.0619 2.6963 4.6381 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 Normal 9 90.00 1 10.00 10 Over weight 3 75.00 1 25.00 4 Total 73 73.00 27 27.00 100 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

Std.Dev. 36.0159 47.2035 34.6717 46.2100 35.6282 39.3732 32.2154 38.2515

Total 119.6500 18.6917 24.5330 11.7800 16.1910 3.5160

% 86.00 10.00 4.00 100.00

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. http://www.srji.co.cc

Vol.1 No.2 2012 Studies have

Scientific Research Journal of India documented that

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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-forheight changes proportion developing increased percentiles in body compared peers. where explained, and undernourished children with CP have composition with Alterations normally include

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 and intake, poor secondary to impaired oral motor and swallowing competence 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 growthstimulating 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

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.

References http://www.srji.co.cc

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Scientific Research Journal of India Terminology and

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5. Kuczmarski R J, Ogdan C L et al. Advance Data CDC Growth Chart: United State, Number 314 December4, 2000 (Revised). U.S Department of Health and Human Services, Centers for Disease Control and Prevention/ National Center for Health Statistics. 6. Incidence of malnutrition from: in individuals with cerebral palsy. Available http.// www.cerebralpalsysource.com/mal nutrition/index.html 7. Okeke IB, Ojinnaka NC. Nutritional status of children with cerebral palsy in enugu Nigeria. European journal of scientific research 2010; 39: 505-513.

classification of cerebral palsy. Dev Med Child Neurol. 1964; 39; 295-297. 2. Chitra Sankar, Nandini Mundkar. Cerebral PalsyDefinition, Classification, Etiology, and Early Diagnosis. Indian J Pediatr .2005; 72 (10) : 865-868. 3. Bell et al. A prospective, of growth, longitudinal study

nutrition and sedentary behavior in young children with cerebral palsy. BMC Public Health 2010, 10:176. 4. Bruce K. Shapiro, Pauline Green, Jackie severely neurological factors. Dev Krick, Darlene Allen, children: nutritional Child Arnold J. Capute. Growth of impaired verse Med

Neurol.1986, 28, 729-733.

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

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