Abstract
The autonomic functions of children with cerebral palsy (CP) have not been sufficiently explored, and corresponding abnormalities are underdiagnosed. In addition, studies evaluating the associations between autonomic dysfunctions and the different aspects of motor performance among these children are scarce. We aimed to investigate vital signs in children with CP and compare them to those of children with typical motor development (TMD) and to determine the associations of autonomic dysfunction with the demographic and clinical data and motor characteristics of these children. A convenience sample of 118 children with CP was evaluated in this cross-sectional study. A group of 69 matched children with TMD served as a control group. We measured the vital signs and key pinch and hand grip strengths of all children in the study. Vital signs were recorded while the children rested in a comfortable sitting position. Children with CP were evaluated for muscle tone and motor abilities. Systolic BP, diastolic BP, heart rate, and respiratory rate were significantly higher in children with CP than in children with TMD (p values of 0.03, 0.006, 0.02, and 0.001, respectively), while blood oxygen saturation and oral body temperature were significantly lower (p values of 0.00 and 0.003, respectively). We detected only weak to moderate correlations between some vital sign abnormalities and children with lower motor performance (diplegic and quadriplegic children, children with level IV or V on the gross motor function classification system (GMFCS), and children with low key pinch and hand grip strength). Children with CP had abnormalities in their vital signs at rest, reflecting a state of dysautonomia. Abnormalities included high systolic BP, diastolic BP, heart rate, and respiratory rate and low blood oxygen saturation and oral body temperature. Children with lower motor performance were at a greater risk of dysautonomia.
Similar content being viewed by others
References
Agnarsson, U., Warde, C., McCarthy, G., Clayden, G. S., & Evans, N. (1993). Anorectal function of children with neurological problems. II. Cerebral palsy. Developmental Medicine and Child Neurology, 35, 903–908.
Agrawal, S. (2010). Autonomic dysfunction in children with cerebral palsy, static encephalopathy, and similar conditions. http://www.articles.complexchild.com/june2010/00207.pdf.
Bartonek, A., Eriksson, M., & Saraste, H. (2002). Heart rate and walking velocity during independent walking in children with low and midlumbar myelomenigocele. Pediatric Physical Therapy, 14, 185–190.
Beckung, E., & Hagberg, G. (2002). Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental Medicine and Child Neurology, 44(5), 309–316.
Bohannon, R. W., & Smith, M. B. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy, 67(2), 206–208.
Dickerson, R. N., Brown, R. O., Hanna, D. L., & Williams, J. E. (2003). Energy requirements of nonambulatory, tube-fed adult patients with cerebral palsy and chronic hypothermia. Nutrition, 19(9), 741–746.
Dirienzo, L. N., Dirienzo, L. T., & Baceski, D. A. (2007). Heart rate response to therapeutic riding in children with cerebral palsy: An exploratory study. Pediatric Physical Therapy, 19, 160–165.
Duffy, C. M., Hill, A. E., Cosgrove, A. P., Corry, I. S., & Graham, H. K. (1996). Energy consumption in children with spina bifida and cerebral palsy: A comparative study. Developmental Medicine and Child Neurology, 38, 238–243.
Ferreira, M. C., Pastore, C., Imada, R., Guare, R., Leite, M., Poyares, D., & Santos, M. T. (2011). Autonomic nervous system in individuals with cerebral palsy: A controlled study. Journal of Oral Pathology & Medicine, 40, 576–581.
Fess, E. E., & Moran, C. (1981). Clinical assessment recommendations. Indianapolis: American Society of Hand Therapists.
Gorter, H., Holty, L., Ramecker, E. E., Elver, H. J., & Oostendorp, R. A. (2009). Changes in endurance and walking ability through functional physical training in children with cerebral palsy. Pediatric Physical Therapy, 2, 31–37.
Hajuj, K., Andrawes, J., & Michal, K. (2013). The associations between motor ability, walking activity and heart rate and heart rate variability parameters among children with cerebral palsy and typically developed controls. NeuroRehabilitation, 33, 113–119. https://doi.org/10.3233/NRE-130934.
Hukins, C. A., & Hillman, D. R. (2000). Daytime predictors of sleep hypoventilation in Duchenne muscular dystrophy. American Journal of Respiratory and Critical Care Medicine, 161, 166e70.
Israeli-Mendlovic, H., Mendlovic, J., & Katz-Leurer, M. (2014). Heart rate and heart rate variability parameters at rest, during activity and passive standing among children with cerebral palsy GMFCS IV–V. Developmental Neurorehabilitation, 17(6), 398–402.
Jaeschke, R., Guyatt, G. H., Sackett, D. L., & for the Evidence-Based Medicine Working Group. (1994). Users’ guides to the medical literature, III: How to use an article about a diagnostic test, B: What are the results and will they help me in caring for my patients? The Journal of the American Medical Association, 271, 703–707.
Korpelainen, J. T., Tolonen, U., Sotaniemi, K. A., & Myllyla, V. V. (1993). Suppressed sympathetic skin response in brain infarction. Stroke, 24, 1389–1392.
Linden, D., & Berlit, P. (1995). Sympathetic skin responses (SSRs) in monofocal brain lesions: Topographical aspects of central sympathetic pathways. Acta Neurologica Scandinavica, 9, 372–376.
Massery, M. (2006). Multisystem consequences of impaired breathing mechanics and/or postural control. In D. Frownfelter & E. Dean (Eds.), Cardiovascular and pulmonary physical therapy evidence and practice (4th ed.). Elsevier Health Sciences: St. Louis.
Maudsley, G., Hutton, J. L., & Pharoah, P. O. D. (1991). Cause of death in cerebral palsy: A descriptive study. Archives of Disease in Childhood, 81, 390–394. https://doi.org/10.1136/adc.81.5.390.
Molnar, G. E. (1992). Cerebral palsy. In G. E. Molnar (Ed.), Pediatric rehabilitation (pp. 481–533). Philadelphia: Williams & Wilkins.
Morris, C., & Bartlett, D. (2004). Gross motor function classification system: Impact and utility. Developmental Medicine and Child Neurology, 46, 60–65.
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39, 214–223.
Pastore, C. A., Samesima, N., Imada, R., Reis, M., Santos, M. T., Ferreira, M. C., Grupi, C., Fumagalli, F., Wagenfuhr, J., & Chammas, M. (2011). Characterization of the electrocardiographic pattern of individuals with cerebral palsy. Journal of Electrocardiology, 2, 138–141.
Portney, L. G., & Watkins, M. P. (2009). Foundations of clinical research: Applications to practice. Upper Saddle River: Pearson Prentice Hall.
Reid, C. J. D., & Borzyskowski, M. (1993). Lower urinary tract dysfunction in cerebral palsy. Archives of Disease in Childhood, 68, 738–742.
Rose, J., Haskell, W. L., & Gamble, J. G. (1993). A comparison of oxygen pulse and respiratory exchange ratio in cerebral palsied and nondisabled children. Archives of Physical Medicine and Rehabilitation, 74, 702–705.
Rosenbaum, P. L., Walter, S. D., Hanna, S. E., Palisano, R. J., Russell, D. J., Raina, P., Wood, E., Bartlett, D. J., & Galuppi, B. E. (2002). Prognosis for gross motor function in cerebral palsy: Creation of motor development curves. The Journal of the American Medical Association, 288, 1357–1363.
Ryan, J. M., Hensey, O., McLoughlin, B., Lyons, A., & Gormley, J. (2014). Reduced moderate-to vigorous physical activity and increased sedentary behavior are associated with elevated blood pressure values in children with cerebral palsy. Physical Therapy, 94, 1144–1153.
Santos, M. T., Guare, R., Leite, M. F., Ferreira, M. C., & Nicolau, J. (2010). Does the neuromotor abnormality type affect the salivary parameters in individuals with cerebral palsy? Journal of Oral Pathology & Medicine, 39, 770–774.
Styer-Acevedo, J. (1994). Physical therapy for the child with cerebral palsy. In J. S. Tecklin (Ed.), Pediatric physical therapy (pp. 89–134). Philadelaphia: JB Lippincott.
Su, C. F., Kuo, T. B., Kuo, J. S., Lai, H. Y., & Chen, H. I. (2005). Sympathetic and parasympathetic activities evaluated by heart-rate variability in head injury of various severities. Clinical Neurophysiology, 116, 1273–1279.
Svedberg, L. (2009). Cold feet in children with neurological disorders. http://hdl.handle.net/2077/21042
Veugelers, R., Benninga, M. A., Calis, E. A., Willemsen, S. P., Evenhuis, H., Tibboel, D., & Penning, C. (2010). Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Developmental Medicine and Child Neurology, 52, e216–e221.
Yang, T. F., Chan, R. C., Liao, S. F., Chuang, T. Y., & Liu, T. J. (1997). Electrophysiologic evaluation of autonomic function in cerebral palsy. American Journal of Physical Medicine & Rehabilitation, 76(6), 458–461.
Yang, T. F., Chan, R. C., Kao, C. L., Chiu, J. W., Liu, T. J., Kao, N. T., & Kuo, T. B. (2002). Power spectrum analysis of heart rate variability for cerebral palsy patients. American Journal of Physical Medicine & Rehabilitation, 81, 350–354.
Zamune´r, A. R., Cunha, A. B., da Silva, E., Negri, A. P., Tudella, E., & Moreno, M. A. (2011). The influence of motor impairment on autonomic heart rate modulation among children with cerebral palsy. Research in Developmental Disabilities, 32, 217–221.
Ziemssen, T., & Reichmann, H. (2010). Cardiovascular autonomic dysfunction in Parkinson’s disease. Journal of the Neurological Sciences, 289, 74–80. https://doi.org/10.1016/j.jns.2009.08.031.
Acknowledgements
The authors extend their appreciation to the Deanship of Scientific Research at Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia, for funding this scientific work (Project ID # 2014022).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed written consent was obtained from each parent or guardian of all children in the study.
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Ibrahim, A.I., Muaidi, Q.I. & Alghamde, A.A. Abnormalities of Vital Signs in Children with Cerebral Palsy: Relationship to Physical Disabilities. J Dev Phys Disabil 30, 55–67 (2018). https://doi.org/10.1007/s10882-017-9577-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10882-017-9577-6