amin shahrokhi

Disruption in the descending pathways may lead to gait impairments in Cerebral Palsy (CP) children. Though, the mechanisms behind walking problems have not been completely understood.

We aimed to define the relationship between the structure of the corticoreticular tract (CRT) and walking capacity in children with CP.

This is a retrospective, observational, and cross-sectional study. Twenty-six children with CP between 4 to 15 years old participated. Also, we used existed data of healthy children aged 4 to 15 years old. CRT structure was characterized using diffusion tensor imaging (DTI). The DTI parameters extracted to quantify CRT structure included: fractional anisotropy (FA), mean (MD), axial (AD), and radial (RD) diffusivity. Balance and walking capacity was evaluated using popular clinical measures, including the Berg balance scale (BBS), Timed-Up-and-Go (TUG; balance and mobility), six-minute walk test (6 MWT; gait endurance), and 10-meter walk Test (10 MWT; gait speed).

There are significant differences between MD, AD, and RD in CP and healthy groups. Brain injury leads to various patterns of the CRT structure in children with CP. In the CP group with abnormal CRT patterns, DTI parameters of the more affected CRT are significantly correlated with walking balance, speed, and endurance measures. 

Considering the high inter-subject variability, the variability of CRT patterns is vital for determining the nature of changes in CRT structure, their relationship with gait impairment, and understanding the underlying mechanisms of movement disorders. This information is also important for the development or prescription of an effective rehabilitation target for individualizing treatment.

Since cerebral palsy (CP) is a corollary to brain damage, persistent treatment should accompany an alteration in brain functional activity in line with clinical improvements. In this regard, the corpus callosum (CC), as a connecting bridge between the two hemispheres, plays an essential role.

This study aimed to investigate the therapeutic effects of occupational therapy (OT) on CC functional activity and walking capacity in children with cerebral palsy.

In this clinical trial study, 4 children with CP (8.25±1.71 years) received 45 min OT sessions 3 times weekly for 8 weeks. Functional magnetic resonance imaging (fMRI) was acquired while conducting passive motor tasks to quantify CC activation. The pre-post activation changes in CC following therapy were quantified in terms of activated voxels. Walking capacity was evaluated using the timed-up-and-go (TUG), 6-minute walk test (6 MWT), and 10-meter walk test (10 MWT) in pre-and post-treatment.

The number of activated voxels in CC indicated significant improvement in participants. Post-treatment activated voxels substantially exceeded pre-treatment active voxels. Clinical measures, including TUG, 6 MWT, and 10 MWT are improved by 11.9%, 12.6%, and 25.4%, respectively.  

Passive task-based fMRI can detect the effects of OT on CC functional activity in children with CP. According to the results, OT improves CC functional activity in addition to gait and balance performance.

The Bayley Scales of Infant and Toddler Development (Bayley III) assess cognitive, language, and motor development of children aged 1–42 months, and have been widely used globally. It is unclear whether or not the reference norms of the Bayley III are acceptable for use in other populations or lead to over or under-estimating development. The purpose of this study was to estimate the distribution of the Bayley scores by age in Persian speaking children and to compare the norms between Persian and reference norms.

We constructed Bayley III norms for cognitive, language, and motor scales using 1,674 typically developing children by consecutive sampling from health care centers. First cut-off point was determined, and then the scaled scores, based on Persian speaking and reference norms, were compared. The proportions of children with low scores (scoring less than -1SD and -2 SD) based on the two norms were compared, to identify over or under-referral for developmental delay resulting from reference norms.

Scaled scores based on Persian norms varied across values based on reference norms on all subtests. The mean differences were significant across all five sub-tests (p < .05), with large effect sizes for receptive and expressive communication, fine and gross motor sub-tests of .20, .23, .14, and .25 respectively, and with small effect size for cognition sub-test of .02. Large effect sizes for all age groups were found for cognition, expressive communication, and fine motor sub-tests. For the receptive communication sub-test, effect sizes were generally large, with the exception of four age groups. For the gross motor sub-test, effect sizes were generally large, with the exception of six age groups. More children scored below 1 and 2 SD using the Persian norms and resulted in under-referral regarding cognitive, receptive and expressive communication, fine and gross motor skills.

The Persian norms differ from the reference norms for all sub-tests and these differences are clinically significant. The use of the reference norms leads to fewer referrals in all sub-scales and leads to fewer diagnoses of children with developmental delay. Population specific norms are required to identify children with low scores for referral and intervention.

The purpose of treatment of children with autism is to help them to acquire functional skills in routine life and to control behaviors that are disruptive.

In this study, the safety and efficiency of cerebrolysin was determined by childhood autism rating scale (CARS) on behavioral, verbal and nonverbal developments of children with autism referred to children’s medical hospital clinic of neurology.

In a quasi-experimental study, 36 children with autism were enrolled and the effect of cerebrolysin on their behavioral, nonverbal and verbal development was determined by CARS questionnaire fulfilled before and one month after complete intervention.

All evaluated items except level and consistency of intellectual response had favorable reduction in scores of CARS questionnaire (P = 0.001). The total score decreased from 40.6 to 36.1 showing 11.1% improvement. Despite the efficiency of cerebrolysin observed in this study, its partial use may be limited by the large number of intramuscular injections, i.e. nine per months. Sustained release formulation may alleviate this limitation, if this therapy proves to be beneficial in future studies.

According to the obtained results, the safety and feasibility of cerebrolysin administration could be considered and be effective on behavioral, nonverbal and verbal development in children with autism.

Vestibular rehabilitation is suggested as one of the effective treatments for vestibular-originated dizziness and vertigo. As there is a proven biologic link between vestibular symptoms and headache, headache improvement with vestibular improvement after vestibular rehabilitation is expected. The aim of the present study was examining vestibular rehabilitation effects on dizziness and headache in 9−15 year old subjects with a vestibular migraine. Eight subjects with vestibular migraine were referred to Rofeideh Rehabilitation Hospital after diagnosis by a pediatric neurologist. They were evaluated via dizziness handicap inventory (DHI), headache impact test-6 (HIT-6) and dizziness and headache frequency. Then they received a home-based vestibular rehabilitation and after one month they were reevaluated. After vestibular rehabilitation for one month, changes in the DHI and HIT-6 score were statistically significant (p < 0.01). In addition, reduction in the dizziness and headache frequency in a month was statistically significant. As vestibular rehabilitation has noticeable effects on dizziness and headache, this treatment is introduced as an effective and non-invasive treatment in children and adolescents with a vestibular migraine.

Seizure is a neurological disorder in children. Children have experienced seizures at least once in the first 16 years of life. The aim of this study is to determine some risk factors of recurrent times to childhood seizures using Parametric Copula Marginal Model applying Bayesian Approach. In this descriptive-longitudinal study, data from a case filed in 300 children who were admitted in four hospitals between 2014 and 2016 due to recurrence of seizure disease were collected. The seizure times of children were recorded after each visit to these centers and the time intervals between seizure recurrence events were calculated. For modeling of time to recurrent seizures in children, the joint distribution of the Parametric Copula Marginal Model applying Bayesian Approach was fitted to the data and analyzed by Bayesian approach. WinBugs and R versions 3.4.1 were used for data analysis. 15.0% of the children had seizure and 64.3% of these children were hospitalized at least once due to seizure recurrence. 25.0% of the mothers of these children had a hard labor. The result of the electrolytic test was 40% normal. 27.0% had a family history of seizure and 78.4% of the children had normal evolutionary status. The 95% confidence interval for the dependency parameter (detailed parameter) was estimated with the parametric marginal risk of the Weibull-Clayton equation (0.434, 0.227). There was a significant relationship between the history of hospitalization and drug use. There was a correlation between the recurrence events of children with seizure. It is suggested that doctors consider the clinical steps, drug use factors, and hospitalization history, which are among the factors associated with frequent recurrence of seizure in children.

To evaluate the distribution of the Bayley screening test scores by age, in Persian children and compare developmental risk categories distributions between Persian and reference norms.
A representative sample of 417, 1 to 42-months-old, typically developing children by consecutive sampling from health -care centers recruited, during the 2014 to 2015 in Tehran city. The Bayley measures children’s cognitive, receptive and expressive communication, fine and gross motor skills. For determining cut points for the subtest scores, two cuts points were determined for each age group, dividing scores into the three bands that identify the at risk, emerging (between the 2nd and 25th percentiles), and competent categories. We estimated the agreement between the distributions of the risk categories between the two samples using weighted kappa statistics.
The comparison of neurodevelopmental classification of children based on two norms determined that; approximately 70-80% of all tests administered to the participating children were classified as normal by both norms. Weighted kappa coefficients for the five subtests ranged from 0.56 to 0.89 suggesting moderate agreement between the classification using the reference and Persian norms. Expressive and receptive communication subtests had the lowest kappa scores (0.56 and 0.59, respectively), and classification of gross motor demonstrated the highest level of agreement (0.89).
Our findings demonstrate that reliance on reference -based norms for the Bayley test in Persian children results in misclassification of developmental delay.

Cerebral Palsy (CP) constitutes a heterogeneous group of developmental disorders resulting from damage to the brain which affects motor system. Cerebrolysin, as a neurotrophic peptide has been used for improving symptoms of patients suffering from neurodegenerative disorders.
Due to the presence of limited information about the usefulness of Cerebrolysin in CP, this study was performed for the evaluation of Cerebrolysin in the management of spasticity in children with CP.
26 Spastic CP patients aged between 2 and 6 years entered this study. At the first visit, Modified Ashworth scale for assessment of spasticity was used. Then Cerebrolysin was administered at a dose of 0.1 cc/kg intramuscularly (IM) for 3 months. In the first month, the medication was injected 5 times per week. In the second month of therapy, injections were performed as follows: 4 injections in the first week, 3 injections in the second week, 2 injections in the third week and a single one in the fourth week. In the third month of therapy, Cerebrolysin was continued as weekly injections. The spasticity of the patients was evaluated at the end of the first and third month of therapy.
Modified Ashworth score at baseline was 20.62 ± 9.65 which reached 15.19 ± 7.30 after 1 month of treatment. This figure was 14.81 ± 3.77 at month 3. Total decline in Modified Ashworth Scale was 5.42 ± 5.33 at the first month and 5.81 ± 2.74 at the third month in comparison to baseline. The difference between Modified Ashworth Scale at baseline and 1 month after therapy was significant (P = 0.000) but there was no significant difference between first month and third month of therapy. (P = 0.755). Also analysis indicates that there was an association between absolute reduction of Modified Ashworth score and the age at beginning of treatment (P = 0.037).
Using Cerebrolysin as a neurotrophic peptide may improve spasticity of children with CP and should be considered as a possible useful treatment in CP cases.

Positioning is a part of routine neonatal care in most neonatal intensive care units. Optimal positioning has been controversially advocated as a practice for providing better neuro-developmental outcomes in prematures.
To evaluate by near-infrared spectroscopy (NIRS) the effect of changing posture on regional saturation of oxygen (rSO2) in the brain in mechanically ventilated preterm newborns during first 3 days after delivery.
Twenty stable ventilated preterm newborns were studied by NIRS in four different positions sequentially including supine, right-side-lying, prone, and left-side-lying, as well as in 3 intermediate periods between the four main positions.
About 45 percent of the sample of 20 neonates was under 30 weeks with a mean gestational age of 30.985 ± 6.459. Also, 50 percent were less than 1500 grams, with a mean weight of 1638.75 ± 623.04 grams. No statistically significant changes in rSO2 were found in the 4 main positions but we found significant difference between the rSO2 values of the “intermediate period between the right-side-lying and the prone position” with all other main positions and intermediate periods.
The four main postures utilized in the practice of positioning infants, do not differ in terms of cerebral oxygenation. However, it seems that wide ranges of spatial mobilization in ventilated preterm neonates may be a potential cause of fall in brain oxygenation.

Inflammatory elements and genetics have major roles in febrile seizures (FS) pathogenesis. Seventy patients were enrolled and compared with 139 controls. The allele and genotype frequency of the IL-2 gene at -330 and positions and the IFN-γ at  position were determined. A significant positive association with GG genotype at position -330 in the patient group was found (P=0.003). Further, a positive association was detected in simple and complex FS groups at the same position (P=0.03, P=0.004). IL-2 GT haplotype was significantly more common in the patients compared to controls (P=0.0008). Higher frequency of GT haplotype was detected in simple FS patients in comparison to controls (P=0.0003). Contrary, IL-2 TG haplotype frequency was lower in complex FS group (P=0.005). Overrepresentation of certain alleles, genotypes and haplotypes in IL-2 gene in FS patients could predispose individuals to this disease.

Advances in perinatal and neonatal care have substantially improved the survival of at-risk infants over the past two decades.
The purpose of this study was to assess the reliability and validity of the Bayley Scales of infant and toddler developmental Screening test in Persian-speaking children.
This was a cross-sectional prospective study of 403 children aged 1 - 42-months. The Bayley scales screening instrument, which consists of five domains (cognitive, receptive, and expressive communication and fine and gross motor items), was used to measure infants’ and toddlers’ development. The psychometric properties examined included the face and content validity of the scale, in addition to cultural and linguistic modifications to the scale and its test-retest and inter-rater reliability.
An expert team changed some of the test items relating to cultural and linguistic issues. In almost all the age groups, cultural or linguistic changes were made to items in the communication domains. According to Cronbach’s alpha for internal consistency, the reliability of the cognitive scale was r = 0.79, and the reliability of the receptive scale was r = 0.76. The reliability for expressive communication, fine motor, and gross motor scales was r = 0.81, r = 0.80, and r = 0.81, respectively. The construct validity of the tests was confirmed using a factor analysis and comparison of the mean scores of the age groups. The intra- and inter-rater reliabilities of the Bayley Scales were good-to-excellent.
The results indicated that the Bayley Scales had a high level of reliability in the present study. Thus, the scale can be used in a Persian population.

For diagnosing children who are suspected to have developmental delay through developmental screening tests, we need a valid and reliable diagnostic tool. The Bayley scales is a well-known diagnostic developmental assessment on cognitive, communication and motor domains. The aim of this study was validity and reliability determination of the Bayley test.
The method of this study was descriptive-analytic. The test was provided through translation- back translation and cultural adaptation. Content and face validity of tool was determined by experts’ opinions. 260 children aged 1 to 42 months were recruited for developmental assessment by Bayley. Reliability of test was calculated through three methods; internal consistency, test-retest and inter-rater. Construct validity was calculated using factor analysis and comparison of the mean scores methods.
Participants were 260 children 15 days to 42 months, including 134 boys (51.5%). Cranach’s alpha coefficients were more than 0.76 for all domains. Pearson correlation coefficient in different domains, were at least 0.987 (P These results indicated that the Bayley is a valid and reliable tool for developmental assessment in Persian children.

Febrile seizure (FS) occurs between 6 months and 6 years of age. Febrile seizure is a common disease in pediatrics. Some patients are retarded with recurrent febrile seizure. For example Drawet syndrome was started with febrile seizure and progress into the intractable seizure and finally are retarded. This article is the clinical trial study. Population in this study are 86 children whit febrile seizure refer to pediatrics’ medical central. This study was carried out in 2013. In this study evaluated patients with febrile seizure’s criteria and included in the population. Children statistics with febrile seizure refer to pediatrics’ medical center registered and compared with other statistics. Data enter the SPSS program 18 version (SPSS Inc, Chicago, USA) and used analysis statistical tests and also T-test, Chi Square tests. Finally evaluated total parameters by MIN+SD and reported significant difference (P-value<0.05). Numbers of patients determined according to previous study. In this study 46 patients with complex febrile seizure and early initiation of treatment were not retarded and haven’t any complications. Early initiation of treatment in the patient whit febrile seizure very important to prophylaxis of developmental delay and developmental regression.

A 3-year-old girl was admitted with typical hemolytic uremic syndrome (HUS) and conservative treatments were initiated. During hospitalization, she had seizures, right hemiparesis, and loss of consciousness. Initial MR of the brain showed changes of acute disseminated encephalomyelitis (ADEM). She was treated with intravenous methylprednisolone and immunoglobulin. Upon improvement of her clinical condition, she was discharged with oral prednisolone which was tapered after two months. After one year fallow-up, the child now has a normal renal function and normal neurodevelopment.

Arthrogriposis is a disorder in which two or more joints in more than one limb of body, place in a stable position and malformation status that usually is the result of joint's immobilization during fetal period. Problems resulting from this congenital deficit can occur in difference places, in upper and lower limbs, trunk, and even in face. It occurs in 3 of 1000 births, in two-third of these patients, all four limbs suffer and one-third of patients suffer in lower limbs and it rarely occurs in upper limbs. In this case affected children and their parents try different treatment such as surgical and non-surgical treatments which are of argument and controversial even among specialists of these treatments. In this paper, a 3-year old boy has been introduced who suffers from congenital deficit with developmental disorder in upper extremity bones and the absence of flexor muscles group and extensor of wrist. The boy was sent to Bahar Rehabilitation Center for occupational therapy and rehabilitation services by physician of rehabilitation clinic in Tehran.