Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification
Jie Yang1,2,3,4, Congjie Chen1,2,3,4, Ningning Chen1,2,3,4
1Department of Rehabilitation, Children's Hospital of Chongqing Medical University (CHCMU), Chongqing, China.
Insights
Cerebral palsy (CP) classification using MRI shows varied rehabilitation potential. Early intervention improves fine motor skills and adaptability across all CP types, especially in children under two.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral palsy (CP) clinical characteristics and MRI classification system (MRICS) correlation is inconsistent.
- Rehabilitation potential across different MRICS categories requires further exploration.
Purpose of the Study:
- To investigate clinical characteristics of CP in relation to MRICS.
- To explore rehabilitation potential in children with CP based on MRICS.
Main Methods:
- Retrospective cohort study of children with CP (2017-2021).
- Analysis of clinical characteristics and rehabilitation potential (fine motor, adaptability) based on MRICS.
- Follow-up period of at least one year for qualified cases.
Main Results:
- Predominant white matter injury was the most common MRICS category (40.6%).
- Spastic diplegia was the leading CP subtype in white matter and miscellaneous MRICS categories.
- Children with white matter injury showed less severe GMFCS (Gross Motor Function Classification System) levels.
- Rehabilitation potential varied by MRICS, with normal MRI scans showing superior outcomes.
- Early rehabilitation (before age 2) enhanced fine motor function and adaptability across all MRICS categories.
Conclusions:
- MRICS is significantly associated with CP clinical characteristics.
- MRICS predicts rehabilitation efficacy in children with CP.
- Early intervention is crucial for optimizing rehabilitation outcomes in CP.
Background:
The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored.
Aims:
To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS.
Materials And Methods:
Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study.
Results:
Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework.
Conclusion:
MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.
