Publications

Below is a selection of publications in peer-reviewed journals authored by members of the Center for Cerebral Palsy team.

Fowler EG, Vuong A, Staudt LA, Greenberg MB, Mesler SA, Chen K, & Stearns-Reider KM (2024). Selective voluntary motor control influences knee joint torque, work and power in children with spastic cerebral palsy. Gait & Posture, 113, 151-157.

Biomechanical impairments found for children with low SMC are concerning as skilled movements during gait, play and sport activities occur at high velocities. Differences in SMC should be considered when designing individualized assessments and interventions.
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The dystrophin‑glycoprotein complex (DGC) is a critical adhesion complex of the muscle cell membrane, providing a mechanical link between the extracellular matrix (ECM) and the cortical cytoskeleton that stabilizes the sarcolemma during repeated muscle contractions. One integral component of the DGC is the transmembrane protein, sarcospan (SSPN). Our findings indicate that SSPN overexpression rescues dystrophin deficiency partially through mechanotransduction signaling cascades mediated through components of the ECM and the cortical cytoskeleton.
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Stearns-Reider KM, Hicks MR, Hammond KG, Reynolds JC, Maity A, Kurmangaliyev YZ, ... & Crosbie RH (2023). Myoscaffolds reveal laminin scarring is detrimental for stem cell function while sarcospan induces compensatory fibrosis. NPJ Regenerative medicine, 8(1), 16.

We developed an on-slide decellularization approach to generate acellular extracellular matrix (ECM) myoscaffolds that can be
repopulated with various cell types to interrogate cell-ECM interactions.  Using this platform, we investigated whether fibrotic ECM scarring affected human skeletal muscle progenitor cell (SMPC) functions that are essential for myoregeneration. 

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Pietruszewski L, Moore-Clingenpeel M, Moellering GC, Lewandowski D, Batterson N, & Maitre NL (2022). Predictive value of the test of infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants. Early Human Development, 174

Current recommendations for early detection tools for cerebral palsy (CP) include assessments that vary in feasibility and resource requirements. This paper evaluates the predictive value of two less resource-intensive tools.
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Ayala L, Winter S, Byrne R, Fehlings D, Gehred A, Letzkus L, Noritz G, Paton MC, Pietruszewski L, Rosenberg N and Tanner K (2021). Assessments and interventions for spasticity in infants with or at high risk for cerebral palsy: a systematic review. Pediatric Neurology, 118

Further research is needed to validate assessments for spasticity in children younger than two years.
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Pietruszewski L, Nelin MA, Batterson N, Less J, Moore-Clingenpeel M, Lewandowski D, Levengood K and Maitre NL (2021). Hammersmith Infant Neurological Examination clinical use to recommend therapist assessment of functional hand asymmetries. Pediatric Physical Therapy, 33(4)

This study idenfied a cut-off score for the HINE asymmetry score used to recommend further evaluation of upper extremity function in infants aged 3-12 months.
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Fowler EG, Oppenheim WL, Greenberg MB, Staudt LA, Joshi SH, Silverman DHS (2020). Brain Metabolism During A Lower Extremity Voluntary Movement Task in Children With Spastic Cerebral Palsy. Front Hum Neurosci; 14.

The purpose of this study was to examine the relationship between brain metabolism and SVMC in children with spastic bilateral CP during movement using PET.
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Pietruszewski L, Burkhardt S, Yoder PJ, Heathcock J, Lewandowski DJ and Maitre NL (2020). Protocol and feasibility-randomized trial of telehealth delivery for a multicomponent upper extremity intervention in infants with asymmetric cerebral palsy. Child neurology open, 7

This paper presents a telehealth intervention for children with asymmetric cerebral palsy that was feasible and potentially effective, but a larger trial is needed to evaluate efficacy.
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Thompson RM, Foley J, Dias L, Swaroop VT (2019). Hip Status and Long-term Functional Outcomes in Spina Bifida. JPO Mar; 39(3):e168-e172.

This long-term outcome study revealed that functional outcomes are not associated with hip status in adult patients with spina bifida. Rather, long-term outcomes are closely correlated with neurological level of involvement and hip range of motion, suggesting that efforts to keep hips reduced are unnecessary.
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Shrader MW, Wimberly RL, Thompson RM (2019). Hip Surveillance for Children with Cerebral Palsy. JAAOS Oct 15;27(20)760-768.

This article reviews the current systems in place worldwide for hip surveillance in children with cerebral palsy.  It concludes that hip surveillance is very effective at identifying hips-at-risk early and preventing painful, debilitating dislocations in this population by allowing for appropriate referrals for orthopaedic management.
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Thompson RM, Ihnow S, Swaroop VT, and Dias L (2017). Tibial derotational osteotomies in two neuromuscular populations: comparing cerebral palsy with myelomeningocele. JCO Aug 1;11(4): 243-248. PMCID: PMC5584491

This study compares outcomes of tibial derotational osteotomies between patients with cerebral palsy and those with myelomeningocele. They found that the risk of complication and recurrence was similar between groups using their technique. Most importantly, they found that the risk of requiring re-derotation was 31.9% less likely per year increase in age at initial surgery.
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Mednick RE, Eller EB, Swaroop VT, and Dias L (2015). Outcomes of Tibial Derotation Osteotomies Performed in Patients with Myelodysplasia. JPO Oct-Nov 35(7):721-4.

This study describes the surgical technique utilized by the authors to perform a derotational osteotomy of the tibia. These authors reported the outcomes of derotational osteotomies utilizing this technique in children with myelodysplasia.  They found a low major complication rate (3.10%) and a low recurrence rate compared to previously-published reports.
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Goldberg EJ, Requejo PS, Fowler EG. Joint moment contributions to swing knee extension acceleration during gait in individuals with spastic diplegic cerebral palsy. Gait Posture. 2011 Jan;33(1):66–70.

This study found that momentum generated by the swing limb appeared to be the primary cause of inadequate knee extension acceleration during swing in patients with spastic cerebral palsy. Stance limb muscle strength did not appear to be the limiting factor in achieving adequate knee extension in children with CP. (Gait & Posture 33:66-70, 2011)
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Fowler EG, Staudt LA, Greenberg MB. Lower-extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairment: Selective Voluntary Motor Control in Patients with CP. Dev Med Child Neurol. 2010 Feb 4;52(3):264–9.

This study confirmed the common clinical finding of increasing proximal to distal selective voluntary motor control impairment in patients with cerebral palsy. These findings may have implications for treatment and research. (Dev Med Child Neurol 52: 264-9, 2010)
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Fowler EG, Knutson LM, DeMuth SK, Siebert KL, Simms VD, Sugi MH, et al. Pediatric Endurance and Limb Strengthening (PEDALS) for Children With Cerebral Palsy Using Stationary Cycling: A Randomized Controlled Trial. Phys Ther. 2010 Mar 1;90(3):367–81.

This Phase I study found significant improvements in locomotor endurance, gross motor function and some measures of strength in children with cerebral palsy after a 12-week stationary cycling program. The study provides preliminary support for this intervention and guidance for future research in this area. (Phys Ther 90:367-381, 2010)
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Siebert KL, DeMuth SK, Knutson LM, Fowler EG. Stationary Cycling and Children with Cerebral Palsy: Case Reports for Two Participants. Phys Occup Ther Pediatr. 2010 May;30(2):125–38.

These case reports describe a stationary cycling intervention and outcomes for two child participants with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. (Phys Occup Ther Pediatr Vol. 30:125-138, 2010)
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Fowler EG, Goldberg EJ. The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy. Gait Posture. 2009 Jan;29(1):102–7.

Selective voluntary motor control is the ability to move a joint independent of other joints in that limb. This is often impaired in cerebral palsy. Using instrumented gait analysis, this study found that a patient’s selective voluntary motor control related to a measurement of interjoint coordination, or the ability to move the hip and knee independently during swing. (Gait & Posture 29:102-107, 2009)
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Fowler EG, Staudt LA, Greenberg MB, Oppenheim WL. Selective Control Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy. Dev Med Child Neurol. 2009 Aug;51(8):607–14.

This study describes a tool to assess selective voluntary motor control, which is an impairment found in patients with spastic cerebral palsy. The tool, developed by the team at the Center for Cerebral Palsy at UCLA, was found to be highly valid and reliable. View the instructional video on the use of SCALE. Written instructions on administration of SCALE, including a score sheet that may be copied for clinicians’ use, is provided in the Appendix. (Dev Med Child Neurol 51: 607-614, 2009) View Appendix to this article. The Appendix includes a SCALE score sheet and directions for administering and grading the SCALE.
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Oppenheim WL. Complementary and alternative methods in cerebral palsy. Dev Med Child Neurol. 2009 Oct;51:122–9.

This review article discusses some of the complimentary and alternative methods used in children that may be continued into adulthood. The pitfalls for patients and conventional physicians, as well as suggestions as to what may be helpful and harmful are discussed. (Dev Med Child Neurol 51 Suppl 4: 122-129, 2009)
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Winstein C, Pate P, Ge T, Ervin C, Baurley J, Sullivan KJ, et al. The Physical Therapy Clinical Research Network (PTClinResNet): Methods, Efficacy, and Benefits of a Rehabilitation Research Network. Am J Phys Med Rehabil. 2008 Nov;87(11):937–50.

This article describes the vision, methods and implementation strategies used in building the infrastructure for PTClinResNet, a clinical research network designed to assess outcomes for health-related mobility associated with evidence-based physical therapy interventions across and within four different disability groups. (Am J Phys Med Rehabil 87:937-950, 2008)
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Fowler EG, Kolobe TH, Damiano DL, Thorpe DE, Morgan DW, Brunstrom JE, et al. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Phys Ther. 2007;87(11):1495.

This article highlights the content and recommendations of a Pediatrics Research Summit developed to foster collaborative research in this area. Two components of physical fitness – muscle strength and cardiorespiratory fitness – were emphasized. Current intervention protocols and outcome measurements were critically evaluated and recommendations were made for future research. (Phys Ther, 87:1495-1510, 2007)
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Fowler EG, Nwigwe AI, Ho TW. Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy. Dev Med Child Neurol. 2007 Feb 13;42(3):182–9.

This study concluded that the pendulum test is a valid tool for assessing spasticity in persons with CP and that the first swing excursion is the most sensitive outcome measure. (Dev Med Child Neurol 42:182-189, 2000)
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Ali O, Shim M, Fowler E, Greenberg M, Perkins D, Oppenheim W, et al. Growth Hormone Therapy Improves Bone Mineral Density in Children with Cerebral Palsy: A Preliminary Pilot Study. J Clin Endocrinol Metab. 2007 Mar 1;92(3):932–7.

This small pilot study showed suggests that 18 months of growth hormone is associated with statistically significant improvement in spinal bone mineral density and linear growth in children with cerebral palsy and low bone mineral density. (J Clin Endocrinol Metab 92:932–937, 2007)
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Ali O, Shim M, Fowler E, Cohen P, Oppenheim W. Spinal Bone Mineral Density, IGF-1 and IGFBP-3 in Children with Cerebral Palsy. Horm Res Paediatr. 2007;68(6):316–20.

This cross-sectional pilot study provides preliminary evidence that the growth hormone-insulin-like growth factor (GH-IGF) axis plays an important role in bone growth in children with cerebral palsy. Results indicate that in osteopenic patients, but not in the 4 patients who had normal bone density of BMD, there was a significant correlation between the IGFBP-3 Z-scores and spinal BMD Z-scores. (Horm Res 68:316–320, 2007)
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Fowler EG, Knutson LM, DeMuth SK, Sugi M, Siebert K, Simms V, et al. Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS) – a randomized controlled trial protocol for a stationary cycling intervention. BMC Pediatr [Internet]. 2007 Dec [cited 2020 Jan 7];7(1).

This paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS); a Phase I randomized controlled trial evaluating the efficacy of a stationary cycling intervention for children with spastic diplegic cerebral palsy. (BMC Pediatrics 7:14-22, 2007)
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Shim ML, Moshang T, Oppenheim WL, Cohen P. Is treatment with growth hormone effective in children with cerebral palsy? Dev Med Child Neurol. 2004;46(8):569–71.

This case report presents three children with cerebral palsy and short stature who were treated with growth hormone and demonstrated significantly increased linear growth rate without side effects. Growth improved to a greater extent in the two children with apparent growth hormone deficiency than in the child with no apparent growth hormone deficiency. (Dev Med Child Neurol 46: 569-571, 2004)
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Fowler EG, Ho TW, Nwigwe AI, Dorey FJ. The effect of quadriceps femoris muscle strengthening exercises on spasticity in children with cerebral palsy. Phys Ther. 2001;81(6):1215–1223.

This study found no evidence that resistive exercise in patients with spastic cerebral palsy increased spasticity. The long-held belief that increased effort would increase spasticity had been the rational for limiting strengthening programs for patients with spastic cerebral palsy. (Phys Ther 81:1215–1223, 2001) This paper won the Jack Walker Award for the best article on clinical research published in the journal Physical Therapy in 2001.
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Galarza M, Fowler EG, Chipps L, Padden TM, Lazareff JA. Functional Assessment of Children with Cerebral Palsy Following Limited (L4-S1) Selective Posterior Rhizotomy - A Preliminary Report. Acta Neurochir (Wien). 2001 Sep 1;143(9):865–72.

Using instrumented gait analysis, improved joint motion during walking was observed in subjects with spastic cerebral palsy one year after undergoing limited selective posterior rhizotomy. Reduced spasticity and increased passive range of motion were measured and strength and motor control were not adversely affected. (Acta Neurochir (Wien) 143: 865-872, 2001)
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Wiele BVD, Staudt L, Rubinstien E, Nuwer M, Peacock W. Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases. Pediatr Anesth. 1996;6(6):479–86.

In this review, the incidence and clinical significance of adverse events related to anesthesia and surgery are described. Neither intra-operative or post-operative events with potential for lasting morbidity, nor life-threatening events occurred. Early surgical complications were absent in this series. (Paediatric Anaesthesia 6:479-486 1996)
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Staudt LA, Peacock WJ, Oppenheim W. The management of childhood spasticity. Operative Orthopaedics Vol 1:313-335, 1993

This chapter reviews the neurophysiological basis of spasticity, its measurement and clinical effects. The medical and surgical management of spasticity is discussed. (in Advances in Operative Orthopaedics Vol 1:313-335, 1993)
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Peacock WJ, Staudt LA. Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg. 1991 Mar;74(3):380–5.

The authors performed clinical examination and gait analysis on children with cerebral palsy before and after selective posterior rhizotomy. The data indicate decreased spasticity and improved range of motion that contribute to improvement in active functional mobility following selective posterior rhizotomy. (J Neurosurg 74:380-385, 1991)
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Staudt LA, Peacock WJ, Oppenheim W. The role of selective posterior rhizotomy in the management of cerebral palsy. Inf Young Children. 1990 2(3):48-58.

This article reviews the history, rationale, patient selection, surgical technique and post-operative management of selective posterior rhizotomy in children with spastic cerebral palsy. (Inf Young Children 3:48-58, 1990)
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Peacock WJ, Staudt LA. Spasticity in Cerebral Palsy and the Selective Posterior Rhizotomy Procedure. J Child Neurol. 1990 Jul;5(3):179–85.

This article discusses the surgical procedure to reduce spasticity by selective posterior rhizotomy. A review of the neurophysiological basis of spasticity is presented. (J Child Neurol 5: 179-185, 1990)
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Staudt LA, Peacock WJ. Selective posterior rhizotomy for treatment of spastic cerebral palsy. Pediatr Phys Ther. 1989 1:3-9.

This article is directed at physical therapists treating children with spastic cerebral palsy. It describes the assessment and patient selection for selective posterior rhizotomy in the treatment of spastic cerebral palsy (Pediatr Phys Ther 1:3-9 1989)
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