Exploring the use of cognitive intervention for children with acquired brain injury

INTRODUCTION

Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance.

OBJECTIVE

This study explores the use of CO-OP with children with ABI.

METHOD

Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6-15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the child's performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis.

RESULTS

Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed.

Childhood Participation in After-School Activities: What is to be Expected?

Participation is recognised as a key to health and wellbeing and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children and adolescents in their time outside formal school. More specifically, the influence of age and gender on after-school participation patterns was explored.

Method:

Three hundred and thirty-two children and adolescents (5 to 18 years old) were divided into five age groups and completed the Children's Assessment of Participation and Enjoyment (CAPE). To test the interaction effect of gender and age on participation measures, ANOVAs were conducted.

Results:

The results indicated differences with moderate to high effect size in participation patterns across age, where a decline in participation was detected as children made the transition to adolescence. Differences with negligible effect size in participation were found between boys and girls in some of the activity types. No interaction effect between age and gender was observed.

Conclusion:

Participation patterns change with age, particularly as children make the transition to adolescence; however, this change does not depend on gender. Intervention strategies might take into account these inherent changes. Future studies might consider additional factors (for example, environment) while examining participation throughout age.

Development of the Child's Challenging Behaviour Scale (CCBS) for mothers of school-aged children with disabilities

BACKGROUND

Caring for a child with a disability can be especially difficult when the child exhibits challenging behaviours. Childhood disability often calls for the mother to be conscientious, capable and organized to meet the child's health and developmental needs. Mothers are known to feel particularly stressed when their child also behaves in ways that are difficult to manage. In these circumstances maternal mental health may be compromised and mothers therefore need more support. The Child's Challenging Behaviour Scale (CCBS) is an 11-item scale that measures a mother's report of challenging behaviours exhibited by their child with disability, that are associated with compromised maternal mental health and caregiving difficulties. This paper describes the initial development and psychometric evaluation of the CCBS.

METHODS

A mixed methodology instrument design model was used to develop the CCBS. A qualitative study generated items, and quantitative data were collected from 152 mothers of a child with a disability.

RESULTS

The CCBS showed excellent internal consistency (Cronbach's alpha = 0.89) and factor analysis supported its unidimensionality. Construct validity was supported by correlations with the PedsQL Psychosocial Health Summary Score (rho =-0.51) and cooperation taking medication (rho = 0.40). There were significant differences in CCBS scores between groups of children with and without either autism or psychiatric conditions. The CCBS showed moderate correlations with self-reported health status; the mother's sense of empowerment (rho =-0.44); and family cohesion (rho =-0.30). Mothers with a mental health condition recorded significantly higher CCBS scores.

CONCLUSIONS

The CCBS is a brief, psychometrically sound instrument that provides clinicians with a new tool that measures a mother's rating of their child's behaviours that are challenging and associated with reduced maternal well-being. The CCBS assists professionals to identify mothers and family situations who may be in need of more support and interventions.

Abstract 3881: A novel class of structure-based cyclin-dependent kinase inhibitors

Deregulation of the Cdk/Rb/E2F axis is a common feature among cancers. Several promising ATP-competitive Cdk inhibitors are undergoing clinical testing as anticancer therapeutics. However a weakness of ATP-competitive Cdk inhibitors is that all kinases share a highly conserved ATP binding site, making it difficult to selectively inhibit cell cycle Cdks. Further, there is significant functional redundancy among cell cycle Cdks, so the ideal Cdk inhibitor would block the activity of multiple cell cycle Cdks while not affecting other kinases. Nature utilizes several modes of regulation that are specific to the Cdks that involve (1) the inhibitory proteins p21, p27, and p57, (2) inhibitory phosphorylation on a tyrosine residue near the ATP binding pocket, (3) activating phosphorylation on the “T-loop” site, and (4) binding of an activating Cyclin subunit. Usurping one of these natural Cdk-specific control mechanisms may be the best hope for developing potent and selective anticancer Cdk inhibitors.

Comparison of the crystal structures of Cyclin A/Cdk2/p27 and Cyclin A/Cdk2 complexes indicated that p27 binding causes a conformational change, which opens a pocket on the surface of Cdk2. We hypothesized that a small molecule that binds to this pocket would force Cdks to adopt an inactive conformation. In silico molecular docking was performed to identify compounds predicted to bind to this pocket. Multiple compounds identified in this screen inhibited the proliferation of breast cancer cells. Inhibition of proliferation correlated with a decrease in the soluble levels of Cdk1, Cdk2, and Cdk4, and an increase in these proteins in the insoluble fraction. Video microscopy of cells stably expressing a GFP-Cdk4 fusion protein showed aggregate formation over time in the presence of the Cdk inhibitors and that the aggregates dissipated after the drug was removed. Proliferation studies performed in parallel also indicated that the effects of the Cdk inhibitors were largely reversible within the first 24 hours.

One of the compounds, NSC117024, preferentially inhibited the proliferation of BT549 breast cancer cells over nontransformed mammary epithelial cells. Inhibition of BT549 proliferation was observed at NSC117024 concentrations as low as 780 nM. Interestingly, suppression of cancer cell division by the compounds occurred as well or better in cells lacking p21 and p27. The compounds directly inhibited Cdk2 activity in kinase assays. Together the results suggest that the novel family of Cdk inhibitors mimic the actions of p21 and p27 and may preferentially inhibit the proliferation of a subset of breast cancer cells. Current efforts are directed toward optimizing NSC117024 antiproliferative activity, developing a biotinylated NSC117024 affinity probe to verify compound specificity, and identifying the genetic features of cancer cells that render them sensitive to NSC117024.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3881.

Increasing HIV transmission through male homosexual and heterosexual contact in Australia: results from an extended back-projection approach

OBJECTIVES

The aim of the study was to reconstruct the HIV epidemic in Australia for selected populations categorized by exposure route; namely, transmission among men who have sex with men (MSM), transmission among injecting drug users (IDUs), and transmission among heterosexual men and women in Australia.

DESIGN

Statistical back-projection techniques were extended to reconstruct the historical HIV infection curve using surveillance data. Methods We developed and used a novel modified back-projection modelling technique that makes maximal use of all available surveillance data sources in Australia, namely, (1) newly diagnosed HIV infections, (2) newly acquired HIV infections and (3) AIDS diagnoses.

RESULTS

The analyses suggest a peak HIV incidence in Australian MSM of approximately 2000 new infections per year in the late 1980s, followed by a rapid decline to a low of <500 in the early 1990s. We estimate that, by 2007, cumulatively approximately 20 000 MSM were infected with HIV, of whom 13% were not diagnosed with HIV infection. Similarly, a total of approximately 1050 and approximately 2600 individuals were infected through sharing needles and heterosexual contact, respectively, and in 12% and 23% of these individuals, respectively, the infection remained undetected.

DISCUSSION

Male homosexual contact accounts for the majority of new HIV infections in Australia. However, the transmission route distribution of new HIV infections has changed over time. The number of HIV infections is increasing substantially among MSM, increasing moderately in those infected via heterosexual exposure, and decreasing in IDUs.

Feasibility of the Canadian Occupational Performance Measure for Routine Use

Purpose:

Despite encouragement, routine outcome measurement is not standard practice in occupational therapy. This applies across most practice areas and outcome measures, including occupational therapy measures such as the Canadian Occupational Performance Measure. Barriers to using outcome measures have been proposed, but are gathered from therapists not measuring outcomes routinely. This study gathered therapists' perceptions on outcome measurement following a period of routine outcome measure use. A secondary aim was to propose a therapist-driven template for summarising outcome data routinely.

Procedures:

Using a process evaluation, a short answer survey was used with three occupational therapists following 5 months of Canadian Occupational Performance Measure use in older people's rehabilitation. The data were summarised descriptively, using a proposed template based on therapist feedback.

Findings:

The therapists perceived that the measure facilitated treatment for both therapists and clients but they experienced challenges related to client cognition and sustaining use. Template creation indicated that the therapists placed more importance on individual than group level data.

Conclusion:

The therapists perceived benefit in routine Canadian Occupational Performance Measure use. The instrument appears feasible for meaningful and routine use but not necessarily for sustained use. Increasing outcome measure use is complex, requiring more knowledge on barriers, expectations of value and methods of data utilisation.

Leisure activity preferences for 6- to 12-year-old children with cerebral palsy

AIM

The objective was to describe leisure activity preferences of children with cerebral palsy (CP) and their relationship to participation. Factors associated with greater interest in leisure activities were identified.

METHOD

Fifty-five school-aged children (36 males, 19 females; mean age 9 y 11 mo; range 6 y 1 mo-12 y 11 mo) with CP (Gross Motor Function Classification System [GMFCS]) level I 62%, level II 22%, level III-IV 16%; 33.3% hemiplegia, 29.6% diplegia, 25.9% quadriplegia, 11.2% other) who could complete the Preferences for Activities of Children (PAC) were recruited.

RESULTS

Social and recreational activities were most preferred, and self-improvement activities were least preferred. Younger age, higher motivation, and IQ predicted interest in active-physical activities (r(2)=0.39). Negative reaction to failure was associated with less preference for social activities (r(2)=0.16), whereas increased prosocial behaviours were related to greater preference for recreational (r(2)=0.13) and self-improvement activities; the latter is also predicted by older age (r(2)=0.24). Interest in skill-based activities was greater in females and in children who were highly motivated, younger, and had greater motor limitations (r(2)=0.51). The findings suggest that personal factors and functional abilities influence leisure activity preferences. High preference for certain activities was not always associated with involvement in these activities.

INTERPRETATION

Determination of preferences is inherent to child-centred practice and should, therefore, be part of the evaluation process. Rehabilitation strategies can minimize barriers to leisure participation, such as fear of failure, low motivation, or environmental obstacles.

Features and impacts of five multidisciplinary community-university research partnerships

Despite the increasing number of multidisciplinary community-university research partnerships designed to address real-world issues, little is known about their nature. This article describes the features and impacts of five research partnerships addressing health or social service issues, which constituted a convenience sample from the province of Ontario, Canada. The article describes their characteristics, ways of operating, outputs, types of requests received from community members and mid-term impacts. Requests directed to partnerships were tracked over a 10-month period in 2003 to 2004, using a research contact checklist, and 174 community members later completed an impact questionnaire capturing perceptions of the impacts of the partnerships on personal knowledge and research skill development, organisational/group access to and use of information, and community and organisational development. The data indicated that partnerships had similar priorities and magnitudes of mid-term impacts, yet differed in the scope of their partnering, realm of intended influence and the number of mechanisms used to engage and communicate with target audiences. The partnerships produced different types of outputs and received different types of requests from community members. The findings inform researchers about partnership diversity and help to establish more realistic expectations about the magnitude of partnerships' impacts.

An Evaluation of a Workshop about Obesity Designed for Occupational Therapists

Background

The evaluation of knowledge translation activities designed to increase knowledge for occupational therapy practitioners is required to advance evidence-based practice.

Purpose

This study examines the development, implementation, and evaluation of a workshop aimed at raising awareness about obesity and the role for occupational therapy interventions with an obese population.

Methods

Fifty-one occupational therapists participated in interactive workshops. Measures of beliefs and attitudes toward obese persons and readiness to work with obese clients were completed.

Findings

Analysis revealed a change in beliefs about obese persons but no changes in attitudes. Participants reported feeling better informed about obesity and more prepared to work with clients with obesity. The potential for occupational therapy interventions to enable occupation for persons with obesity was recognized.

Implications

This study provides evidence to support the use of interactive workshops for the purpose of translating knowledge using an approach that is relevant to occupational therapy practice

Identification of a small molecule inhibitor of serine 276 phosphorylation of the p65 subunit of NF-kappaB using in silico molecular docking

NF-kappaB is activated in many types of cancer. Phosphorylation of p65 at serine 276 is required for the expression of a subset of NF-kappaB regulated genes, including vascular cell adhesion molecule-1 (VCAM-1) and interleukin-8 (IL-8). Thus, inhibition of serine 276 phosphorylation may prevent metastasis and angiogenesis in certain tumor types. Using in silico molecular docking, small molecules that are predicted to bind to a structural pocket near serine 276 were identified. One compound, NSC-127102, hinders serine 276 phosphorylation and the expression of IL-8 and VCAM-1. Small molecules such as NSC-127102 may be optimized for the future treatment of cancer.

Predictors of Change Over Time in the Activity Participation of Children and Youth with Physical Disabilities

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children/youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on three occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in five types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity, and vary as a function of children's sex and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention.

Development of the Assistance to Participate Scale (APS) for children's play and leisure activities

AIM

This paper describes the development and psychometric evaluation of the Assistance to Participate Scale (APS). The APS measures the assistance that a school-aged child with a disability requires to participate in play and leisure activities from the primary carer's perspective.

METHOD

Mixed methodology using an instrument design model was used to complete two studies. First, a qualitative research design was used to generate items and scoring criteria for the APS. Second, a quantitative study evaluated the instrument using data collected from 152 mothers with children aged 5-18 years. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the APS.

RESULTS

Exploratory factor analysis revealed two correlated components, reflecting home-based and community-based play activities. Both subscales and the total APS scale showed good internal consistency. The APS correlated as predicted with individual domains and overall scores for other validated measures (Pediatric Evaluation of Disability Inventory caregiver scales and Pediatric Quality of Life Inventory) with correlations ranging from rho = 0.42 to rho = 0.77. The APS was able to discriminate between groups of children based on type of schooling (regular or segregated), need for equipment/assistive devices, frequency of lifting and disability.

CONCLUSIONS

The APS provides professionals with a brief psychometrically sound tool that measures the amount of caregiver assistance provided to a child with a disability to participate in play and recreation. The APS may be used as an outcome measure and to evaluate and predict the amount and type of additional assistance families need to facilitate their child's participation in an important aspect of the child's daily life and development: play and recreation.

A novel class of cyclin-dependent kinase inhibitors identified by molecular docking act through a unique mechanism

The cyclin-dependent kinase (Cdk) family is emerging as an important therapeutic target in the treatment of cancer. Cdks 1, 2, 4, and 6 are the key members that regulate the cell cycle, as opposed to Cdks that control processes such as transcription (Cdk7 and Cdk9). For this reason, Cdks 1, 2, 4, and 6 have been the subject of extensive cell cycle-related research, and consequently many inhibitors have been developed to target these proteins. However, the compounds that comprise the current list of Cdk inhibitors are largely ATP-competitive. Here we report the identification of a novel structural site on Cdk2, which is well conserved between the cell cycle Cdks. Small molecules identified by a high throughput in silico screen of this pocket exhibit cytostatic effects and act by reducing the apparent protein levels of cell cycle Cdks. Drug-induced cell cycle arrest is associated with decreased Rb phosphorylation and decreased expression of E2F-dependent genes. Multiple lines of evidence indicate that the primary mechanism of action of these compounds is the direct induction of Cdk1, Cdk2, and Cdk4 protein aggregation.

A measure of community members' perceptions of the impacts of research partnerships in health and social services

Currently, there are no psychometrically sound outcome measures by which to assess the impacts of research partnerships. This article describes the development of a 33-item, survey questionnaire measuring community members' perceptions of the impact of research partnerships addressing health or social issues. The Community Impacts of Research Oriented Partnerships (CIROP) was developed using information from the literatures on health promotion, community development, research utilization, and community-based participatory research, and from focus groups involving 29 key informants. Data from 174 community members were used to determine the factor structure, internal consistency, and test-retest reliability of the four CIROP scales, and to provide evidence of construct validity. The CIROP informs research partnerships about the extent of their impact in the areas of Personal Knowledge Development, Personal Research Skill Development, Organizational/Group Access To and Use of Information, and Community and Organizational Development, allowing them to demonstrate accountability to funding bodies. As well, the CIROP can be used as a research tool to assess the effectiveness of knowledge sharing approaches, determine the most influential activities of research partnerships, and determine structural characteristics of partnerships associated with various types of impact. The CIROP provides a better understanding of community members' perspectives and expectations of research partnerships, with important implications for knowledge transfer and uptake.

Children with Disabilities' Perceptions of Activity Participation and Environments: A Pilot Study

Background. Children with disabilities are particularly vulnerable to participation restrictions resulting from the interactions between children and their physical and social environments. Purpose. The purpose of this study was to gain a better understanding of how children with disabilities view their participation in out-of-school-time (OST) activities in a range of environmental settings. Methods. A case-study design was used to examine six children's views on their OST activities using the Children's Assessment of Participation and Enjoyment (CAPE), photographs of their OST activity settings, and semi-structured interviews. Findings. CAPE results indicated that the children participated most often in recreational activities. Through the use of photographs and interviews, four major themes emerged that emphasized a deep interconnection between childhood activities and settings. Implications. This unique pilot study contributes to developing an understanding for occupational therapists about how children with disabilities view their participation, their activity environments, and how photographs can be used to engage children in research.

The Clinical Utility of a Tool for Optimising Written Productivity

Occupational therapists working with children with handwriting issues lack a standard framework for selecting treatment activities. This study investigated the utility of a decision-making guide, the Tool for Optimising Written Productivity (TOW-P). In the study, 14 occupational therapists used the TOW-P to guide the selection of interventions for 60 children with handwriting issues. The therapists completed two questionnaires about the usefulness of the tool. Feedback was used to modify the structure and format of the tool. The results indicated that the TOW-P provides a clinically useful framework to assist therapists in the selection of appropriate intervention strategies for children with written productivity issues.

Radiation dose measurements for personnel performing 90Y-ibritumomab tiuxetan administration: a comparison between two injection methods for dose reduction

The purpose of this study was to directly measure, using thermoluminescent dosimeters, the radiation doses received by radiation team members performing (90)Y-ibritumomab tiuxetan administration. The occupational doses associated with two injection methods for patient administration - an automatic syringe driver and an injection box - were compared. The associated risks, namely cancer induction and hereditary effect, were also estimated from the results and compared with risk factors recommended by the International Commission on Radiological Protection publication 103. The results showed that the doses received by the index and thumb of the right hand and the index finger of the left hand of the radiation oncologist were significantly reduced by using the injection box method. The difference in the dose received by the medical physicist using the two methods was not statistically significant. It was observed that three pairs of latex gloves could further reduce the dose to the hands. The radiological risks of cancer induction and hereditary effect were negligible: of the order of 10(-6) and 10(-7) per (90)Y-ibritumomab tiuxetan administration, respectively, for both methods. However, the results of our study also showed that it would be possible in a busy centre for pregnant women to receive a dose of (90)Y-ibritumomab tiuxetan that exceeds the recommended annual dose limit for the surface of the abdomen.