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Mohammad SS, Paget SP, Dale RC. Current therapies and therapeutic decision making for childhood-onset movement disorders. Mov Disord 2019; 34:637-656. [PMID: 30919519 DOI: 10.1002/mds.27661] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Movement disorders differ in children to adults. First, neurodevelopmental movement disorders such as tics and stereotypies are more prevalent than parkinsonism, and second, there is a genomic revolution which is now explaining many early-onset dystonic syndromes. We outline an approach to children with movement disorders starting with defining the movement phenomenology, determining the level of functional impairment due to abnormal movements, and screening for comorbid psychiatric conditions and cognitive impairments which often contribute more to disability than the movements themselves. The rapid improvement in our understanding of the etiology of movement disorders has resulted in an increasing focus on precision medicine, targeting treatable conditions and defining modifiable disease processes. We profile some of the key disease-modifying therapies in metabolic, neurotransmitter, inflammatory, and autoimmune conditions and the increasing focus on gene or cellular therapies. When no disease-modifying therapies are possible, symptomatic therapies are often all that is available. These classically target dopaminergic, cholinergic, alpha-adrenergic, or GABAergic neurochemistry. Increasing interest in neuromodulation has highlighted that some clinical syndromes respond better to DBS, and further highlights the importance of "disease-specific" therapies with a future focus on individualized therapies according to the genomic findings or disease pathways that are disrupted. We summarize some pragmatic applications of symptomatic therapies, neuromodulation techniques, and some rehabilitative interventions and provide a contemporary overview of treatment in childhood-onset movement disorders. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shekeeb S Mohammad
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Kids Neuroscience Centre, The Kids Research Institute at the Children's Hospital at Westmead, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia.,Movement Disorders Unit, T.Y. Nelson Department of Neurology, the Children's Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Ryll UC, Eliasson AC, Bastiaenen CH, Green D. To Explore the Validity of Change Scores of the Children's Hand-use Experience Questionnaire (CHEQ) in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:168-180. [PMID: 29482408 DOI: 10.1080/01942638.2018.1438554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS To explore the validity of change scores of the Children's Hand-use Experience Questionnaire (CHEQ). METHODS Analysis of the CHEQ included 44 children (15 girls) between 6-16 years (median 9.0; IQR 8-11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected change were formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. RESULTS All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. CONCLUSIONS Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population.
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Affiliation(s)
- Ulrike C Ryll
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Ann-Christin Eliasson
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Carolien Hg Bastiaenen
- b Caphri Research Institute, Program Functioning and Rehabilitation, Department of Epidemiology , Maastricht University , Maastricht , The Netherlands.,c School of Health Professions, Department of Health , Zurich University of Applied Sciences , Winterthur , Switzerland
| | - Dido Green
- d Centre for Rehabilitation, Oxford Brookes University , Oxford , UK.,e Department of Occupational Therapy , Jönköping University , Jönköping , Sweden
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Dwyer R, Ward R, Richardson E, Davidson SA, Thetford A, Valentine J. Traumatic spinal cord injuries: A retrospective cohort study of children seen in Western Australia between 1996 and 2016. J Pediatr Rehabil Med 2019; 12:235-243. [PMID: 31476174 DOI: 10.3233/prm-180545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe the medical complexity of traumatic spinal cord injury (TSCI) in paediatric patients in Western Australia (WA). Secondly, to determine if Princess Margaret Hospital (PMH) for Children (the tertiary paediatric centre in WA where all TSCI patients are managed) is meeting the requirements of the Australasian Rehabilitation Outcomes Centre (AROC) paediatric rehabilitation minimum data set gathered on each patient. METHODS Retrospective cohort study of patients seen at PMH between 1996-2016. The AROC minimum dataset information data were gathered on each patient. Functional status and rehabilitation outcomes were assessed using Functional Independence Measure for Children (weeFIM), Canadian Occupational Performance Measure (COPM), and Goal Attainment Scaling (GAS). Patient complexity was captured by documenting the specialty teams involved, the number of readmissions, and the International Statistical Classification of Disease and Related Health Problems Z codes. RESULTS Data from 19 patients (13 males, age range 6 months-15 years; 6 females, age range 4 years-13 years) were available. There were 10 cervical TSCIs with a median length of stay of 213 days and 9 thoracic TSCIs with a median length of stay of 49 days. Patients had between zero and six comorbidities prior to their TSCI. CONCLUSIONS Children with medical complexity are responsive to rehabilitation but have a high burden of care, requiring multiple-specialty care and hospital re-admissions. AROC has set a minimum data set recommendation for the collection and examination of patient data. PMH meets the AROC guidelines for patient data collection and descriptive analyses.
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Affiliation(s)
- Rachel Dwyer
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Roslyn Ward
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Australia
| | - Emma Richardson
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Sue-Anne Davidson
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anna Thetford
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Australia
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Tuersley L, Bray N, Edwards RT. Development of the Wheelchair outcomes Assessment Tool for Children (WATCh): A patient-centred outcome measure for young wheelchair users. PLoS One 2018; 13:e0209380. [PMID: 30586390 PMCID: PMC6306207 DOI: 10.1371/journal.pone.0209380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop a patient-centred outcome measure (PCOM) for use with children and young people accessing National Health Service (NHS) wheelchair and posture services. Identifying and addressing outcomes of most importance to young wheelchair users (≤ 18 years) will help services maximise the benefits achievable within available resources. METHODS A mixed-methods approach was used, involving questionnaire surveys and qualitative interviews, and building on previous work identifying how young wheelchair users define health-related quality of life (HRQoL). Framework analysis was used to analyse the interview transcripts. Survey questionnaires seeking views on the importance of a range of outcomes were completed by 21 young wheelchair users or their parents. Subsequent face-to-face interviews with 11 parents or dyads of parents and young wheelchair users explored these responses and identified novel outcomes. Interviewees also scored and recorded satisfaction levels for their key outcomes. RESULTS All outcomes proposed in the survey were rated as 'extremely important' by at least one respondent, as were additional outcomes uncovered in the qualitative data. In consultation with the service providers and service users, the Wheelchair outcomes Assessment Tool for Children (WATCh) was developed to allow service users and providers to identify, score and monitor individual users' most important outcomes. The final WATCh tool comprises 16 outcome options, of which service users select five to be monitored. The tool will be used to measure key outcomes identified by service users before and after wheelchair provision.
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Affiliation(s)
- Lorna Tuersley
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
- * E-mail:
| | - Nathan Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
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Ben-Pazi H, Aran A, Pandyan A, Gelkop N, Ginsberg G, Pollak Y, Elnatan D. Auditory stimulation improves motor function and caretaker burden in children with cerebral palsy- A randomized double blind study. PLoS One 2018; 13:e0208792. [PMID: 30543665 PMCID: PMC6292588 DOI: 10.1371/journal.pone.0208792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the impact of auditory stimulation on motor function in children with cerebral palsy (CP) and disabling hypertonia. Method 9 matched pairs (age: 7y5m, SD 4y1m; 13 boys; gross-motor-functional-classification-scale: median 4; manual-ability-classification-system: median 4) were randomized to receive either auditory stimulation embedded in music (study, n = 9) or music alone (sham, control, n = 9) for at least 10 minutes 4 times a week for 4 weeks. Goal-Attainment-Scale, Care-and-Comfort-Hypertonicity-Questionnaire, Gross-Motor-Function–Measure and Quality-of-Upper-Extremity-Skills-Test (QUEST) were assessed before and 5 months following intervention. Result Children receiving auditory stimulation attained more goals than children who listened to music alone (p = 0.002). Parents reported improved care and comfort in children in the study group compared to a slight deterioration in controls (p = 0.002). Upper extremity skills improved in the study group compared to controls (p = 0.006). Similar gross motor function changes were documented in both groups (p = 0.41). One participant reported increased seizure frequency; no other participants with epilepsy reported increased seizure frequency (n = 6/18) and no other adverse events were reported. Interpretation Auditory stimulation alleviated hypertonia and improved fine and gross motor functions.
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Affiliation(s)
- Hilla Ben-Pazi
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University, Keele, United Kingdom
| | - Nava Gelkop
- Physical therapy, Keren-Or Center, Jerusalem, Israel
- Meshi Children's Rehabilitation Center, Jerusalem, Israel
| | | | - Yehuda Pollak
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debby Elnatan
- Meshi Children's Rehabilitation Center, Jerusalem, Israel
- * E-mail:
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Javadi D, Lamarche L, Avilla E, Siddiqui R, Gaber J, Bhamani M, Oliver D, Cleghorn L, Mangin D, Dolovich L. Feasibility study of goal setting discussions between older adults and volunteers facilitated by an eHealth application: development of the Health TAPESTRY approach. Pilot Feasibility Stud 2018; 4:184. [PMID: 30564435 PMCID: PMC6292127 DOI: 10.1186/s40814-018-0377-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In keeping with the changing needs of the Canadian population, primary care systems need to become more person-focused in providing quality care to older adults. As part of Health TAPESTRY, a complex intervention to strengthen primary care for older adults, a goal setting exercise was developed and tested in an initial feasibility study, intended to foster collaboration between patients and providers. METHODS Participants-clinic clients-were recruited from the McMaster Family Health Team in Hamilton, Ontario. Five participants took part in the goal setting feasibility study phase I, which tested the functionality of a technology-enabled goal setting exercise between older adults and volunteers. Based on observations and feedback from volunteers, interprofessional team members, and older adults, the exercise was refined to include a guided survey and goals report. The goal setting survey is a list of probing questions designed based on SMART (specific, measurable, attainable, relevant, timely) goal setting strategies and goal attainment scaling (GAS). This was used in phase II, carried out with 16 participants, where the feasibility of goal setting and goal attainment with support from volunteers and interprofessional teams was tested. Volunteers carried out the goal setting survey via a tablet computer, a report of client goals was generated and sent to interprofessional teams, and client goals were discussed during clinic huddles. At 6 months of follow-up, clients self-evaluated their progress using GAS. RESULTS AND DISCUSSION The goal setting exercise in phase I took an average of 24:45 (SD 11:42) minutes and yielded a diverse set of life and health goals. Goals identified by older adults were primarily focused on the maintenance of a certain level of activity or health state. Phase I work resulted in important changes to the goal setting process (e.g., asking about goal setting later in conversation, changing wording of questions) and development of a summary report of goals sent to the interprofessional team. In phase II, 44 goals were set by 16 participants during an average 7:23 (SD 4:26) minute discussion. Of these goals, 43.9% were characterized as health goals while 63.4% were characterized as life goals. Under the umbrella of Life goals, productivity featured most prominently at 22.9% of all goals. Goal attainment was not measured in phase I. In phase II, clients had an average weighted goal attainment score of 51.5. Considering client preferences for one goal over another, 68.8% of clients, on average, at least partially achieved the goals they had set. CONCLUSION Goal setting as part of the Health TAPESTRY approach was feasible and provided interprofessional teams with client narratives that helped improve care management for older adults. The overall intervention-including the refined goal setting component-is being scaled and evaluated in a pragmatic randomized controlled trial.
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Affiliation(s)
- Dena Javadi
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Larkin Lamarche
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Ernie Avilla
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Raied Siddiqui
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Jessica Gaber
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Mehreen Bhamani
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Doug Oliver
- McMaster University, DFM DBHSC, 3rd Floor, 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Laura Cleghorn
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Dee Mangin
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
| | - Lisa Dolovich
- McMaster University, DFM DBHSC, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6 Canada
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Jackman M, Novak I, Lannin N, Froude E, Miller L, Galea C. Effectiveness of Cognitive Orientation to daily Occupational Performance over and above functional hand splints for children with cerebral palsy or brain injury: a randomized controlled trial. BMC Pediatr 2018; 18:248. [PMID: 30064403 PMCID: PMC6069709 DOI: 10.1186/s12887-018-1213-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/06/2018] [Indexed: 12/02/2022] Open
Abstract
Background Functional hand splinting is a common therapeutic intervention for children with neurological conditions. The aim of this study was to investigate the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach over and above conventional functional hand splinting, and in combination with splinting, for children with cerebral palsy or brain injury. Methods A multisite, assessor-blinded, parallel, randomized controlled trial was conducted in Australia. Participants (n = 45) were randomly allocated to one of three groups; (1) splint only (n = 15); (2) CO-OP only (n = 15); (3) CO-OP + splint (n = 15). Inclusion: age 4–15 years; diagnosis of cerebral palsy or brain injury; Manual Ability Classification System I–IV; hand function goals; sufficient language, cognitive and behavioral ability. Primary outcome measures were the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS). Treatment duration for all groups was 2 weeks. CO-OP was provided in a group format, 1 h per day for 10 consecutive weekdays, with parents actively involved in the group. Hand splints were wrist cock-up splints that were worn during task practice. Three individual goals were set and all participants were encouraged to complete a daily home program of practicing goals for 1 h. Analyses were conducted on an intention to treat basis. Results The COPM showed that all three groups improved from baseline to immediately post-treatment. GAS showed a statistically significant difference immediately post-intervention between the splint only and CO-OP only groups p = 0.034), and the splint only and CO-OP + splint group (p = 0.047) favoring CO-OP after controlling for baseline. Conclusions The CO-OP Approach™ appeared to enhance goal achievement over and above a functional hand splint alone. There was no added benefit of using hand splints in conjunction with CO-OP, compared to CO-OP alone. Hand splints were not well tolerated in this population. Practice of functional goals, through CO-OP or practice at home, leads to goal achievement for children with cerebral palsy or brain injury. Trial registration Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000690752) on 24/06/2013. Electronic supplementary material The online version of this article (10.1186/s12887-018-1213-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Jackman
- School of Child and Adolescent Medicine, The University of Sydney, Sydney, Australia. .,Occupational Therapy Department, John Hunter Children's Hospital, Newcastle, Australia.
| | - Iona Novak
- School of Child and Adolescent Medicine, The University of Sydney, Sydney, Australia.,Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
| | - Natasha Lannin
- Alfred Health, La Trobe University, Melbourne, Australia
| | - Elspeth Froude
- School of Health Science, Australian Catholic University, Sydney, Australia
| | - Laura Miller
- School of Health Science, Australian Catholic University, Brisbane, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, Australia
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Harpster K, Sheehan A, Foster EA, Leffler E, Schwab SM, Angeli JM. The methodological application of goal attainment scaling in pediatric rehabilitation research: a systematic review. Disabil Rehabil 2018; 41:2855-2864. [PMID: 29954232 DOI: 10.1080/09638288.2018.1474952] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: The objectives of this review article were to (1) describe the populations and interventions to which Goal Attainment Scaling (GAS) has been applied in pediatric rehabilitation, (2) summarize the scientific rigor of published studies utilizing GAS as an outcome measure in pediatric rehabilitation, and (3) illustrate the responsiveness of GAS following intervention.Materials and methods: Four electronic databases were searched for English language, human subject studies. Two reviewers independently extracted data, graded evidence, and rated study quality.Results: Fifty-two studies utilizing GAS as an outcome measure within pediatric rehabilitation were included. A majority of studies were characterized as low-level evidence in the Sackett hierarchy (Sackett levels IV-V; 33 of 52). Quality appraisal scores for all reviewed studies ranged from 1-13 points (17 possible points) and averaged 4.71 points. GAS appeared to detect meaningful change in more than 60% of studies.Conclusions: GAS is a clinically useful tool for measuring progress toward goals, but has not been utilized with a high level of methodological rigor in research. Emphasis on reduced variation in administration and interpretation will strengthen the utility of GAS for efficacy and program evaluation in future research.Implications for rehabilitationGoal Attainment Scaling (GAS) can be used across a diversity of interventions and diagnoses as an outcome measure in pediatric rehabilitation.Careful consideration should be used in the study design to standardize administration and scoring of GAS to strengthen the study.Goal Attainment Scaling is responsive to change, and the tool appears to detect meaningful change the majority of the time in pediatric rehabilitation.
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Affiliation(s)
- Karen Harpster
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Amber Sheehan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ellen A Foster
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Eryn Leffler
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah M Schwab
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer M Angeli
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
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Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review. Clin Rehabil 2018; 32:954-966. [DOI: 10.1177/0269215518758484] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. Methods: The scoping review process described by Arksey and O’Malley was used to guide article selection and data extraction. Results: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). Conclusion: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.
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McPherson AC, McAdam L, Keenan S, Schwellnus H, Biddiss E, DeFinney A, English K. A feasibility study using solution-focused coaching for health promotion in children and young people with Duchenne muscular dystrophy. Dev Neurorehabil 2018; 21:121-130. [PMID: 28272972 DOI: 10.1080/17518423.2017.1289271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the feasibility and acceptability of a coaching intervention (Solution-Focused Coaching in pediatric rehabilitation [SFC-Peds]) related to physical activity and diet in males with Duchenne muscular dystrophy. METHODS A pre-post design was employed. Participants had five coaching sessions over 8 weeks. The first session was face-to-face, followed by four virtual sessions. Feasibility criteria included recruitment rates, attrition, and intervention fidelity. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were employed to look at outcome trends. The acceptability was assessed using a survey. RESULTS Five males (11-19 years) participated. All feasibility criteria were met. Clinically significant increases were observed for GAS and COPM scores. Participants reported SFC-Peds to be acceptable. Broad barriers and facilitators to coaching success were identified. CONCLUSIONS A SFC-Peds intervention for health promotion is feasible and acceptable in children with DMD and their families. A rigorous efficacy study assessing SFC-Peds intervention is warranted.
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Affiliation(s)
- Amy C McPherson
- a Bloorview Research Institute , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | - Laura McAdam
- a Bloorview Research Institute , Toronto , Ontario , Canada.,c Department of Paediatrics , University of Toronto , Toronto, Ontario , Canada
| | - Sarah Keenan
- a Bloorview Research Institute , Toronto , Ontario , Canada.,d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Heidi Schwellnus
- a Bloorview Research Institute , Toronto , Ontario , Canada.,d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Elaine Biddiss
- a Bloorview Research Institute , Toronto , Ontario , Canada.,e The Institute of Biomaterials & Biomedical Engineering and Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | - Andrea DeFinney
- d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Kirsten English
- d Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
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Gibson N, Chappell A, Blackmore AM, Morris S, Williams G, Bear N, Allison G. The effect of a running intervention on running ability and participation in children with cerebral palsy: a randomized controlled trial. Disabil Rehabil 2017; 40:3041-3049. [DOI: 10.1080/09638288.2017.1367426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Noula Gibson
- Princess Margaret Hospital for Children, Perth, Western Australia
- Ability Centre, Perth, Western Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Annie Chappell
- Ability Centre, Perth, Western Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | | | - Susan Morris
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Gavin Williams
- School of Health Sciences, University of Melbourne, Victoria, Australia
| | - Natasha Bear
- Princess Margaret Hospital for Children, Perth, Western Australia
- Natasha Bear Statistics, Perth, Western Australia
| | - Garry Allison
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
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Löwing K, Thews K, Haglund-Åkerlind Y, Gutierrez-Farewik EM. Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II. Phys Occup Ther Pediatr 2017; 37:268-282. [PMID: 27058177 DOI: 10.3109/01942638.2016.1150384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). METHOD A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. RESULTS A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. CONCLUSION The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.
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Affiliation(s)
- Kristina Löwing
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Karin Thews
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | | | - Elena M Gutierrez-Farewik
- a Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden.,b KTH Mechanics, Royal Institute of Technology , Stockholm , Sweden.,c KTH BioMEx Center, Royal Institute of Technology , Stockholm , Sweden
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Cucchiaro G, Craig K, Marks K, Cooley K, Cox TKB, Schwartz J. Short- and long-term results of an inpatient programme to manage Complex Regional Pain Syndrome in children and adolescents. Br J Pain 2017; 11:87-96. [PMID: 28491301 DOI: 10.1177/2049463717695695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this retrospective study was to determine whether an inpatient approach and the use of regional anaesthesia techniques can accelerate the recovery to normal functions in children with Complex Regional Pain Syndrome (CRPS). This study looked at the data of patients admitted to the rehabilitation unit with a diagnosis of CRPS from January 2010 to April 2015. Variables such as hospital stay, medications administered, regional anaesthesia procedures, changes in functional status prior to treatment and at the time of discharge, psychological evaluation and diagnosis were evaluated. A total of 31 patients (21 females and 10 males) were admitted with a diagnosis of CRPS 1 and 2. In all, 97% of the patients received a peripheral or central nerve catheter for an average of 4 days with pain scores of Verbal Numeric Scale (VNS) score = 1.0 ± 0.7 and an average length of hospital stay of 8.2 ± 2.6 days. The modified Functional Independence Measure for Children (WeeFIM) scores and Canadian Association of Occupational Therapists tests significantly improved at the time of hospital discharge, as well as their pain scores, which decreased from 8.2 ± 2 to 1.6 ± 3. In conclusion, these data suggest that the use of regional anaesthesia techniques and an intensive inpatient rehabilitation programme could accelerate the recovery of children with CRPS.
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Affiliation(s)
- Giovanni Cucchiaro
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kevin Craig
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kerri Marks
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kristin Cooley
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Jennifer Schwartz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Gaasterland CMW, Jansen-van der Weide MC, Weinreich SS, van der Lee JH. A systematic review to investigate the measurement properties of goal attainment scaling, towards use in drug trials. BMC Med Res Methodol 2016; 16:99. [PMID: 27534620 PMCID: PMC4989379 DOI: 10.1186/s12874-016-0205-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background One of the main challenges for drug evaluation in rare diseases is the often heterogeneous course of these diseases. Traditional outcome measures may not be applicable for all patients, when they are in different stages of their disease. For instance, in Duchenne Muscular Dystrophy, the Six Minute Walk Test is often used to evaluate potential new treatments, whereas this outcome is irrelevant for patients who are already in a wheelchair. A measurement instrument such as Goal Attainment Scaling (GAS) can evaluate the effect of an intervention on an individual basis, and may be able to include patients even when they are in different stages of their disease. It allows patients to set individual goals, together with their treating professional. However, the validity of GAS as a measurement instrument in drug studies has never been systematically reviewed. Therefore, we have performed a systematic review to answer two questions: 1. Has GAS been used as a measurement instrument in drug studies? 2: What is known of the validity, responsiveness and inter- and intra-rater reliability of GAS, particularly in drug trials? Methods We set up a sensitive search that yielded 3818 abstracts. After careful screening, data-extraction was executed for 58 selected articles. Results Of the 58 selected articles, 38 articles described drug studies where GAS was used as an outcome measure, and 20 articles described measurement properties of GAS in other settings. The results show that validity, responsiveness and reliability of GAS in drug studies have hardly been investigated. The quality of the reporting of validity in studies in which GAS was used to evaluate a non-drug intervention also leaves much room for improvement. Conclusions We conclude that there is insufficient information to assess the validity of GAS, due to the poor quality of the validity studies. Therefore, we think that GAS needs further validation in drug studies, especially since GAS can be a potential solution when a small heterogeneous patient group is all there is to test a promising new drug. Trial registration The protocol has been registered in the PROSPERO international prospective register for systematic reviews, with registration number CRD42014010619. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014010619. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0205-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte M W Gaasterland
- Pediatric clinical Research Office, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, Netherlands.
| | - Marijke C Jansen-van der Weide
- Pediatric clinical Research Office, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, Netherlands
| | - Stephanie S Weinreich
- Pediatric clinical Research Office, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, Netherlands.,Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, BS7, PO Box 7057, 1007, MB, Amsterdam, Netherlands
| | - Johanna H van der Lee
- Pediatric clinical Research Office, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, Netherlands
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Johnston BC, Miller PA, Agarwal A, Mulla S, Khokhar R, De Oliveira K, Hitchcock CL, Sadeghirad B, Mohiuddin M, Sekercioglu N, Seweryn M, Koperny M, Bala MM, Adams-Webber T, Granados A, Hamed A, Crawford MW, van der Ploeg AT, Guyatt GH. Limited responsiveness related to the minimal important difference of patient-reported outcomes in rare diseases. J Clin Epidemiol 2016; 79:10-21. [PMID: 27381737 DOI: 10.1016/j.jclinepi.2016.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To explore the responsiveness of patient-reported outcomes (PROs) in interventional studies involving patients with rare lysosomal storage diseases (LSDs). STUDY DESIGN AND SETTING We searched eight databases for experimental and nonexperimental studies. Pairs of trained reviewers independently screened articles and subsequently extracted data from the eligible studies. Among studies with 10 or more patients using a valid PRO, we assessed the responsiveness of PROs based on a reanalysis of the data using minimal important difference estimates. Our analyses focused on statistically significant within-group differences in PROs for observational studies or the statistically significant between-group differences in PRO scores for controlled studies. RESULTS Of 2,679 unique records, 62 interventional studies addressing patients with Fabry (55%), Gaucher (19%), Pompe (16%), and mucopolysaccharidoses (11%) proved eligible. The most frequently used PROs were the Short-Form-36 (25 studies), Brief Pain Inventory (20 studies), EuroQoL-5D (9 studies), and the Fatigue Severity Scale (6 studies). Observational studies suggest that PROs sometimes detect significant within-group changes when present. Randomized trials raise questions regarding the responsiveness of PROs to small differences between groups. CONCLUSIONS Most studies have relied on generic PROs to evaluate quality of life and symptoms in patients with rare LSDs. PROs appear more responsive in observational studies than randomized trials.
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Affiliation(s)
- Bradley C Johnston
- Systematic Overviews through advancing Research Technology, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, 686 Bay St, Toronto, Ontario, Canada M5G 0A4; Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, Canada M5G 1X8; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, Canada M5T 3M6.
| | - Patricia A Miller
- School of Rehabilitation Science, McMaster University, 1400 Main St. W., Hamilton, Ontario, Canada L8S 1C7
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, Canada M5S 1A8
| | - Sohail Mulla
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1
| | - Rabia Khokhar
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1
| | - Kyle De Oliveira
- School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Christine L Hitchcock
- Systematic Overviews through advancing Research Technology, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, 686 Bay St, Toronto, Ontario, Canada M5G 0A4
| | - Behnam Sadeghirad
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1; HIV/STI Surveillance Research Center and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, 1 Haft Bagh St, Kerman 76169, Iran
| | - Mukarram Mohiuddin
- Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons, 9400 West Higgins Road, Rosemont, IL 60018, USA
| | - Nigar Sekercioglu
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1
| | - Michal Seweryn
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Gregórzecka 20, 31-351, Krakow, Poland
| | - Magdalena Koperny
- Public Health and Health Promotion Department, Province Sanitary-Epidemiological Station of Lesser Poland, Pradnicka 76, 31-202, Krakow, Poland
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7, 31-034, Krakow, Poland
| | - Thomasin Adams-Webber
- Hospital Library, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8
| | - Alicia Granados
- Sanofi Genzyme, 500 Kendall Street, Cambridge, MA 02142, USA
| | - Alaa Hamed
- Sanofi Genzyme, 500 Kendall Street, Cambridge, MA 02142, USA
| | - Mark W Crawford
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, Canada M5G 1X8
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1
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Thomas RE, Johnston LM, Sakzewski L, Kentish MJ, Boyd RN. Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 53-54:267-278. [PMID: 26955912 DOI: 10.1016/j.ridd.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.
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Affiliation(s)
- Rachel E Thomas
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Leanne M Johnston
- Division of Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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Hui C, Snider L, Couture M. Self-regulation workshop and Occupational Performance Coaching with teachers: A pilot study. The Canadian Journal of Occupational Therapy 2016; 83:115-25. [PMID: 27026722 DOI: 10.1177/0008417415627665] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Teachers' occupational role and performance can be undermined when working with students with disruptive classroom behaviours. PURPOSE This pilot study aimed to explore the impact of school-based occupational therapy intervention on teachers' classroom management self-efficacy and perceived performance/satisfaction in their management of students with disruptive behaviours. METHOD This pilot study used a multiple-case replication study design. A cohort of regular classroom elementary school teachers (n = 11) participated in a 1-day workshop on sensorimotor strategies for supporting student self-regulation followed by eight individual sessions of Occupational Performance Coaching (OPC). Measurement tools were the Canadian Occupational Performance Measure, Goal Attainment Scaling (GAS), and Teachers' Self-Efficacy Scale-Classroom Management. FINDINGS Improvement in teachers' perception of performance, satisfaction, and classroom management was seen. GAS showed clinically significant improvement. Improvements were sustained at 7 weeks follow-up. IMPLICATIONS Preliminary results support the use of sensorimotor education combined with OPC to enable teachers' occupational performance.
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Martins E, Cordovil R, Oliveira R, Letras S, Lourenço S, Pereira I, Ferro A, Lopes I, Silva CR, Marques M. Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2016; 58:348-60. [PMID: 26613800 DOI: 10.1111/dmcn.12988] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 01/01/2023]
Abstract
AIM This systematic review and meta-analysis presents an overview of the efficacy of suit therapy on functioning in children and adolescents with cerebral palsy (CP). METHOD A systematic review with meta-analysis was conducted. A comprehensive search of peer-reviewed articles was performed on electronic databases, from their inception to May 2014. Studies included were rated for methodological quality using the Physiotherapy Evidence Database scale. Effects of suit therapy on functioning were assessed using meta-analytic techniques. RESULTS From the 46 identified studies, four met the inclusion criteria and were included in the meta-analysis. Small, pooled effect sizes were found for gross motor function at post-treatment (g=0.46, 95% confidence interval [CI] 0.10-0.82) and follow-up (g=0.47, 95% CI 0.03-0.90). INTERPRETATION The small number of studies, the variability between them, and the low sample sizes are limitations of this review. Findings suggest that to weigh and balance benefits against harms, clinicians, patients, and families need better evidence to examine and prove the effects of short intensive treatment such as suit therapy on gross motor function in children and adolescents with CP. Therefore, more research based on high-quality studies focusing on functioning in all dimensions of the International Classification of Functioning, Disability and Health perspective is necessary to clarify the impact of suit therapy.
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Affiliation(s)
- Elisabete Martins
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Rita Cordovil
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Raul Oliveira
- Laboratory of Motor Behavior, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Sara Letras
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | | | - Inês Pereira
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Ana Ferro
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | - Inês Lopes
- Escola Superior de Saúde do Alcoitão, Lisbon, Portugal
| | | | - Marta Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Field DA, Miller WC, Ryan SE, Jarus T, Abundo A. Measuring Participation for Children and Youth With Power Mobility Needs: A Systematic Review of Potential Health Measurement Tools. Arch Phys Med Rehabil 2016; 97:462-477.e40. [DOI: 10.1016/j.apmr.2015.08.428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/07/2015] [Accepted: 08/21/2015] [Indexed: 01/10/2023]
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James S, Ziviani J, Ware RS, Boyd RN. Test-retest Reproducibility of the Assessment of Motor and Process Skills in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2016; 36:144-54. [PMID: 26606274 DOI: 10.3109/01942638.2015.1076555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To examine test-retest reproducibility of the Assessment of Motor and Process Skills (AMPS) in children aged 8-16 years with unilateral cerebral palsy (UCP). METHODS Thirty children with mild to moderate UCP (mean age = 11y 7m, SD 2y 4m; males = 18; Manual Ability Classification System level I = 10, II = 20; Gross Motor Function Classification System level I = 9, II = 21) enrolled in a large randomized controlled trial were recruited via consecutive series sampling. Children carried out two AMPS tasks over two consecutive days according to standardized AMPS administration procedures. The standard error of measurement (SEM), smallest detectable change (SDC), 95% limits of agreement using the Bland-Altman method, and intraclass correlation coefficients (ICC; 2,1) were calculated. RESULTS The SDC was 0.23 logits for the AMPS motor scale and 0.30 logits for the AMPS process scale. Test-retest reliability was excellent for both the AMPS motor scale (ICC = 0.93) and the AMPS process scale (ICC = 0.86). Intra-rater reliability (n = 10) was excellent for AMPS motor scale (ICC = 0.96) and AMPS process scale (ICC = 0.98). CONCLUSIONS The AMPS can be used by therapists with 8- to 16-year-old children with UCP as an outcome measure with changes in scores reflecting real changes in performance or capacity.
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Affiliation(s)
- Sarah James
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Royal Children's Hospital , Brisbane , QLD , Australia
| | - Jenny Ziviani
- b Children's Allied Health Research, Queensland Health , Brisbane , QLD , Australia.,c School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , QLD , Australia
| | - Robert S Ware
- d School of Population Health, The Univers of Queensland , Brisbane , QLD , Australia.,e Queensland Children's Medical Research Institute, The University of Queensland , Brisbane , QLD , Australia
| | - Roslyn N Boyd
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Royal Children's Hospital , Brisbane , QLD , Australia
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Adair B, Ullenhag A, Keen D, Granlund M, Imms C. The effect of interventions aimed at improving participation outcomes for children with disabilities: a systematic review. Dev Med Child Neurol 2015; 57:1093-104. [PMID: 26010935 DOI: 10.1111/dmcn.12809] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
AIM Enhancement of participation has been described as the ultimate outcome for health and educational interventions. The goal of this systematic review was to identify and critically appraise studies that aimed to improve the participation outcomes of children with disabilities. METHOD Nine databases that index literature from the fields of health, psychology, and education were searched to retrieve information on research conducted with children with disabilities aged between 5 years and 18 years. Articles were included if the author(s) reported that participation was an intended outcome of the intervention. The articles included were limited to those reporting high-level primary research, as defined by Australia's National Health and Medical Research Council evidence hierarchy guidelines. No restrictions were placed on the type of intervention being investigated. RESULTS Seven randomized controlled or pseudo-randomized studies were included. Only three of these studies identified participation as a primary outcome. Both individualized and group-based approaches to enhancing participation outcomes appeared to be effective. Studies of interventions with a primary focus on body function or activity level outcomes did not demonstrate an effect on participation outcomes. INTEPRETATION Few intervention studies have focused on participation as a primary outcome measure. Approaches using individually tailored education and mentoring programmes were found to enhance participation outcomes, while exercise programmes, where participation was a secondary outcome, generally demonstrated little effect.
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Affiliation(s)
- Brooke Adair
- School of Allied Health, Australian Catholic University, Fitzroy, Vic., Australia
| | - Anna Ullenhag
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Deb Keen
- Autism Centre of Excellence, Griffith University, Mt Gravatt, Qld, Australia
| | - Mats Granlund
- CHILD, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Christine Imms
- School of Allied Health, Australian Catholic University, Fitzroy, Vic., Australia
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Imms C, Mathews S, Nicola Richmond K, Law M, Ullenhag A. Optimising leisure participation: a pilot intervention study for adolescents with physical impairments. Disabil Rehabil 2015. [DOI: 10.3109/09638288.2015.1068876] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pool D, Valentine J, Blackmore AM, Colegate J, Bear N, Stannage K, Elliott C. Daily functional electrical stimulation during everyday walking activities improves performance and satisfaction in children with unilateral spastic cerebral palsy: a randomized controlled trial. Arch Physiother 2015; 5:5. [PMID: 29340174 PMCID: PMC5721722 DOI: 10.1186/s40945-015-0005-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this paper is to determine whether daily functional electrical stimulation (FES) is effective in improving self-perceptions of individually identified mobility performance problems in children with unilateral spastic cerebral palsy (USCP). We hypothesized that children receiving 8 weeks of FES treatment would have higher scores for self-perceived performance and satisfaction on the Canadian Occupational Performance Measure (COPM) for individually identified priorities than children not receiving FES. METHODS Thirty-two children (mean age 10 y 8 mo SD 3y 3mo) with USCP and a Gross Motor Function Classification System I or II were randomly assigned to the FES treatment group (8 weeks of daily FES) and control group (usual treatments). Participants were assessed at baseline (week 0), post treatment (week 8) and 6 weeks follow-up (week 14). The primary outcome measures were self-perceived scores for performance and satisfaction of child- and parent-identified priorities assessed using the COPM post treatment and at follow-up. The secondary outcome measures were the categorization of the performance problems from the COPM and self-report responses according to the International Classification of Functioning Child and Youth version (ICF-CY). This was clinically important because an understanding of mobility performance problems for children with USCP is needed for family-centred service planning. RESULTS Performance scores (mean difference 1.6, 95 % CI 0.1 to 3.2, p = 0.034) and satisfaction scores post treatment (mean difference 2.4, 95 % CI 0.5 to 4.2, p = 0.004) were significantly higher in the treatment group than in the control group. There were no significant differences between the groups for performance scores at follow up, however there was a significant difference between the groups for satisfaction (mean difference 1.9, 95 % CI 0.1 to 3.8, p = 0.03) in favour of the treatment group. Priorities were identified across all levels of the ICF-CY but were most commonly identified in the activity and participation domains of the ICF-CY (79.5 %). CONCLUSIONS Daily FES applied during everyday walking is effective in addressing self-perceptions of individually identified priorities by improving the performance and satisfaction of functional skills after treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Register ACTRN12614000949684. Registered 4 September 2014.
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Affiliation(s)
- Dayna Pool
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008 Perth, Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Australia
| | | | - Jennifer Colegate
- Department of Occupational Therapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Australia
| | - Natasha Bear
- Department of Physiotherapy and Paediatric Rehabilitation, Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008 Perth, Australia
| | - Katherine Stannage
- Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, Australia
| | - Catherine Elliott
- Faculty of Health Science, Curtin University of Technology, Perth, Australia
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Simpson D. Coaching as a Family-centred, Occupational Therapy Intervention for Autism: A Literature Review. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2015. [DOI: 10.1080/19411243.2015.1040941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Beveridge B, Feltracco D, Struyf J, Strauss E, Dang S, Phelan S, Wright FV, Gibson BE. "You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy. Phys Occup Ther Pediatr 2015; 35:327-41. [PMID: 25529412 DOI: 10.3109/01942638.2014.990547] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the "newest thing" in treatment. The aim of this qualitative study was to explore parents' values about walking in relation to their experiences with robotic gait training for their children. METHODS Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. RESULTS Parents valued walking, especially "correct" walking, as a key component of their children's present and future well-being. They continually sought the "next best thing" in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. CONCLUSIONS The results can help inform rehabilitation therapists' knowledge of parents' values and perspectives, and guide effective collaborations toward meeting the therapeutic needs of children with CP.
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Affiliation(s)
- Briony Beveridge
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Deanna Feltracco
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Jillian Struyf
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Emily Strauss
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Saniya Dang
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Shanon Phelan
- b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,c 3 Department of Occupational Therapy, University of Alberta , Edmonton, Canada
| | - F Virginia Wright
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada.,b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Barbara E Gibson
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada.,b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
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Palisano RJ, Chiarello LA, McCoy SW, Bartlett D, An M. Use of the Child Engagement in Daily Life and Ease of Caregiving for Children to Evaluate Change in Young Children with Cerebral Palsy. Phys Occup Ther Pediatr 2014; 35:280-295. [PMID: 25166344 DOI: 10.3109/01942638.2014.907221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Aims: Participation in family and recreational activities, self-care, and parent ease of caregiving are important outcomes for young children with cerebral palsy (CP). The aim of this study was to examine use of the Child Engagement in Daily Life and the Ease of Caregiving for Children to measure change over time. Methods: A convenience sample of 387 parents of young children with CP (18 months to 5 years of age) completed the measures twice, a mean of 12.7 months apart. Results: For the Child Engagement in Daily Life, parents of children in Gross Motor Function Classification System level I and levels II-III reported more change for the Self-care domain (medium effect) than the Family and Recreational Activities domain (small effect) and the Ease of Caregiving for Children (small effect). The change reported by parents of children in levels IV-V on all three measures was less than the criterion for a small effect. Minimal detectable change for each measure varied from 12.1 to 14.1, out of a total possible score of 100. Conclusion: Further research is recommended to determine responsiveness to change following intervention.
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Affiliation(s)
- Robert J Palisano
- 1Department of Physical Therapy & Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania, USA
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Wright FV, Majnemer A. The concept of a toolbox of outcome measures for children with cerebral palsy: why, what, and how to use? J Child Neurol 2014; 29:1055-65. [PMID: 24820336 DOI: 10.1177/0883073814533423] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/15/2022]
Abstract
Accurate and well-targeted measurement of a child's abilities and participation in daily activities pre- and post-intervention is essential to understanding the effects of therapies provided by pediatric practitioners. There is growing interest in identification of outcome core sets for specified client groups. This article elaborates on the concepts to consider when selecting and interpreting measures from an outcomes toolbox for children with cerebral palsy. Principles discussed include use of self-report measures to open a dialogue with the child/parent; a holistic assessment approach to identify a child's challenges, strengths, and contextual factors that can influence functioning; links between measurement and heightened engagement of the child/family in the rehabilitation process and goals; and the need to plan the evaluation and dialogue aspects of the assessment process. If clinicians across the international rehabilitation community draw from the same toolbox, the end result could be a cohesive approach and common language to outcome measurement.
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Affiliation(s)
- F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada Montreal Children's Hospital-McGill University Health Centre, Montréal, Quebec, Canada
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Mumford L, Lam R, Wright V, Chau T. An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration. Dev Neurorehabil 2014; 17:232-42. [PMID: 23869969 DOI: 10.3109/17518423.2013.776125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. METHODS We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. RESULTS At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. CONCLUSION This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.
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Jackman M, Novak I, Lannin N. Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols. BMC Neurol 2014; 14:144. [PMID: 25023385 PMCID: PMC4107752 DOI: 10.1186/1471-2377-14-144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) and brain injury (BI) are common conditions that have devastating effects on a child's ability to use their hands. Hand splinting and task-specific training are two interventions that are often used to address deficits in upper limb skills, both in isolation or concurrently. The aim of this paper is to describe the method to be used to conduct two randomised controlled trials (RCT) investigating (a) the immediate effect of functional hand splints, and (b) the effect of functional hand splints used concurrently with task-specific training compared to functional hand splints alone, and to task-specific training alone in children with CP and BI. The Cognitive Orientation to Occupational Performance (CO-OP) approach will be the task-specific training approach used. METHODS/DESIGN Two concurrent trials; a two group, parallel design, RCT with a sample size of 30 participants (15 per group); and a three group, parallel design, assessor blinded, RCT with a sample size of 45 participants (15 per group). INCLUSION CRITERIA age 4-15 years; diagnosis of CP or BI; Manual Abilities Classification System (MACS) level I - IV; hand function goals; impaired hand function; the cognitive, language and behavioural ability to participate in CO-OP. Participants will be randomly allocated to one of 3 groups; (1) functional hand splint only (n=15); (2) functional hand splint combined with task-specific training (n=15); (3) task-specific training only (n=15). Allocation concealment will be achieved using sequentially numbered, sealed opaque envelopes opened by an off-site officer after baseline measures. Treatment will be provided for a period of 2 weeks, with outcome measures taken at baseline, 1 hour after randomisation, 2 weeks and 10 weeks. The functional hand splint will be a wrist cock-up splint (+/- thumb support or supination strap). Task-specific training will involve 10 sessions of CO-OP provided in a group of 2-4 children. Primary outcome measures will be the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS). Analysis will be conducted on an intention-to-treat basis. DISCUSSION This paper outlines the protocol for two randomised controlled trials investigating functional hand splints and CO-OP for children with CP and BI.
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Affiliation(s)
- Michelle Jackman
- University of Notre Dame, School of Medicine, Sydney, Australia
- Department of Occupational Therapy, John Hunter Children’s Hospital, Locked Bag 1, HRMC, Newcastle, NSW 3210, Australia
| | - Iona Novak
- University of Notre Dame, School of Medicine, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - Natasha Lannin
- Department of Occupational Therapy, La Trobe University, Faculty of Health Sciences, Melbourne, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
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Schroeder AS, Homburg M, Warken B, Auffermann H, Koerte I, Berweck S, Jahn K, Heinen F, Borggraefe I. Prospective controlled cohort study to evaluate changes of function, activity and participation in patients with bilateral spastic cerebral palsy after Robot-enhanced repetitive treadmill therapy. Eur J Paediatr Neurol 2014; 18:502-10. [PMID: 24821475 DOI: 10.1016/j.ejpn.2014.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Robot-enhanced therapies are increasingly being used to improve gross motor performance in patients with cerebral palsy. AIM To evaluate gross motor function, activity and participation in patients with bilateral spastic cerebral palsy (BS-CP) after Robot-enhanced repetitive treadmill therapy (ROBERT) in a prospective, controlled cohort study. METHODS Participants trained for 30-60 min in each of 12 sessions within a three-week-period. Changes in Gross Motor Function Measure (GMFM 66) scores, standardized walking distance, self-selected and maximum walking speed (ICF domain "Activity"), and Canadian Occupational Performance Measure (COPM; "Participation") were measured. Outcome measures were assessed three weeks in advance (V1), the day before (V2) as well as the day after, and 8 weeks after ROBERT (V3 + V4). RESULTS 18 patients with BS-CP participated; age 11.5 (mean, range: 5.0-21.8) years, body weight 36.4 (15.0-72.0) kg. GMFCS levels I-IV were: n = 4; 5; 8; 1. There was no significant difference comparing V1 and V2. GMFM 66 (total +2.5 points, Dimension D +3.8 and E +3.2) and COPM (Performance +2.1 points, Satisfaction +1.8 points) showed statistically significant improvements for V3 or V4 compared to V1 or V2 representing clinically meaningful effect sizes. Age, GMFCS level, and repeated ROBERT blocks correlated negatively with GMFM improvement, but not with COPM improvement. INTERPRETATION Following ROBERT, this prospective controlled cohort study showed significant and clinically meaningful improvements of function in ICF domains of "activity" and "participation" in patients with BS-CP. Further assessment in a larger cohort is necessary to allow more specific definition of factors that influence responsiveness to ROBERT program.
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Affiliation(s)
- A S Schroeder
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany.
| | - M Homburg
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - B Warken
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - H Auffermann
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Koerte
- Institute of Clinical Radiology, University of Munich, Germany
| | - S Berweck
- Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany
| | - K Jahn
- German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
| | - F Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany
| | - I Borggraefe
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Germany; German Center for Vertigo and Balance Disorders, IFB(LMU), University of Munich, Germany
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James S, Ziviani J, Boyd R. A systematic review of activities of daily living measures for children and adolescents with cerebral palsy. Dev Med Child Neurol 2014; 56:233-44. [PMID: 23937056 DOI: 10.1111/dmcn.12226] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to systematically review the psychometric properties and clinical utility of measures of activities of daily living (ADL) for children with cerebral palsy (CP) aged 5 to 18 years. METHOD Five electronic databases were searched to identify available ADL measures with published psychometric data for school-aged children with CP. Measures were included if at least 60% of the items addressed ADL in the full assessment or in an independent domain. A modified CanChild Outcome Rating Form was used to report the validity, reliability, responsiveness, and clinical utility of the measures. RESULTS Twenty-six measures were identified and eight met inclusion criteria. The Pediatric Evaluation of Disability Inventory (PEDI) had the strongest psychometric properties but was limited by its age range. The Assessment of Motor and Process Skills (AMPS) was the most comprehensive evaluation of underlying motor and cognitive abilities yet further psychometric testing is required for children with CP. INTERPRETATION The PEDI should be used to measure ADL capability in elementary school aged children. The AMPS is the best measure to evaluate ADL performance or capacity and is suitable for all ages. Future research should examine the reliability of the AMPS to determine its stability in children and adolescents with CP.
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Affiliation(s)
- Sarah James
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Royal Children's Hospital, Brisbane, Qld, Australia
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Abstract
Introduction: Every aspect of the wheelchair and seating provision process has an impact on overall outcomes for service users. This critical appraisal sought to identify outcome measures suitable for evaluation of wheelchair and seating provision, considering activity, participation, and impact of the service delivery on quality of life. Method: Outcome measures were identified using databases: Medline, CINHAL, PsychInfo, and Google Scholar. An evaluation was conducted to establish those that were particularly useful and a critical appraisal was completed. Findings: Five outcome measures identified as relevant for critical appraisal included: Wheelchair Outcome Measure; Functioning Every day in a Wheelchair; Goal Attainment Scale; Psychosocial Impact of Assistive Devices Scales; and the Quebec User Evaluation of Satisfaction with Assistive Technology. The strengths and limitations of each were identified. Conclusion: No single outcome measure captures all necessary information; trade-offs are inevitable. When choosing an outcome measure, the specific goals of the service evaluation and the resources available need to be considered within context. Critical appraisal of five outcome measures deemed appropriate for the evaluation highlighted some areas for consideration to inform decision making. A move towards sustainability indicators is suggested to monitor, measure, and respond to the provision processes and outcomes required to meet this primary need.
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Affiliation(s)
- Siobhan Kenny
- Occupational Therapist, Peamount Healthcare, Newcastle, Co. Dublin, Ireland
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Thomas RE, Johnston LM, Boyd RN, Sakzewski L, Kentish MJ. GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol. BMC Pediatr 2014; 14:35. [PMID: 24502231 PMCID: PMC3926674 DOI: 10.1186/1471-2431-14-35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. METHODS/DESIGN An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. DISCUSSION This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus individual models of physiotherapy following intramuscular injections of Botulinum Toxin-A to the lower limbs for ambulant children with cerebral palsy. TRIAL REGISTRATION ACTRN12611000454976.
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Affiliation(s)
- Rachel E Thomas
- Queensland Cerebral Palsy Health Service, The Royal Children's Hospital, Brisbane, Australia.
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de Brito Brandão M, Gordon AM, Mancini MC. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. Am J Occup Ther 2014; 66:672-81. [PMID: 23106987 DOI: 10.5014/ajot.2012.004622] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We compared children's self-care performance and caregivers' perception of children's performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive training (HABIT). METHOD Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children's daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention. RESULTS Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04). CONCLUSION The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children's daily functioning.
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Affiliation(s)
- Marina de Brito Brandão
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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86
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Raghavendra P, Newman L, Grace E, Wood D. 'I could never do that before': effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities. Child Care Health Dev 2013; 39:552-61. [PMID: 23763256 DOI: 10.1111/cch.12048] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Youth use the Internet for a variety of purposes including social networking. Youth with disabilities are limited in their social networks and friendships with peers. The aim was to investigate the effectiveness of tailored one-on-one support strategies designed to facilitate social participation of youth with disabilities through the use of the Internet for social networking. METHODS Eighteen youth aged 10-18 years with cerebral palsy, physical disability or acquired brain injury received support, training and assistive technology at their home to learn to use the Internet for building social networks. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) were used to evaluate objective changes in performance and satisfaction. Interviews with the youth identified subjective changes they experienced through participation in the programme and to determine whether and how the intervention influenced their social participation. RESULTS Youth showed an increase in performance and satisfaction with performance on identified goals concerning social networking on the COPM; Paired T-test showed that these differences were statistically significant at P < 0.001. GAS T-scores demonstrated successful outcomes (>50) for 78% of the youth. Interviews showed that youth were positive about the benefits of hands-on training at home leading to increased use of the Internet for social networking. CONCLUSIONS The Internet could be a viable method to facilitate social participation for youth with disabilities. Youth identified the benefits of one-to-one support at home and training of the family compared with typical group training at school. Despite its success with this group of youth, the time and effort intensive nature of this approach may limit the viability of such programmes. Further longitudinal research should investigate whether Internet use is sustained post intervention, and to identify the factors that best support ongoing successful and safe use.
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Affiliation(s)
- P Raghavendra
- Disability & Community Inclusion, Faculty of Health Sciences, Flinders University, Adelaide, SA 5001, Australia.
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Graham F, Rodger S, Ziviani J. Effectiveness of occupational performance coaching in improving children's and mothers' performance and mothers' self-competence. Am J Occup Ther 2013; 67:10-8. [PMID: 23245778 DOI: 10.5014/ajot.2013.004648] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study examined the effectiveness of occupational performance coaching in improving children's and mothers' occupational performance and mothers' parenting self-competence. METHOD A one-group time-series design was used to evaluate changes in children's (n = 29) and mothers' (n = 8) occupational performance at four time points: (1) pre-wait list, (2) preintervention, (3) postintervention, and (4) follow-up. RESULTS Significant improvements in occupational performance occurred postintervention for children, F(1, 78) = 153.72, p < .001, η² = .86, and mothers, F(1, 78) = 153.72, p < .001, η² = .86, that were maintained 6 wk after intervention. Mothers' self-competence in parenting also improved, F(1, 72) = 17.36, p < .001, η² = .42. CONCLUSION Findings provide preliminary evidence supporting the effectiveness of occupational performance coaching in improving children's and mothers' occupational performance and mothers' parenting self-competence. Improvements were sustained and appeared to generalize to other areas of performance.
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Affiliation(s)
- Fiona Graham
- Rehabilitation Teaching and Research Unit, University of Otago, PO Box 4345, Christchurch 8140 New Zealand.
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Clare L, Bayer A, Burns A, Corbett A, Jones R, Knapp M, Kopelman M, Kudlicka A, Leroi I, Oyebode J, Pool J, Woods B, Whitaker R. Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT). Trials 2013; 14:152. [PMID: 23710796 PMCID: PMC3680175 DOI: 10.1186/1745-6215-14-152] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/16/2013] [Indexed: 12/12/2022] Open
Abstract
Background Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer’s disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration Current Controlled Trials ISRCTN21027481
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK.
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Boyd RN, Mitchell LE, James ST, Ziviani J, Sakzewski L, Smith A, Rose S, Cunnington R, Whittingham K, Ware RS, Comans TA, Scuffham PA. Move it to improve it (Mitii): study protocol of a randomised controlled trial of a novel web-based multimodal training program for children and adolescents with cerebral palsy. BMJ Open 2013; 3:e002853. [PMID: 23578686 PMCID: PMC3641482 DOI: 10.1136/bmjopen-2013-002853] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Persons with cerebral palsy require a lifetime of costly and resource intensive interventions which are often limited by equity of access. With increasing burden being placed on health systems, new methods to deliver intensive rehabilitation therapies are needed. Move it to improve it (Mitii) is an internet-based multimodal programme comprising upper-limb and cognitive training with physical activity. It can be accessed in the client's home at their convenience. The proposed study aims to test the efficacy of Mitii in improving upper-limb function and motor planning. Additionally, this study hopes to further our understanding of the central neurovascular mechanisms underlying the proposed changes and determine the cost effectiveness of Mitii. METHODS AND ANALYSIS Children with congenital hemiplegia will be recruited to participate in this waitlist control, matched pairs, single-blind randomised trial. Children be matched at baseline and randomly allocated to receive 20 weeks of 30 min of daily Mitii training immediately, or waitlisted for 20 weeks before receiving the same Mitii training (potential total dose=70 h). Outcomes will be assessed at 20 weeks after the start of Mitii, and retention effects tested at 40 weeks. The primary outcomes will be the Assessment of Motor and Process Skills (AMPS), the Assisting Hand Assessment (AHA) and unimanual upper-limb capacity using the Jebsen-Taylor Test of Hand Function (JTTHF). Advanced brain imaging will assess use-dependant neuroplasticity. Measures of body structure and functions, activity, participation and quality of life will be used to assess Mitii efficacy across all domains of the International Classification of Functioning, Disability and Health framework. ETHICS AND DISSEMINATION This project has received Ethics Approval from the Medical Ethics Committee of The University of Queensland (2011000608) and the Royal Children's Hospital Brisbane (HREC/11/QRCH/35). Findings will be disseminated widely through conference presentations, seminars and peer-reviewed scientific journals. TRIAL REGISTRATION ACTRN12611001174976.
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Affiliation(s)
- Roslyn N Boyd
- School of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Goal Attainment Scaling in rehabilitation: A literature-based update. Ann Phys Rehabil Med 2013; 56:212-30. [DOI: 10.1016/j.rehab.2013.02.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/31/2013] [Accepted: 02/02/2013] [Indexed: 11/23/2022]
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91
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Hoare B, Imms C, Villanueva E, Rawicki HB, Matyas T, Carey L. Intensive therapy following upper limb botulinum toxin A injection in young children with unilateral cerebral palsy: a randomized trial. Dev Med Child Neurol 2013; 55:238-47. [PMID: 23236956 DOI: 10.1111/dmcn.12054] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/27/2022]
Abstract
AIM Botulinum toxin A (BoNT-A) combined with occupational therapy is effective in improving upper limb outcomes in children with unilateral cerebral palsy (CP). It is now essential to identify the most effective therapies following BoNT-A. Given the added burden for children and families, the aim of this study was to explore whether modified constraint-induced movement therapy (mCIMT) leads to sufficiently superior gains compared with bimanual occupational therapy (BOT) in young children with unilateral CP following BoNT-A injections. METHOD In this randomized, controlled, evaluator-blinded trial, 34 children (20 males, 14 females; mean age 3y, SD 1y 4mo, range 18mo-6y) with unilateral CP were randomized using concealed allocation to one of two 8-week interventions. The experimental group (n=17) received BoNT-A and mCIMT. The comparison group (n=17) received BoNT-A and BOT. Participants were recruited from a physical rehabilitation clinic and randomized between August 2003 and May 2009. Primary outcome was measured using the Assisting Hand Assessment at 3 months. Secondary outcomes were measured at 3 months and 6 months using the Quality of Upper Extremity Skills Test, the Pediatric Evaluation of Disability Inventory, Canadian Occupational Performance Measure, and the Goal Attainment Scale. RESULTS There were no clinically important differences between groups at baseline. Immediately following intervention, there was no evidence of a superior effect for BoNT-A + mCIMT as determined by the Assisting Hand Assessment (estimated mean difference [EMD] 0.81, upper 95% confidence limit 3.6; p=0.32) or secondary outcomes. However, both groups showed improvement over time (BoNT-A + mCIMT: EMD 2.7, 95% confidence interval [CI] 0.7-5.2; BONT-A + BOT: EMD 4.7, 95% CI 2.1-8.6). Follow-up at 6 months also demonstrated no superior effect for BoNT-A + mCIMT. INTERPRETATION Following upper limb injection of BoNT-A, there was no evidence that mCIMT, despite the significantly increased intensity of the home programme, produced a superior effect across a range of outcomes compared with a structured programme of BOT in young children with unilateral CP.
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Affiliation(s)
- Brian Hoare
- Department of Occupational Therapy, La Trobe University, Bundoora, Australia
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Gimeno H, Gordon A, Tustin K, Lin JP. Functional priorities in daily life for children and young people with dystonic movement disorders and their families. Eur J Paediatr Neurol 2013; 17:161-8. [PMID: 22889754 DOI: 10.1016/j.ejpn.2012.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/19/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aims to describe the most prevalent functional concerns of a group of young people with dystonia and their primary carers, and to explore the relationship between concerns, aetiology, severity of motor disability and manual ability. METHOD The Canadian Occupational Performance Measure (COPM) was completed with 57 children with dystonic movement disorders (65% males/35% females, mean 11.2 years (3.5-18.1)): 25% had primary dystonia, 75% secondary dystonia. Gross motor and manual function were classified using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). COPM concerns were analysed with respect to aetiology and severity of motor disability. RESULTS Almost three quarters of the respondents were GMFCS/MACS IV-V. All respondents had at least one concern around self-care. Other concerns included access to assistive technology, pain, dressing activities, use of tools and social participation. The nature and presence of concerns did not statistically differ according to the severity of gross motor or manual function impairment, though qualitative differences were noted. No statistical difference was found in relation to aetiology. INTERPRETATION Children and young people with dystonia have common functional concerns and priorities independent of the cause of dystonia, gross motor severity or manual function ability.
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Affiliation(s)
- Hortensia Gimeno
- Complex Motor Disorders Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
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93
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Dunford C, Bannigan K, Wales L. Measuring Activity and Participation Outcomes for Children and Youth with Acquired Brain Injury: An Occupational Therapy Perspective. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13603244419158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Intervention outcomes for children and youth with acquired brain injuries should be measured in terms of participation in activities. The aim of this study was to explore the occupational therapy outcome measures used with this group. Method: One cycle of an action research study, which focused specifically on occupational therapists, is reported. Ten occupational therapists working with children and youth with acquired brain injuries collated the outcome measures they used and mapped their frequently used measures onto the International Classification of Functioning, Disability and Health — Children and Youth, using established linking rules. Findings: Forty-two outcome measures and assessments were identified. Of these, 19 were used frequently and 15 were used as outcome measures. All activity and participation domains were represented, with learning and applying knowledge, mobility, communication and self-care (except looking after one's health) particularly well covered. Conclusion: Occupational therapists are using measures that reflect the domains of activity and participation, unlike those previously identified which were linked predominantly to body functions. The importance of occupational therapists working in rehabilitation teams is reiterated in that some of the domains that are not covered by occupational therapists impact on participation, for example, pain.
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Affiliation(s)
- Carolyn Dunford
- Head of Research, Harrison Research Centre, The Children's Trust, Tadworth, Surrey
| | - Katrina Bannigan
- Reader in Occupational Therapy/Director of Research Centre for Occupation and Mental Health, Faculty of Health and Life Sciences, York St John University, York
| | - Lorna Wales
- Research and Clinical Specialist Occupational Therapist, Harrison Research Centre, The Children's Trust, Tadworth, Surrey
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Blumetti FC, Wu JCN, Bau KV, Martin B, Hobson SA, Axt MW, Selber P. Orthopedic surgery and mobility goals for children with cerebral palsy GMFCS level IV: what are we setting out to achieve? J Child Orthop 2012; 6:485-90. [PMID: 24294311 PMCID: PMC3511688 DOI: 10.1007/s11832-012-0454-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/02/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multilevel orthopedic surgery is considered to be the gold standard treatment for ambulatory children with cerebral palsy (CP), classified at levels I, II, or III according to the Gross Motor Function Classification System (GMFCS). Hip enlocation and stability are the main goals of orthopedic intervention in the GMFCS level IV subgroup and are well researched; however, there is no evidence to date to support or challenge the effectiveness of orthopedic treatment to preserve functional mobility in this patient group. The aim of this study was to evaluate the results of orthopedic surgery to maintain or restore standing transfers and supported walking in children with CP at GMFCS level IV. METHODS Twenty-two children with CP GMFCS level IV who underwent orthopedic surgery to improve mobility between the years 2004 and 2008 were included in this study. A retrospective chart review was performed and a satisfaction questionnaire sent to all patients. The primary outcome measure was the attainment and maintenance of mobility goals 2 years post-surgery. The secondary outcome measures were family/patient satisfaction, Functional Mobility Scale (FMS), and complications. RESULTS The two goals identified by the patients and carers were standing transfers and supported walking. At the 2-year post-surgery assessment, 14 children (63.6 %) did not reach their pre-determined goals. In the questionnaire, 21.4 % of the families reported that surgery was not beneficial. The FMS score remained unchanged in 95.4 % of the patients. Fourteen patients (63.6 %) had at least one complication that prolonged their post-operative rehabilitation (e.g., neuropraxia). CONCLUSION This study suggests that orthopedic surgery in children with CP at GMFCS level IV is unlikely to maintain or restore mobility. Furthermore, it carries a significant risk of complications. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Francesco Camara Blumetti
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Jenny Chia Ning Wu
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Karen Vanessa Bau
- Physiotherapy Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Brian Martin
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Sally Anne Hobson
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Matthias Wolfgang Axt
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Paulo Selber
- Orthopaedic Department, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia ,Orthopedic Department, Royal Children’s Hospital, Melbourne, VIC Australia
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95
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Assessment tools and classification systems used for the upper extremity in children with cerebral palsy. Clin Orthop Relat Res 2012; 470:1257-71. [PMID: 21932104 PMCID: PMC3314769 DOI: 10.1007/s11999-011-2065-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinicians interested in assessment and outcome measurement of upper extremity (UE) function and performance in children with cerebral palsy (CP) must choose from a wide range of tools. QUESTIONS/PURPOSES We systematically reviewed the literature for UE assessment and classification tools for children with CP to compare instrument content, methodology, and clinical use. METHODS We searched Health and Psychosocial Instruments (HaPI), US National Library of Medicine (PubMed), and Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) databases (1937 to the present) to identify UE assessment and outcomes tools. We identified 21 tools for further analysis and searched HaPI, PubMed, CINAHL Plus, and Google Scholar ( http://scholar.google.com/schhp?tab=ws ) databases to identify all validity and reliability studies, systematic reviews, and original references for each of the 21 tools. RESULTS The tools identified covered ages birth to adulthood. International Classification of Functioning, Disability and Health domains addressed by these tools included body function, body structure, activities and participation, and environmental factors. Eleven of the tools were patient or family report, seven were clinician-based observations, and three tools could be used in either fashion. All of the tools had published evidence of validity. Nine of the tools were specifically designed for use in subjects with CP. Two of the tools required formal certification before use. Ten of the tools were provided free of charge by the investigators or institution who developed them. CONCLUSIONS Familiarity with the psychometric and clinometric properties of assessment and classification tools for the UE in children with CP greatly enhances a clinician's ability to select and use these tools in daily clinical practice for both clinical decision-making and assessment of outcome.
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Wallen MA, Ziviani JM. Canadian Occupational Performance Measure: Impact of Blinded Parent-Proxy Ratings on Outcome. The Canadian Journal of Occupational Therapy 2012; 79:7-14. [DOI: 10.2182/cjot.2012.79.1.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. There is potential for unintended effects on intervention outcome when using the Canadian Occupational Performance Measure (COPM) in intervention studies. Purpose. To determine the effect of blinded parent-proxy ratings of the COPM on outcomes at later endpoints. Methods. Data were drawn from a randomized trial of 50 children with hemiplegic cerebral palsy aged 19 months to seven years. Outcomes were measured at baseline, post-intervention, and six months. Parents of 36 children were randomly allocated to complete six-month COPM proxy ratings blinded or unblinded to previous ratings. A group of 32 parents rated the six-month COPM blinded and then re-rated it after access to previous ratings. Findings. There was no statistically significant difference in ratings between those completing the COPM blinded compared to unblinded. Implications. The COPM should continue to be rated blinded at post-intervention endpoints in the absence of further research to the contrary.
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Ten Berge SR, Boonstra AM, Dijkstra PU, Hadders-Algra M, Haga N, Maathuis CGB. A systematic evaluation of the effect of thumb opponens splints on hand function in children with unilateral spastic cerebral palsy. Clin Rehabil 2011; 26:362-71. [DOI: 10.1177/0269215511411936] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the effects of a neoprene thumb opponens splint on hand function during a self-selected activities of daily living task in children with unilateral spastic cerebral palsy with thumb-in-palm position of the affected hand. Design: Systematic evaluation of seven cases using a multiple baseline design across individuals. Setting: Outpatient clinic. Subjects: Seven children with unilateral cerebral palsy (2–7 years old), Manual Ability Classification System level 2–3 participated in the study. Interventions: Neoprene thumb opponens splints (McKie splint) were used. Children were followed for about four months. Baseline period ranged from 4 to 9 weeks, intervention period was two months and duration of follow-up one month. Main measures: Hand function was assessed using goal attainment scaling and visual analogue scales. Data was assessed visually. Results: In four children goal attainment scaling and/or visual analogue scale scores increased after introducing the splint. These effects remained when splints were not worn. Two children only benefited from the splint when it was worn. Thumb opponens splints were tolerated well by all children who participated in this study. Conclusions: Thumb opponens splints may have a positive effect on hand function in children with unilateral spastic cerebral palsy.
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Affiliation(s)
- Sabine R Ten Berge
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen The Netherlands
| | - Anne M Boonstra
- Revalidatie Friesland Center for Rehabilitation, Beetsterzwaag, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Mijna Hadders-Algra
- Department of Paediatrics, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Nienke Haga
- Adelante Zorggroep Center for Rehabilitation, Valkenburg, The Netherlands
| | - Carel GB Maathuis
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen The Netherlands
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Steenbeek D, Gorter JW, Ketelaar M, Galama K, Lindeman E. Responsiveness of Goal Attainment Scaling in comparison to two standardized measures in outcome evaluation of children with cerebral palsy. Clin Rehabil 2011; 25:1128-39. [PMID: 21795404 DOI: 10.1177/0269215511407220] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the responsiveness of Goal Attainment Scaling compared with the Pediatric Evaluation of Disability Inventory (PEDI) and the 66-item Gross Motor Function Measure (GMFM-66) in multidisciplinary rehabilitation practice. DESIGN Observational study. Pretest-posttest design. SUBJECTS/PATIENTS Twenty-three children with cerebral palsy, aged 2-13 years. METHODS Goal Attainment Scaling, PEDI and GMFM-66 assessments were performed before and after six months of treatment. Physical, occupational and speech therapists constructed and scored 6-point Goal Attainment Scaling scales meeting predetermined criteria, describing the main functional goal per discipline. The contents of the three measures were compared using International Classification of Functioning, Disability and Health child and youth version (ICF-CY) codes. Spearman's rho correlations between Goal Attainment Scaling change scores per discipline and change scores obtained with the PEDI functional skills scales and GMFM-66 were calculated. Complete goal attainment was compared with significant change in terms of the standardized measures. RESULTS Twenty per cent of the Goal Attainment Scaling items were not covered by items of the PEDI or the GMFM-66. Inconclusive correlations were found between Goal Attainment Scaling and PEDI change scores (r 0.28-0.64). Even after exclusion of the non-corresponding items, correlations were moderate (r 0.57-0.73). Of 39/64 Goal Attainment Scaling scales scored as complete goal attainment, 16 individual PEDI scores did not show change on the corresponding scale. Low correlation was found between Goal Attainment Scaling change scores and GMFM-66 change scores. CONCLUSION Goal Attainment Scaling, PEDI and GMFM-66 were complementary in their ability to measure individual change over time in children with cerebral palsy. Using only the standardized instruments could have caused many individual rehabilitation goals actually attained being missed in the outcome evaluation.
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Löwing K, Hamer EG, Bexelius A, Carlberg EB. Exploring the relationship of family goals and scores on standardized measures in children with cerebral palsy, using the ICF-CY. Dev Neurorehabil 2011; 14:79-86. [PMID: 21410399 DOI: 10.3109/17518423.2011.552088] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To explore the relationships of family selected goals and scores on standardized measures using the ICF-CY as a classification system. METHODS Goal attainment scaling (GAS)-goals (n = 110) of 22 children, 11 girls, 1-6 years, bilateral or unilateral cerebral palsy, GMFCS I-IV and MACS I-IV were linked to the ICF-CY. The children had participated in goal-directed therapy during 12 weeks. GAS-goals, baseline assessments and change scores from PEDI and GMFM-66 were used to explore the relationships. RESULTS All GAS-goals were classified in the Activity and Participation domain within ICF-CY. The number of GAS-goals correlated to baseline scores in PEDI and GMFM-66. The change scores in PEDI and GMFM-66 correlated to goal attainment in the Mobility and the Self-Care chapter. CONCLUSIONS The family goals were reflected in standardized measures. The combined use of standardized and individual measures offers a possibility to explore the focus in therapy and the impact in children with cerebral palsy.
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Affiliation(s)
- Kristina Löwing
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.
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100
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Abstract
BACKGROUND AND PURPOSE Adults with cerebral palsy (CP) are at risk for decreased mobility and health complications, and exercise may combat some of these negative changes. Because people with CP have difficulty generating sufficient muscle force, exercise augmented with functional electrical stimulation (FES) is an option for increasing exercise intensity. This mixed-method (quantitative-qualitative) case report describes the effects-across the International Classification of Functioning, Disability and Health (ICF) model-of cycling with FES (FES cycling) in an adult with CP. CASE DESCRIPTION An ambulatory 49-year-old man with spastic diplegic CP cycled with FES at home for 30 minutes, 3 times per week, for 12 weeks. Volitional efforts were augmented by FES of the bilateral quadriceps, gastrocnemius, and gluteal muscles. Testing was performed before and after the intervention and 4 weeks after intervention withdrawal. OUTCOMES After training, quadriceps muscle strength (force-generating capacity) improved by 22.2%, hamstring muscle strength improved by 18.5%, and the Timed "Up & Go" Test time decreased from 11.9 to 9.0 seconds. The patient reported increased performance and satisfaction for self-identified goals at the ICF level of participation, and his score on the Medical Outcomes Study 36-Item Health Survey questionnaire increased from 62.1 to 77.6. However, he reported increased back pain, which he attributed to positioning while cycling. Qualitative interviews provided context (the patient's perspective) for some of the quantitative results. DISCUSSION The patient made gains in body structure and function, activity, and participation (ICF levels) after FES cycling. The mixed-method approach provided insight into his experiences and perceptions about the measures assessed quantitatively. Further investigation on FES cycling in this population as well as positioning during cycling is warranted.
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