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Wu J, Bai C, Yan B, Mutalifu N, Guan Q, Li J, Luan X. Development and validation of a predictive model for poor prognosis of communication disorders in children with cerebral palsy after cervical perivascular sympathectomy. Neurosurg Rev 2024; 47:142. [PMID: 38587684 PMCID: PMC11001727 DOI: 10.1007/s10143-024-02380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
Cervical perivascular sympathectomy (CPVS) can improve communication disorders in children with cerebral palsy (CP); however, there are no research reports on the factors affecting surgical efficacy. This study aimed to establish a nomogram for poor prognosis after CPVS. We collected data from 313 CP patients who underwent CPVS at the Neurosurgery Cerebral Palsy Center of the Second Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2023. Among them, 70% (n = 216) formed the training cohort and 30% (n = 97) the validation cohort. The general data and laboratory examination data of both groups were analyzed. In training cohort, 82 (37.96%) showed improved postoperative communication function. Logistic analysis identified motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity as the prognostic factors. Using these four factors, a prediction model was constructed with an area under the curve (AUC) of 0.807 (95% confidence interval [CI], 0.743-0.870), indicating its ability to predict adverse outcomes after CPVS. The validation cohort results showed an AUC of 0.76 (95% CI, 0.650-0.869). The consistency curve and Hosmer-Lemeshow test (χ2 = 10.988 and p = 0.202, respectively) demonstrated good consistency between the model-predicted incidence and the actual incidence of poor prognosis. Motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity are independent risk factors associated with the prognosis of communication disorders after CPVS. The combined prediction model has a good clinical prediction effect and has promising potential to be used for early prediction of prognosis of CPVS.
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Affiliation(s)
- Junjie Wu
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Chao Bai
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Baofeng Yan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Nurehemaiti Mutalifu
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Qi Guan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Jianglong Li
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Xinping Luan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China.
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Hemsley B, Almond B, Given F, Darcy S, L'Espoir Decosta P, Dann S, Carnemolla P, Freeman-Sanderson A, Debono D, Balandin S. Craving inclusion: a systematic review on the experiences and needs of people with disability eating out. Disabil Rehabil 2023:1-16. [PMID: 38146693 DOI: 10.1080/09638288.2023.2295006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
Purpose: To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance accessibility of eating out experiences, inform future inclusive research, and guide policy development.Materials and Methods: This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included.Results: Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed.Conclusion: People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff.
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Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Barbara Almond
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Fiona Given
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Simon Darcy
- The Business School, University of Technology Sydney, Sydney, Australia
| | | | - Stephen Dann
- Research School of Management, Australian National University, Canberra, Australia
| | | | | | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Susan Balandin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Deakin University, Geelong, Australia
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K SSNSP, Taksande A, Meshram RJ. Reviving Hope: A Comprehensive Review of Post-resuscitation Care in Pediatric ICUs After Cardiac Arrest. Cureus 2023; 15:e50565. [PMID: 38226102 PMCID: PMC10788704 DOI: 10.7759/cureus.50565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
This comprehensive review thoroughly examines post-resuscitation care in pediatric ICUs (PICUs) following cardiac arrest. The analysis encompasses adherence to resuscitation guidelines, advances in therapeutic interventions, and the nuanced management of neurological, cardiovascular, and respiratory considerations during the immediate post-resuscitation phase. Delving into the complexities of long-term outcomes, cognitive and developmental considerations, and rehabilitation strategies, the review emphasizes the importance of family-centered care for pediatric survivors. A call to action is presented, urging continuous education, research initiatives, and quality improvement efforts alongside strengthened multidisciplinary collaboration and advocacy for public awareness. Through implementing these principles, healthcare providers and systems can collectively contribute to ongoing advancements in pediatric post-resuscitation care, ultimately improving outcomes and fostering a culture of excellence in pediatric critical care.
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Affiliation(s)
- Sri Sita Naga Sai Priya K
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bekteshi S, Konings M, Karlsson P, Criekinge TV, Dan B, Monbaliu E. Teleintervention for users of augmentative and alternative communication devices: A systematic review. Dev Med Child Neurol 2023; 65:171-184. [PMID: 36047007 DOI: 10.1111/dmcn.15387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 01/04/2023]
Abstract
AIM To synthesize existing evidence on the effectiveness of speech-language teleinterventions delivered via videoconferencing to users of augmentative and alternative communication (AAC) devices. METHOD A systematic literature search was conducted in 10 electronic databases, from inception until August 2021. Included were speech-language teleinterventions delivered by researchers and/or clinicians via videoconferencing to users of AAC devices, without restrictions on chronological age and clinical diagnosis. The quality of the studies included in the review was appraised using the Downs and Black checklist and the Single-Case Experimental Design Scale; risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies - of Interventions and the single-case design risk of bias tools. RESULTS Six teleinterventions including 25 participants with a variety of conditions, such as Down syndrome, autism, Rett syndrome, and amyotrophic lateral sclerosis met the inclusion criteria. Five studies used a single-case experimental design and one was a cohort study. Teleinterventions included active consultation (n = 2), functional communication training (n = 2), brain-computer interface (n = 1), and both teleintervention and in-person intervention (n = 1). All teleinterventions reported an increase in participants' independent use of AAC devices during the training sessions compared to baseline, as well as an overall high satisfaction and treatment acceptability. INTERPRETATION Speech-language teleinterventions for users of AAC devices show great potential for a successful method of service delivery. Future telehealth studies with larger sample sizes and more robust methodology are strongly encouraged to allow the generalization of results across different populations. WHAT THIS PAPER ADDS Individuals can learn to use augmentative and alternative communication (AAC) devices independently during tele-AAC interventions. Service providers and recipients reported an overall high satisfaction and acceptability for AAC services delivered via teleinterventions. Speech-language teleinterventions may be an effective method of providing AAC intervention services.
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Affiliation(s)
- Saranda Bekteshi
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
| | - Marco Konings
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
| | - Petra Karlsson
- Cerebral Palsy Alliance, University of Sydney, Sydney, NSW, Australia
| | - Tamaya Van Criekinge
- Department of Rehabilitation Sciences, Musculoskeletal Research Group, KU Leuven, Bruges, Belgium
| | - Bernard Dan
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Elegast Monbaliu
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, KU Leuven, Bruges, Belgium
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Ortiz Castellanos AE, Liu CM, Shi C. Deep Mobile Linguistic Therapy for Patients with ASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12857. [PMID: 36232157 PMCID: PMC9566798 DOI: 10.3390/ijerph191912857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Autistic spectrum disorder (ASD) is one of the most complex groups of neurobehavioral and developmental conditions. The reason is the presence of three different impaired domains, such as social interaction, communication, and restricted repetitive behaviors. Some children with ASD may not be able to communicate using language or speech. Many experts propose that continued therapy in the form of software training in this area might help to bring improvement. In this work, we propose a design of software speech therapy system for ASD. We combined different devices, technologies, and features with techniques of home rehabilitation. We used TensorFlow for Image Classification, ArKit for Text-to-Speech, Cloud Database, Binary Search, Natural Language Processing, Dataset of Sentences, and Dataset of Images with two different Operating Systems designed for Smart Mobile devices in daily life. This software is a combination of different Deep Learning Technologies and makes Human-Computer Interaction Therapy very easy to conduct. In addition, we explain the way these were connected and put to work together. Additionally, we explain in detail the architecture of software and how each component works together as an integrated Therapy System. Finally, it allows the patient with ASD to perform the therapy anytime and everywhere, as well as transmitting information to a medical specialist.
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Affiliation(s)
- Ari Ernesto Ortiz Castellanos
- College of Electrical Engineering and Computer Science, National Taipei University of Technology, Taipei City 106, Taiwan or
| | - Chuan-Ming Liu
- Department of Computer Science and Information Engineering, National Taipei University of Technology, Taipei City 106, Taiwan
| | - Chongyang Shi
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing 102488, China
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Vaillant E, Oostrom KJ, Beckerman H, Vermeulen JR, Buizer AI, Geytenbeek JJM. Convergent validity of functional communication tools and spoken language comprehension assessment in children with cerebral palsy. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:963-976. [PMID: 35637603 PMCID: PMC9796366 DOI: 10.1111/1460-6984.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The majority of children with cerebral palsy (CP) experience challenges in functional communication from a young age. A pivotal aspect of functional communication is language comprehension. A variety of classification systems and questionnaires are available to classify and describe functional communication skills in children with CP. A better understanding of the convergent validity of (subsections of) these tools, as well as their relationship with spoken language comprehension, will be valuable in both clinical practice and research. AIMS To investigate the convergent validity of (subsections of) functional communication tools and the relationship with spoken language comprehension in children with CP. METHODS & PROCEDURES Cross-sectional data on 138 children were subdivided into three developmental stages based on (Dutch) educational phases: ages 18 months-3;11y (n = 59), 4;0-5;11 years (n = 37) and 6;0-8;11 years (n = 42). The following functional communication tools were used to classify and describe functional communication: Communication Function Classification System (CFCS), subscales of the Caregivers Priorities and Child Health Index of Life with Disabilities-Dutch Version (CPCHILD-DV) and the Focus on Communication Under Six-34 (FOCUS-34) questionnaire. Spoken language comprehension was assessed with the Computer-Based instrument for Low motor Language Testing (C-BiLLT). Correlations between the functional communication tools, and with the C-BiLLT, were calculated using Pearson's and Spearman's correlation coefficients. It was hypothesized a priori that correlations of at least 0.60 suggest good convergent validity. OUTCOMES & RESULTS At all developmental stages, a significant ordered decreasing tendency of communication outcomes was found across CFCS levels; lower CFCS levels were associated with lower scores on the CPCHILD-DV and FOCUS-34, and with a lower level of spoken language comprehension (C-BiLLT). Correlation coefficients of the functional communication tools exceeded 0.60 at all developmental stages. Correlations between C-BiLLT raw scores and the functional communication tools varied between 0.351 and 0.591 at developmental stage 18 months-3;11 years, between 0.781 and 0.897 at developmental stage 4;0-5;11 years, and between 0.635 and 0.659 at developmental stage 6;0-8;11 years. CONCLUSIONS & IMPLICATIONS The functional communication tools assessed in this study showed convergent validity at all developmental stages. The CFCS, currently most widely used in paediatric rehabilitation, is adequate in the classification of functional communication. However, for more detailed clinical goal setting and evaluation of change in functional communication, the additional use of FOCUS-34 or CPCHILD-DV is recommended. WHAT THIS PAPER ADDS What is already known on the subject A range of functional communication tools are available that help describe and classify functional communication in children with CP. These include the CFCS, subsections of CPCHILD-DV and FOCUS-34. The CFCS classifies functional communication in daily life with familiar and unfamiliar partners. Specific subsections of the CPCHILD-DV and FOCUS-34 include items that pertain to communicative participation. The innovative C-BiLLT provides a standardized method to assess spoken language comprehension in children with CP and significant motor impairments. What this paper adds to existing knowledge In the present study, convergent validity was confirmed between CFCS and specific subsections of the CPCHILD-DV and FOCUS-34. Correlations between these functional communication tools and the C-BiLLT were moderate to strong. What are the potential or actual clinical implications of this work? For clinical and research purposes (for instance, accurate prescription of augmentative and alternative communication-AAC), healthcare and educational professionals together with parents need to know how functional communication tools converge and how functional communication levels relate to the comprehension of spoken language. The CFCS provides a valid classification of functional communication abilities in children with CP. However, to measure change in functional communication and to evaluate treatment outcomes, use of additional functional communication tools such as the CPCHILD-DV and FOCUS-34 is recommended. When discrepancies are found between communicative abilities and spoken language comprehension, it is strongly recommended that valid tools are used in a more detailed examination of the child's spoken language comprehension skills and functional communication.
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Affiliation(s)
- Emma Vaillant
- Amsterdam UMCVrije Universiteit Amsterdam, Department of Rehabilitation MedicineCP Expertise CenterAmsterdam Movement SciencesDe Boelelaan 1117Amsterdamthe Netherlands
| | - Kim J. Oostrom
- Amsterdam UMC, University of Amsterdam, Emma Children's HospitalDepartment of Child and Adolescent Psychiatry and Psychosocial CareAmsterdam Reproduction and Development, Meibergdreef 9Amsterdamthe Netherlands
| | - Heleen Beckerman
- Amsterdam UMCVrije Universiteit Amsterdam, Department of Rehabilitation MedicineCP Expertise CenterAmsterdam Movement SciencesDe Boelelaan 1117Amsterdamthe Netherlands
| | - Jeroen R. Vermeulen
- Maastricht UMC+Department of NeurologySchool of Mental Health and Neuro ScienceMaastrichtthe Netherlands
| | - Annemieke I. Buizer
- Amsterdam UMCVrije Universiteit Amsterdam, Department of Rehabilitation MedicineCP Expertise CenterAmsterdam Movement SciencesDe Boelelaan 1117Amsterdamthe Netherlands
| | - Johanna J. M. Geytenbeek
- Amsterdam UMCVrije Universiteit Amsterdam, Department of Rehabilitation MedicineCP Expertise CenterAmsterdam Movement SciencesDe Boelelaan 1117Amsterdamthe Netherlands
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Duke RE, Chimaeze T, Kim MJ, Ameh S, Burton K, Bowman R. The Effect of Insight Questions Inventory and Visual Support Strategies on Carer-Reported Quality of Life for Children With Cerebral Palsy and Perceptual Visual Dysfunction in Nigeria: A Randomized Controlled Trial. Front Hum Neurosci 2021; 15:706550. [PMID: 34867233 PMCID: PMC8636698 DOI: 10.3389/fnhum.2021.706550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Structured clinical history question inventories have previously been used to try and elicit symptoms of perceptual visual dysfunction (PVD) in children with cerebral palsy (CP) in different settings. Earlier studies have suggested that PVD may affect quality of life and specific habilitational strategies, linked to inventory responses, may improve quality of life. Through an RCT, based on a community based sample of children with CP in Cross River State, Nigeria, we aimed to determine if a structured history inventory such as the Insight question inventory (IQI) and associated tailored visual support strategies (IQI VSS) for the management of those children who have PVD, can improve quality of life and is superior to standard therapy. Children with CP were recruited by the key informant method and confirmed by clinical examination. The parent reported IQI was used to identify children with PVD. Primary outcome measures were both Pediatric Quality of Life 4.0 Generic (PedsQL 4.0 Generic) and Pediatric Quality of Life 3.0 Cerebral Palsy (PedsQL 3.0 CP) scale scores. Children were enrolled with a parallel arm allocation to either IQI and IQI VSS or to standard therapy for CP. Children were followed up for 6 weeks with weekly phone call session and the questionnaires repeated at the end of the 6 weeks’ period. Results show that the children in the treatment group (n = 191) showed no significantly different change between baseline and follow up in quality of life (PedsQL 4.0 Generic p = 0.943: and PedsQL-CP 3.0 p = 0.287), compared to the control group. There was suggestion of a better improvement (p = 0.035) in the PedsQL 3.0 CP subscale of speech and communication for the intervention group. The use of IQI VSS for the treatment of PVD in children with CP in this population does not show any superiority over current standard CP management in terms of overall quality of life. However, there was some evidence of improvement in quality of life in the area of speech and communication. Further research and refinement of these management method is required. Clinical Trial Registration:www.ClinicalTrials.gov, identifier [PACTR20161200188] 6396.
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Affiliation(s)
- Roseline E Duke
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom.,Children's Eye Center, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Torty Chimaeze
- Department of Pediatrics, Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Min J Kim
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
| | - Soter Ameh
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Kathryn Burton
- Cambridgeshire Community Services, Oxfordshire, United Kingdom
| | - Richard Bowman
- London School of Hygiene and Tropical Medicine, International Center for Eye Health, University of London, London, United Kingdom
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Cantero MJP, Medinilla EEM, Martínez AC, Gutiérrez SG. Comprehensive approach to children with cerebral palsy. An Pediatr (Barc) 2021; 95:276.e1-276.e11. [PMID: 34526244 DOI: 10.1016/j.anpede.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up. We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists.
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Affiliation(s)
- María José Peláez Cantero
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | | | - Ana Cordón Martínez
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario de Málaga, Málaga, Spain
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9
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Peláez Cantero MJ, Moreno Medinilla EE, Cordón Martínez A, Gallego Gutiérrez S. [Comprehensive approach to children with cerebral palsy]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00249-6. [PMID: 34462228 DOI: 10.1016/j.anpedi.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022] Open
Abstract
Infantile cerebral palsy is one of the most prevalent diseases and the most frequent cause of disability in paediatrics. Children with cerebral palsy have complex health care needs and often require the care of a multidisciplinary team. However, in many cases there is no paediatrician with overall responsibility for coordinating follow-up. We have produced a support document intended for paediatricians coordinating the care of children with cerebral palsy. Our aim is to provide an ordered compilation of the main issues these patients may develop, to know how to identify and address them if necessary, and to establish criteria for referring these patients to other specialists.
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Affiliation(s)
- María José Peláez Cantero
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario de Málaga, Málaga, España.
| | | | - Ana Cordón Martínez
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario de Málaga, Málaga, España
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10
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Di Lieto MC, Pecini C, Brovedani P, Sgandurra G, Dell'Omo M, Chilosi AM, Guzzetta A, Perazza S, Sicola E, Cioni G. Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia. Front Neurol 2021; 11:601148. [PMID: 33551960 PMCID: PMC7854548 DOI: 10.3389/fneur.2020.601148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1–13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.
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Affiliation(s)
- Maria Chiara Di Lieto
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Chiara Pecini
- Department of Education, Language, Interculture and Psychology, University of Florence, Florence, Italy
| | - Paola Brovedani
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Dell'Omo
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Anna Maria Chilosi
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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11
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Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep 2020; 20:3. [PMID: 32086598 PMCID: PMC7035308 DOI: 10.1007/s11910-020-1022-z] [Citation(s) in RCA: 420] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. RECENT FINDINGS Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Michael Fahey
- Department of Paediatric Neurology, Monash Health, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Megan Finch-Edmondson
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Kids Rehab WA, Perth Children's Hospital, Perth, Australia
| | - Maria Mc Namara
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Madison Cb Paton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Himanshu Popat
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Emma Stanton
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Olivia P Finemore
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Alice Tricks
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Anna Te Velde
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
| | - Leigha Dark
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Natalie Morton
- Allied and Public Helath, Faculty of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, PO Box 6427, Frenchs Forest, Sydney, NSW, 2086, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Pitathawatchai P, Khaimook W, Kirtsreesakul V. Pilot implementation of newborn hearing screening programme at four hospitals in southern Thailand. Bull World Health Organ 2019; 97:663-671. [PMID: 31656331 PMCID: PMC6796664 DOI: 10.2471/blt.18.220939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the effectiveness and benefit of a universal newborn hearing screening programme at four different hospitals in southern Thailand, between January and July 2017. METHODS One screener per hospital recorded demographic data of all newborns and their exposure to risk of hearing loss, and evaluated their hearing by transient otoacoustic emission technology. Those who demonstrated bilateral moderate to profound hearing loss at both a first and second screening were referred for diagnostic assessment. Those with confirmed hearing loss received treatment and regular follow-up appointments, and their speech development was assessed at 1 year of age. We determined effectiveness by comparing our achieved coverage and proportion of follow-up and referrals with benchmarks set by the American Academy of Pediatrics (≥ 95%, ≥ 95% and ≤ 4%, respectively), and determined benefit by calculating the composite language scores of hearing-impaired infants who received early intervention. FINDINGS We screened 6140 eligible newborns, and achieved a screening coverage of 95.4% (5859/6140), lost 25.7% (63/245) and 22.0% (9/41) to follow-up at the second screening and diagnostic assessment stages, respectively, and obtained an overall proportion of referrals of 0.7% (41/6140). Twelve infants were confirmed as having hearing loss and received early intervention; nine (75%) demonstrated normal speech development by their first birthday. Our universal hearing screening yielded a prevalence of sensorineural hearing loss of less than 0.1% (3/6140). CONCLUSION Although ineffective by American Academy of Pediatrics standards, we demonstrated the benefit of early intervention in infants diagnosed with hearing loss.
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Affiliation(s)
- Pittayapon Pitathawatchai
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich road, Hat Yai, Chang Wat Songkhla, 90110, Thailand
| | - Wandee Khaimook
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich road, Hat Yai, Chang Wat Songkhla, 90110, Thailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich road, Hat Yai, Chang Wat Songkhla, 90110, Thailand
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Bertucco M, Sanger TD. A Model to Estimate the Optimal Layout for Assistive Communication Touchscreen Devices in Children With Dyskinetic Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2019; 26:1371-1380. [PMID: 29985146 DOI: 10.1109/tnsre.2018.2840445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Excess involuntary movements and slowness of movement in children with dyskinetic cerebral palsy often result in the inability to properly interact with augmentative and alternative communication (AAC) devices. This significantly limits communication. It is, therefore, essential to know how to adjust the device layout in order to maximize each child's rate of communication. The aim of this paper was to develop a mathematical model to estimate the information rate in children with dyskinetic cerebral palsy and to determine the optimal AAC layout for a touchscreen tablet that results in enhanced speed of communication. The model predicts information rate based on button size, number, spacing between buttons, and the probability of making an error or missing target buttons. Estimation of the information rate confirmed our hypothesis of lower channel capacity in children with dyskinetic cerebral palsy compared with age-matched healthy children. Information rate increased when the AAC layout was customized based on the optimal parameters predicted by the model. In conclusion, this paper quantifies the effect of motor impairments on communication with assistive communication devices and shows that communication performance can be improved by optimally matching the parameters of the AAC touchscreen device to the abilities of the child.
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Pennington L, Akor WA, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Cochrane Database Syst Rev 2018; 7:CD012507. [PMID: 30040119 PMCID: PMC6513435 DOI: 10.1002/14651858.cd012507.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills. OBJECTIVES To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies. SELECTION CRITERIA We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it. AUTHORS' CONCLUSIONS There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Wanwuri A Akor
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Kate Laws
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park Centre for Neuro‐Rehabilitation and Neuro‐PsychiatryRegional Communication Aid ServiceBenfield RoadNewcastle upon TyneUKNE6 4 QD
| | - Juliet Goldbart
- Manchester Metropolitan UniversityFaculty of Health, Psychology & Social CareBrooks Building, Birley Fields Campus53 Bonsall StreetManchesterUKM15 6GX
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Li LX, Zhang MM, Zhang Y, He J. Acupuncture for cerebral palsy: A meta-analysis of randomized controlled trials. Neural Regen Res 2018; 13:1107-1117. [PMID: 29926839 PMCID: PMC6022466 DOI: 10.4103/1673-5374.233455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE: To evaluate the efficacy and safety of acupuncture therapy for children with cerebral palsy. DATA SOURCES: We conducted electronic searches of PUBMED (1950/2017), EMBASE (1974/2017), ScienceDirect (1986/2017), Academic Source Premier (1887/2017), the Cochrane Library (Issue 4, April 2017), Science Citation Index Expanded (1900/2017), China National Knowledge Infrastructure (1915/2017), China Biological Medicine (1990/2017-04), WanFang (1980/2017), VIP (1989/2017), and Chinese Science Citation Database (1989/2017). DATA SELECTION: We included randomized controlled trials that aimed to compare the effect of acupuncture plus rehabilitation training versus rehabilitation training alone. Data about functional motor abilities, daily activity/social participation, effective rate, intellectual development, and adverse effects were included. We used Revman 5.2 software for statistical analysis. OUTCOME MEASURES: The primary outcomes included functional motor abilities, daily activity, and effective rate. The secondary outcomes included intellectual development and adverse effects. RESULTS: Twenty-one studies with a total of 1718 participants met the inclusion criteria. The effect size of gross motor function (SMD = 0.64, 95% CI: 0.52 to 0.76, P < 0.00001; I2 = 0%, P = 0.69; in 13 studies with 1144 patients) and the total effective rate (RR = 1.28, 95% CI: 1.20 to 1.37, P < 0.00001; I2 = 18%, P = 0.27; in 12 studies with 1106 patients) suggested that acupuncture plus rehabilitation produced a significant improvement in gross motor function and a high total effective rate. The pooled fine motor function (SMD = 3.48, 95% CI: 2.62 to 4.34, P < 0.00001; I2 = 64%, P = 0.10; in 2 studies with 193 patients), modified Ashworth scale scores (SMD = –0.31, 95% CI: –0.52 to –0.11, P = 0.003; I2 = 74%, P = 0.004; in 5 studies with 363 patients) and activities of daily living (SMD = 1.45, 95% CI: 1.20 to 1.71, P < 0.00001; I2 = 78%, P = 0.004; in 4 studies with 313 patients) also indicated improvements in children with cerebral palsy. Publication bias was not observed. Only mild adverse events related to acupuncture were reported. CONCLUSION: Acupuncture plus rehabilitation training improved gross motor function, reduced muscle spasms, and enhanced daily life activities in children with cerebral palsy. However, this conclusion should be interpreted with caution due to the small number of randomized controlled trials available and the small sample sizes. More high-quality and large-scale studies are needed.
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Affiliation(s)
- Ling-Xin Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming-Ming Zhang
- Chinese Cochrane Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yin Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Chorna O, Hamm E, Cummings C, Fetters A, Maitre NL. Speech and language interventions for infants aged 0 to 2 years at high risk for cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:355-360. [PMID: 27897320 PMCID: PMC5395422 DOI: 10.1111/dmcn.13342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
AIM We evaluated the level of evidence of speech, language, and communication interventions for infants at high-risk for, or with a diagnosis of, cerebral palsy (CP) from 0 to 2 years old. METHOD We performed a systematic review of relevant terms. Articles were evaluated based on the level of methodological quality and evidence according to A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS The search terms provided 17 publications consisting of speech or language interventions. There were no interventions in the high level of evidence category. The overall level of evidence was very low. Promising interventions included Responsivity and Prelinguistic Milieu Teaching and other parent-infant transaction frameworks. INTERPRETATION There are few evidence-based interventions addressing speech, language, and communication needs of infants and toddlers at high risk for CP, and none for infants diagnosed with CP. Recommendation guidelines include parent-infant transaction programs.
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Affiliation(s)
- Olena Chorna
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Ellyn Hamm
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Caitlin Cummings
- Division of Clinical Therapies, Department of Speech-Language Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Ashley Fetters
- Division of Clinical Therapies, Department of Speech-Language Pathology, Nationwide Children's Hospital, Columbus, OH
| | - Nathalie L Maitre
- Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Pennington L, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Hippokratia 2017. [DOI: 10.1002/14651858.cd012507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lindsay Pennington
- Newcastle University; Institute of Health and Society; Sir James Spence Institute - Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne UK NE1 4LP
| | - Kate Laws
- City Hospitals Sunderland NHS Foundation Trust; Department of Speech and Language Therapy; Childrens Centre Durham Road Sunderland UK SR3 4AF
| | - Juliet Goldbart
- Manchester Metropolitan University; Faculty of Health, Psychology & Social Care; Brooks Building, Birley Fields Campus 53 Bonsall Street Manchester UK M15 6GX
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O'Toole C, Lee ASY, Gibbon FE, van Bysterveldt AK, Conway P, Hart NJ. Parent-mediated interventions to promote communication and language development in children with Down syndrome aged between birth and six years. Hippokratia 2016. [DOI: 10.1002/14651858.cd012089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ciara O'Toole
- University College Cork; Department of Speech and Hearing Sciences; Brookfield Health Sciences Complex College Road Cork Ireland
| | - Alice S-Y Lee
- University College Cork; Department of Speech and Hearing Sciences; Brookfield Health Sciences Complex College Road Cork Ireland
| | - Fiona E Gibbon
- University College Cork; Department of Speech and Hearing Sciences; Brookfield Health Sciences Complex College Road Cork Ireland
| | - Anne K van Bysterveldt
- University of Canterbury; School of Health Sciences; Kirkwood Avenue Ilam Christchurch New Zealand 8041
| | - Paul Conway
- University of Limerick; Department of Education and Professional Studies; Room CM-074(b) Limerick Ireland
| | - Nicola J Hart
- Down Syndrome Ireland; National Resource Team; 6, Carrig Glen Calverstown Kildare Ireland
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Abstract
As the physiologic recovery period concludes, the patient is evaluated for surgical procedures that may rebalance muscle function and correct deformity. Upper extremity function is the product of complex and highly sophisticated mechanisms working in unison, and a careful, systematic preoperative evaluation is critical. A good function of the hand cannot be achieved without adequate position of the shoulder, elbow, forearm, and wrist. The goals of surgery must be practical and clearly understood by the patient and the family.
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Affiliation(s)
- Idris Gharbaoui
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Katarzyna Kania
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Patrick Cole
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
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Mary Watson R, Pennington L. Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:241-59. [PMID: 25652139 PMCID: PMC4371637 DOI: 10.1111/1460-6984.12138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. AIMS To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. METHODS & PROCEDURES An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. OUTCOMES & RESULTS Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. CONCLUSIONS & IMPLICATIONS The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice.
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Affiliation(s)
- Rose Mary Watson
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
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A scoping review of interventions to supplement spoken communication for children with limited speech or language skills. PLoS One 2014; 9:e90744. [PMID: 24625465 PMCID: PMC3953121 DOI: 10.1371/journal.pone.0090744] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
Background Augmentative and Alternative Communication (AAC) is used for treating children with severe disorders of speech-language production and/or comprehension. Various strategies are used, but research and debate on their efficacy have remained limited to a specific area and have rarely reached the general medical community. Objective To systematically evaluate outcomes of AAC interventions in children with limited speech or language skills. Methods Searches were conducted (up to December 2012) in the MEDLINE, EMBASE, PsycINFO, CINAHL, DARE, and Cochrane Library databases. Furthermore, relevant journals were searched by hand. References from identified studies were examined. Only RCTs were considered. Trial quality was assessed according to a standardized and validated set of criteria. Results Fourteen of 1661 retrieved papers met inclusion criteria. A total of 666 children were included in the review and 7 papers involved only children <5 years old. Papers were of average quality and all but one had been published during the previous 10 years by one of 8 research groups, 5 of which from the United States. Seven studies directly addressed AAC use by children with different disabilities. Seven studies enrolled typically developing children: 5 evaluated the use of AAC technologies by children without disabilities in order to obtain results that could be used to improve interventions in peers with disabilities, and 2 evaluated peers’ attitudes towards children who used AAC. Both interventions and outcome measures varied widely between studies. Overall findings demonstrate the effectiveness of the AAC interventions considered, but the focus on RCTs alone appears too restrictive. Conclusions Solid evidence of the positive effects of AAC interventions in children with severe communication disorders must be generated, and different methods are needed besides RCTs. Moreover, it is important that knowledge, research, and debate extend to the medical community in order to ensure clinically effective AAC provision for these children (and their parents).
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Cockerill H, Elbourne D, Allen E, Scrutton D, Will E, McNee A, Fairhurst C, Baird G. Speech, communication and use of augmentative communication in young people with cerebral palsy: the SH&PE population study. Child Care Health Dev 2014; 40:149-57. [PMID: 23656274 DOI: 10.1111/cch.12066] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Communication is frequently impaired in young people (YP) with bilateral cerebral palsy (CP). Important factors include motoric speech problems (dysarthria) and intellectual disability. Augmentative and Alternative Communication (AAC) techniques are often employed. The aim was to describe the speech problems in bilateral CP, factors associated with speech problems, current AAC provision and use, and to explore the views of both the parent/carer and young person about communication. METHODS A total population of children with bilateral CP (n = 346) from four consecutive years of births (1989-1992 inclusive) with onset of CP before 15 months were reassessed at age 16-18 years. Motor skills and speech were directly assessed and both parent/carer and the young person asked about communication and satisfaction with it. RESULTS Sixty had died, eight had other conditions, 243 consented and speech was assessed in 224 of whom 141 (63%) had impaired speech. Fifty-two (23% of total YP) were mainly intelligible to unfamiliar people, 22 (10%) were mostly unintelligible to unfamiliar people, 67 (30%) were mostly or wholly unintelligible even to familiar adults. However, 89% of parent/carers said that they could communicate 1:1 with their young person. Of the 128 YP who could independently complete the questions, 107 (83.6%) were happy with their communication, nine (7%) neither happy nor unhappy and 12 (9.4%) unhappy. A total of 72 of 224 (32%) were provided with one or more types of AAC but in a significant number (75% of 52 recorded) AAC was not used at home, only in school. Factors associated with speech impairment were severity of physical impairment, as measured by Gross Motor Function Scale level and manipulation in the best hand, intellectual disability and current epilepsy. CONCLUSIONS In a population representative group of YP, aged 16-18 years, with bilateral CP, 63% had impaired speech of varying severity, most had been provided with AAC but few used it at home for communication.
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Affiliation(s)
- H Cockerill
- Department of Paediatric Neurosciences Evelina Childrens Hospital Guy's and St Thomas NHS Foundation Trust, London, UK; King's Health Partners, London, UK; Department of Language and Communication Science, City University, London, UK
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Sacaze E, Garlantezec R, Rémy-néris O, Peudenier S, Rauscent H, le Tallec H, Bernier-Francois V, Pichancourt D, Brochard S. A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: Preliminary results. Ann Phys Rehabil Med 2013; 56:253-67. [DOI: 10.1016/j.rehab.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 11/21/2012] [Accepted: 11/24/2012] [Indexed: 11/30/2022]
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Positron emission tomography-computer tomography scan used as a monitoring tool following cellular therapy in cerebral palsy and mental retardation-a case report. Case Rep Neurol Med 2013; 2013:141983. [PMID: 23431488 PMCID: PMC3575675 DOI: 10.1155/2013/141983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/06/2012] [Indexed: 12/11/2022] Open
Abstract
Cerebral palsy (CP) is one of the non-progressive neurological diseases caused by damage to the brain tissue at birth, which leads to physical, cognitive and perceptive symptoms. Even after lifelong medical and therapeutic management there are residual deficits which affect the quality of life of the patients and their families. We examined a maximally rehabilitated, 20 year old male suffering from CP and Mental Retardation (MR). He had diplegic gait and Intelligence Quotient (IQ) score of 44 with affected fine motor activities, balance, speech and higher functions. Positron Emission Tomography—Computer Tomography (PET-CT) scan identified frontal, temporal, parietal, occipital, left cerebellar lobes, amygdala, hippocampus, and parahippocampus as the affected areas. He was treated with cellular therapy of Autologous Bone Marrow Derived Mono-Nuclear Cells (MNCs) transplantation followed by multidisciplinary rehabilitation. Six months following therapy, PET-CT scan showed significant increase in metabolic activity in all four lobes, mesial temporal structures and left cerebellar hemisphere, also supported by clinical improvement in IQ, social behavior, speech, balance and daily functioning. These findings provide preliminary evidence to support the efficacy of cellular therapy for the treatment of CP with MR. PET-CT scan can also be viewed as an impressive tool to monitor the effects of cellular therapy.
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Ferm U, Ahlsén E, Björck-Åkesson E. Patterns of communicative interaction between a child with severe speech and physical impairments and her caregiver during a mealtime activity. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2012; 37:11-26. [PMID: 22300257 DOI: 10.3109/13668250.2011.649718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Interaction between caregivers and children with severe impairments is closely related to the demands of daily activities. This study examines the relationship between interaction and the routine mealtime activity at home. METHOD Patterns of interaction between a child (aged 6 years and 6 months) with severe speech and physical impairments and her caregiver (focus dyad) and a child without impairments (aged 6 years and 6 months) and her caregiver (comparison dyad) were analysed using video recordings and activity-based communication analysis. RESULTS The focus dyad's interaction was unaided. The dyad did not use the Blissymbol board but communicated using words, vocalisations, word approximations, and body communication. Interaction in the focus dyad included relatively few pauses and frequent interchanges of short and sometimes simultaneous communicative contributions. Strong relations between patterns of interaction and immediate activity management goals such as assisting with eating, eating and drinking were found and compared for the two dyads. Results were discussed with regard to child development and communication intervention. CONCLUSIONS The focus dyad showed interactive efficiency and the fulfilment of goals relating to basic understanding and closeness, but mainly with regard to immediate mealtime issues. The comparison child and caregiver were more independent in the activity which made it possible for them to reach more extensive, and from a child perspective, age-adequate goals than the focus dyad.
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Affiliation(s)
- Ulrika Ferm
- DART-Centre for Augmentative and Alternative Communication and Assistive Technology, Regional Habilitation Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Sweden.
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Wadnerkar MB, Pirinen T, Haines-Bazrafshan R, Rodgers J, James D. A single case study of a family-centred intervention with a young girl with cerebral palsy who is a multimodal communicator. Child Care Health Dev 2012; 38:87-97. [PMID: 21392057 DOI: 10.1111/j.1365-2214.2011.01214.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This paper describes the impact of a family-centred intervention that used video to enhance communication in a young girl with cerebral palsy. This single case study describes how the video-based intervention worked in the context of multimodal communication, which included high-tech augmentative and alternative communication (AAC) device use. This paper includes the family's perspective of the video intervention and they describe the impact of it on their family. METHODS This single case study was based on the premise that the video interaction guidance intervention would increase attentiveness between participants during communication. It tests a hypothesis that eye gaze is a fundamental prerequisite for all communicative initiatives, regardless of modality in the child. Multimodality is described as the range of communicative behaviours used by the child and these are coded as AAC communication, vocalizations (intelligible and unintelligible), sign communication, nodding and pointing. Change was analysed over time with multiple testing both pre and post intervention. Data were analysed within INTERACT, a computer software to analyse behaviourally observed data. Behaviours were analysed for frequency and duration, contingency and co-occurrence. RESULTS Results indicated increased duration of mother's and girl's eye gaze, increased frequency and duration in AAC communication by the girl and significant change in frequency [χ(2) (5, n = 1) = 13.25, P < 0.05] and duration [χ(2) (5, n = 1) = 12.57, P < 0.05] of the girl's multimodal communicative behaviours. Contingency and co-occurrence analysis indicated that mother's eye gaze followed by AAC communication was the most prominent change between the pre- and post-intervention assessments. CONCLUSIONS There was a trend for increased eye gaze in both mum and girl and AAC communication in the girl following the video intervention. The family's perspective concurs with the results.
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Affiliation(s)
- M B Wadnerkar
- NIHR National Biomedical Research Unit in Hearing, University of Nottingham, UK
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Roulstone S. Evidence, expertise, and patient preference in speech-language pathology. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 13:43-48. [PMID: 21329410 DOI: 10.3109/17549507.2010.491130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A consideration of evidence-based practice has led many to debate the nature of evidence. Rejecting the idea that randomized controlled trials should be the only legitimate source of evidence, writers have argued that other types of research and knowledge should be considered legitimate sources of evidence. This paper suggests that one should draw on systematic research, including qualitative research, for evidence, and that other types of knowledge such as craft and practice knowledge are part of the profession's expertise. This paper argues that evidence and expertise are both required for evidence-based practice to occur. Finally, a consideration of patients' values and expectations is explored as a third component of evidence-based practice. The paper argues that all three components are necessary for evidence-based practice.
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Amatya B, Khan F. Rehabilitation for cerebral palsy: Analysis of the Australian rehabilitation outcome dataset. J Neurosci Rural Pract 2011; 2:43-9. [PMID: 21716838 PMCID: PMC3123005 DOI: 10.4103/0976-3147.80097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To examine the outcome of inpatient rehabilitation for cerebral palsy (CP), using the Australian Rehabilitation Outcomes Center (AROC) database. Materials and Methods: De-identified data from the AROC database was analyzed for all rehabilitation admissions during 2003 – 2008, using four classes for the functional level. The outcomes included: Functional Independence Measure (FIM) scores, FIM efficiency, hospital length of stay (LOS), and discharge destination. Results: Of 141 case episodes 56.7% were female, mean age 48.5 years, 87.2% were discharged to the community and 64.5% (n = 91) were in the lowest functional classes (217, 218, and 219). The majority of CP patients were treated in the public hospital system (66.7% versus 33.3%), and had a slightly longer LOS compared with those treated in private facilities (22.6 versus 17.9 days, mean difference - 4.7 days, 95% CI - 9.2 to - 0.2, P = 0.041). The FIM for all classes (216 – 218) showed significant functional improvement during the admission (P = 0.001). As expected those in the most functionally impaired classes showed most change (FIM change: 16.6 in class 217, 15.3 in class 218). FIM efficiency was the highest in classes 217 compared to the other classes. The year-to-year trend demonstrated a mixed pattern for hospital LOS and was not significant (P = 0.492). Conclusion: The AROC dataset is a valuable research tool for describing rehabilitation outcomes. However, more specific information needs to be collected alongside the core AROC data, to allow a more meaningful evaluation of outcomes for CP rehabilitation.
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Affiliation(s)
- Bhasker Amatya
- Department of Rehabiliation Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Fary Khan
- Department of Rehabiliation Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
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Schlosser RW, Sigafoos J. Navigating Evidence-Based Information Sources in Augmentative and Alternative Communication. Augment Altern Commun 2009; 25:225-35. [DOI: 10.3109/07434610903360649] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pennington L, Thomson K, James P, Martin L, McNally R. Effects of it takes two to talk--the hanen program for parents of preschool children with cerebral palsy: findings from an exploratory study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2009; 52:1121-1138. [PMID: 19635943 DOI: 10.1044/1092-4388(2009/07-0187)] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To investigate whether It Takes Two to Talk-The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents. METHOD Eleven children aged 19-36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion. RESULTS Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers' linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers' views of parenting did not change. CONCLUSIONS It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.
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Affiliation(s)
- Lindsay Pennington
- Newcastle University-Clinical Medical Sciences (Child Health), Sir James Spence Institute Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom.
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Garth B, Murphy GC, Reddihough DS. Perceptions of participation: child patients with a disability in the doctor-parent-child partnership. PATIENT EDUCATION AND COUNSELING 2009; 74:45-52. [PMID: 18760558 DOI: 10.1016/j.pec.2008.07.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 06/03/2008] [Accepted: 07/15/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To explore how the doctor-parent-child partnership is experienced and if the child patient is considered a contributor. METHODS Qualitative methodology using semi-structured interviews with 33 participants (9 paediatricians, 14 parents, and 10 children aged 8-12 with cerebral palsy) from a paediatric teaching hospital in Victoria, Australia. RESULTS Children were reported to participate in the doctor-parent-child partnership. The child was not perceived to be an 'equal' or 'regular' partner as there were reports of variability in the involvement between children, as well as variability in the progressive involvement of each child. Three categories emerged in relation to the child's position in the partnership: creating a space for the child's involvement; acknowledging the variability of child preferences to be involved; and negotiating the child's age and development. CONCLUSION The doctor-parent-child partnership was perceived not necessarily to be dyadic, shared exclusively by the parent and paediatrician. Children were reported to contribute to the partnership, although there were limitations to the child's involvement. PRACTICE IMPLICATIONS Previous understandings of partnership are not sufficient to explain the complexities involved in a doctor-parent-child partnership, and a social-model approach to care is highlighted as an important factor for enabling the development of a triadic partnership.
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Affiliation(s)
- Belinda Garth
- School of Public Health, Faculty of Health Science, La Trobe University, Bundoora 3086, Victoria, Australia.
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Idro R, Carter JA, Fegan G, Neville BGR, Newton CRJC. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 2006; 91:142-8. [PMID: 16326798 PMCID: PMC2082712 DOI: 10.1136/adc.2005.077784] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Persisting neurological and cognitive impairments are common after cerebral malaria. Although risk factors for gross deficits on discharge have been described, few studies have examined those associated with persistent impairments. METHODS The risk factors for impairments following cerebral malaria were determined by examining hospital records of 143 children aged 6-9 years, previously admitted with cerebral malaria, who were assessed at least 20 months after discharge to detect motor, speech and language, and other cognitive (memory, attention, and non-verbal functioning) impairments. RESULTS The median age on admission was 30 months (IQR 19-42) and the median time from discharge to assessment was 64 months (IQR 40-78). Thirty four children (23.8%) were defined as having impairments: 14 (9.8%) in motor, 16 (11.2%) in speech and language, and 20 (14.0%) in other cognitive functions. Previous seizures (OR 5.6, 95% CI 2.0 to 16.0), deep coma on admission (OR 28.8, 95% CI 3.0 to 280), focal neurological signs observed during admission (OR 4.6, 95% CI 1.1 to 19.6), and neurological deficits on discharge (OR 4.5, 95% CI 1.4 to 13.8) were independently associated with persisting impairments. In addition, multiple seizures were associated with motor impairment, age <3 years, severe malnutrition, features of intracranial hypertension, and hypoglycaemia with language impairments, while prolonged coma, severe malnutrition, and hypoglycaemia were associated with impairments in other cognitive functions. CONCLUSIONS Risk factors for persisting neurological and cognitive impairments following cerebral malaria include multiple seizures, deep/prolonged coma, hypoglycaemia, and clinical features of intracranial hypertension. Although there are overlaps in impaired functions and risk factors, the differences in risk factors for specific functions may suggest separate mechanisms for neuronal damage. These factors could form the basis of future preventive strategies for persisting impairments.
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Affiliation(s)
- R Idro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute/Wellcome Trust Research Labs, Kilifi, Kenya.
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Pennington L, Goldbart J, Marshall J. Speech and language therapy to improve the communication skills of children with cerebral palsy. Cochrane Database Syst Rev 2004; 2004:CD003466. [PMID: 15106204 PMCID: PMC8407241 DOI: 10.1002/14651858.cd003466.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited. OBJECTIVES To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns. SEARCH STRATEGY Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched. SELECTION CRITERIA Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined. DATA COLLECTION AND ANALYSIS L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers. MAIN RESULTS Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment. REVIEWERS' CONCLUSIONS Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Juliet Goldbart
- Manchester Metropolitan UniversityDepartment of Psychology and Speech PathologyElizabeth Gaskell SiteHathersage RoadManchesterUKM13 0JA
| | - Julie Marshall
- Manchester Metropolitan UniversityProfessional Registration DeptElizabeth Gaskell SiteHathersage RoadManchesterUKM13 0JA
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