How does participation of youth with spina bifida vary by age?

Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature

Objectives

The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies.

Methods

A literature review of articles published in English and French between 1990 and April 2020 was conducted.

Results

Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases.

Conclusion

Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.

Occupation Based Telerehabilitation Intervention for Adolescents with Myelomeningocele: A Pilot Study

AIMS

This pilot study examined the impact of an occupation based intervention using a telerehabilitation format with adolescents with myelomeningocele (MMC).

METHODS

We conducted a nonrandomized pilot study including four adolescents ages 14-18 with MMC. The intervention program included 10-12 sessions of the Cognitive Orientation to daily Occupational Performance remotely delivered via videoconferencing. Outcome measures included the Canadian Occupational Performance Measure (COPM), Wee-Functional Independence Measure;(Wee-FIM), and the Pediatric Quality of Life Inventory (PedsQL). Assessments were administered at baseline, post intervention and at three-month follow-up.

RESULTS

Following intervention, participants rated their performance as having improved 2 points on the COPM for 8 out of 12 trained goals and on 2 out of 8 untrained goals. At 3-month follow-up improvement was reported on 9 out of 12 trained goals and 3 out of 8 untrained goals All participants made clinically significant improvements on the Wee-FIM total score following intervention and improvements were maintained at 3-month follow-up. The intervention effect on the PedsQL was inconclusive. Feedback interviews suggested that participants experience high satisfaction from the results and implementation of the intervention.

CONCLUSIONS

Our results demonstrate potential efficacy of occupation based teleintervention for adolescents with MMC.

Views on everyday life among adults with spina bifida: an exploration through photovoice

The aim of this study was to actively integrate expertise of persons living with spina bifida, to explore conditions embedded in their everyday life. This was important because young adults with spina bifida risk not being able to fully participate in the community on equal terms and in accordance with their own preferences. Photovoice, a community-based participatory research approach, was utilized to engage participants through dialogue and photography. An exhibition was created to share results with community and stakeholders. An overarching theme that characterized the experiences of the group was, “an adaptation for us, but it works for no one”. Findings are presented as: “Accessibility—a never-ending project,” “Tensions of a normative view,” and “Power to influence.” Findings integrated everyday life metaphors photographically depicted by broken elevators, unsafe transportation, closed doors and not experiencing real opportunities of involvement. Tensions in everyday life experienced by persons living with spina bifida can inform conditions relevant and necessary to support community participation, particulary among persons living with disability.

Patterns and predictors of participation in children and adolescents with spina bifida

Purpose: Participation is defined as involvement and engagement in all life situations and is seen as an essential condition for children's development. Here, we analyzed the patterns and predictors of participation for Lithuanian children and adolescents with spina bifida (SB).Material and methods: A cross-sectional design was employed. Parents of children aged 5-18 years with SB (n = 99) completed the Participation and Environment Measure for Children and Youth. Information about children's health conditions and functional issues was also collected. Descriptive statistics were used to analyze participation patterns, and multiple linear regression analyses were employed to identify the significant explanatory factors in each setting.Results: Participation restriction was mainly observed in preschool/school and the community settings. The environmental factors consistently explained at least one dimension of participation across all settings. Intellectual abilities had a substantial effect on participation in the home and preschool/school setting, whereas the contribution of bowel incontinence was observed in the preschool/school setting.Conclusions: Our findings highlight the role of intellectual functioning, bowel continence, and the environmental factors in explaining participation of children with SB across different settings and, therefore, demonstrate the need for more supports and environmental modifications (especially for those who have lower level of cognitive abilities), as well as interventions targeting improved bowel continence.Implications for rehabilitationChildren with spina bifida had low levels of participation in the community and preschool/school settings.The most important predictors for participation were intellectual abilities, bowel continence, and the environmental factors.Practitioners should pay more attention to environmental modifications (especially for children who have lower level of cognitive abilities) as primary targets of interventions aimed at promoting participation.Strategies to improve bowel continence could improve participation in the preschool/school setting.

Participation of Children with Spina Bifida: A Scoping Review Using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a Reference Framework

Background and objectives. Participation is a fundamental right of the child, regardless of his health status. Assessing and supporting the participation of children with spina bifida (SB) presents a significant challenge for practitioners. The purpose of this study was to examine what is known about the participation of children with SB. Materials and Methods. The framework for scoping reviews from Arksey & O’Malley was used. A literature search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (Medline), PsychINFO and the Education Resources Information Centre (ERIC) databases retrieved 136 papers, 10 of which met the criteria for inclusion and were selected for analysis. Synthesis of the results on participation within occupational domains of leisure, school and community, and factors influencing participation of children with SB was performed. Results. All the included studies were non-experimental and used cross-sectional, population-based or qualitative design. Most studies analysed social participation or participation in physical activities, except one that focused on school participation. Data from these studies have shown that children with SB experience greater participation restrictions compared to their typical peers or children with other chronic diseases. The participation was mainly affected by contextual factors. Relationships between pathology and participation were not sufficiently validated. Conclusions. There is little research on the participation of children with SB. Future studies must consider contextual factors and interventions facilitating or impeding participation.

Obesity Prevention for Individuals with Spina Bifida

PURPOSE OF REVIEW

Obesity is a common comorbidity in individuals with spina bifida. Carrying excess weight exacerbates the inherent health challenges associated with spina bifida, impedes the individual's ability to self-manage their condition, and creates further challenges for family members and caregivers. This manuscript provides a narrative review of key issues for understanding and prevention of obesity in persons with spina bifida within the context of the social ecological model.

RECENT FINDINGS

Specific variables related to obesity and spina bifida include individual factors (i.e., body composition and measurement issues, energy needs, eating patterns, physical activity, and sedentary activity) family factors (i.e., parenting/family, peers), community factors (i.e., culture, built environment, healthcare and healthcare providers, and school), and societal factors (i.e., policy issues). Due to the complex etiology of obesity and its increased prevalence in individuals with spina bifida, it is critical to initiate prevention efforts early with a multifactorial approach for this at-risk population. Increased research is warranted to support these efforts.

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model

PURPOSE

To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model.

METHOD

113 children with MMC, aged 3-18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain.

RESULTS

The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p = 0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function.

CONCLUSION

In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence. Implications for Rehabilitation When working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability. Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence. It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains. Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living. It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age. While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

A qualitative exploration of the experiences of children with spina bifida and their parents around incontinence and social participation

BACKGROUND

Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about children's experiences of these continence issues.

OBJECTIVE

This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide.

METHODS

Children and youth aged 6-18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed.

RESULTS

Eleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance.

DISCUSSION

The experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence.

Spina bifida

Spina bifida is a birth defect in which the vertebral column is open, often with spinal cord involvement. The most clinically significant subtype is myelomeningocele (open spina bifida), which is a condition characterized by failure of the lumbosacral spinal neural tube to close during embryonic development. The exposed neural tissue degenerates in utero, resulting in neurological deficit that varies with the level of the lesion. Occurring in approximately 1 per 1,000 births worldwide, myelomeningocele is one of the most common congenital malformations, but its cause is largely unknown. The genetic component is estimated at 60-70%, but few causative genes have been identified to date, despite much information from mouse models. Non-genetic maternal risk factors include reduced folate intake, anticonvulsant therapy, diabetes mellitus and obesity. Primary prevention by periconceptional supplementation with folic acid has been demonstrated in clinical trials, leading to food fortification programmes in many countries. Prenatal diagnosis is achieved by ultrasonography, enabling women to seek termination of pregnancy. Individuals who survive to birth have their lesions closed surgically, with subsequent management of associated defects, including the Chiari II brain malformation, hydrocephalus, and urological and orthopaedic sequelae. Fetal surgical repair of myelomeningocele has been associated with improved early neurological outcome compared with postnatal operation. Myelomeningocele affects quality of life during childhood, adolescence and adulthood, posing a challenge for individuals, families and society as a whole. For an illustrated summary of this Primer, visit: http://go.nature.com/fK9XNa.

Association between motor functioning and leisure participation of children with physical disability: an integrative review

AIM

The aim of this integrative review is to synthesize the evidence of association between motor functioning and leisure participation of children with physical disability.

METHOD

We conducted a systematic electronic search of key databases from the period 1 January 2001 to 30 April 2014 using relevant keywords. The Mixed Method Appraisal Tool was used to assess the quality of the qualitative and quantitative studies included and carried out in children with physical disability aged 6 to 12 years. We synthesized and compared information from both type of studies to identify the extent, and way by which, motor functioning influences leisure participation.

RESULTS

Thirty-five studies were included and analyzed for this review. Twenty-four studies used quantitative and 11 studies used qualitative methodology. We identified the association between motor functioning and six dimensions of participation including diversity, intensity, context, preferences, enjoyment and quality of participation. Motor functioning was found to have a weak to moderate association with involvement in specific leisure activity types and dimensions. We developed a conceptual framework to illustrate the influence of motor functioning on leisure participation from this review.

INTERPRETATION

Whether motor functioning poses a barrier to leisure participation for children with physical disability appears to depend on the functional movement required to participate in a particular leisure activity.

The participation of children and youth with disabilities in activities outside of school: A scoping review

Background.

Participation in occupations is vital for learning and development. Children with disabilities are at risk for decreased participation.

Purpose.

The purpose of this study is to examine peer-reviewed literature about the participation-based experiences of children and youth with disabilities in activities outside of formal preschool and school academics.

Method.

A scoping review was conducted to examine research studies published between 1990 and 2012. Studies included participants from 2 to 18 years who had at least one physical or intellectual/cognitive disability.

Findings.

Forty-nine articles discussing 32 studies and three systematic reviews met the inclusion criteria. Perceptions of and influences on participation were important emerging themes about direct impacts on patterns of participation. A child or youth’s level of functioning, activity level, level of enjoyment, and contextual factors were found to influence their level of successful participation.

Implications.

Occupational therapists can use the findings from this review to consider supports and barriers within interventions to enhance participation in meaningful life situations.

Exploring psychosocial correlates of physical activity among children and adolescents with spina bifida

BACKGROUND

To enhance physical activity of children with spina bifida, it is important to investigate the correlates of physical activity to support the development of interventions to promote active lifestyles.

OBJECTIVE

This study aimed to identify psychosocial correlates of physical activity among children and adolescents with spina bifida.

METHODS

A survey was conducted with 31 students (15 boys), aged 10-17 years with spina bifida. A questionnaire was used to collect data of physical activity, demographic and psychosocial variables (attitudes, sports goal orientation and perceptions). Unadjusted and adjusted binary logistic regressions were performed to examine the relationship of psychosocial factors and physical activity participation. Data were collected in 2013.

RESULTS

Only 38.7% reported to participate in both organized and non-organized physical activity. Results showed no relationship between participation in organized and non-organized physical activity and psychosocial correlates. The result of the adjusted regression analysis show that perception of competence (OR = 9.55, 1.06-85.99, p < 0.05) was the only variable positively associated with participation in non-organized physical activity.

CONCLUSIONS

Most of the participants reported that they did not participate in physical activity regularly. Psychosocial variables were not related with physical activity, except perception of competence. Studies with bigger samples are needed, focused on the same and in others factors to identify the predictors of physical activity of young people with spina bifida.

Physical fitness and exercise training on individuals with spina bifida: a systematic review

Spina Bifida (SB) is characterized by several physical impairments; however, data on physical fitness and on the benefits of exercise training in individuals with SB are dispersed in the literature. Thus, this systematic review aimed to describe (i) physical fitness components (cardiorespiratory endurance, muscle strength, body composition, flexibility and neuromotor) and (ii) exercise training effects on the physical fitness of individuals with SB. CINAHL, MEDLINE and EMBASE were searched from January to March 2013 and updated in December 2013. Twenty-three studies were included. A summary of the results was performed using a best-evidence synthesis. Participants with SB had lower cardiorespiratory endurance (-32 to 54% in VO2 peak) and muscle strength (-58 to 90%) and higher body fat (159%) than their healthy peers. Mobility restrictions were present in 26.3-61% of participants. No data on neuromotor fitness were found. Aerobic and strength training improved participants' cardiorespiratory endurance (effect sizes 0.78-1.4) and muscle strength (effect sizes 0-0.59). Individuals with SB have impaired cardiorespiratory endurance, muscle strength, body composition and flexibility when compared to healthy peers. Exercise training seems to improve two of these fitness components (cardiorespiratory endurance and muscle strength). Nevertheless, the heterogeneity of the studies' designs, methods and instruments used limits the establishment of firm conclusions and highlights the need for further research.

Health-related quality of life for children with rare diagnoses, their parents' satisfaction with life and the association between the two

Purpose

To examine children’s health-related quality of life and parents’ satisfaction with life and explore the association between the two in families where a child has a rare disorder.

Methods

We used a cross-sectional study design. A questionnaire was sent to parents of 439 school children (6–18 years) with congenital rare disorders. Children’s health-related quality of life (HRQOL) was examined by Pediatric Quality of Life Inventory^TM 4.0 (PedsQL) Norwegian version. Satisfaction with life was examined by Satisfaction with Life Scale (SWLS).

Results

The response rate was 48% (n = 209). The average age of the children was 12 years and 50% were girls. The parents scored their children with reduced physical, emotional, social and school functioning. The reductions were greatest in the physical area. Parents scored average to high on SWLS but significantly lower than the general Norwegian population. There was a positive association between parental SWLS and the children’s social functioning and school functioning.

Conclusion

Children with congenital, rare disorders often require assistance from many parts of the public service system. Caring for their physical needs should not conflict with their educational and social needs. It is important that the children’s school-life is organized so that the diagnosis does not interfere with the children’s education and social life more than necessary.