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Rosenberg L, Zecharia S, Gilboa Y, Golos A. Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy. Disabil Rehabil 2024:1-8. [PMID: 38591970 DOI: 10.1080/09638288.2024.2339535] [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: 09/24/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention. MATERIALS AND METHODS An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context. RESULTS Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living. CONCLUSIONS The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.
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Affiliation(s)
- Lori Rosenberg
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Shira Zecharia
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Anat Golos
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Rioual J, Perret C, Arnaud C, Vidart d’Egurbide Bagazgoïtia N. Unmet environmental needs and unmet healthcare needs in a population of young adults with cerebral palsy: what the SPARCLE study tells us. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294999. [PMID: 38370854 PMCID: PMC10869570 DOI: 10.3389/fresc.2024.1294999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
Introduction Optimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling. Methods Young adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs. Results We studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment. Discussion Our results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.
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Affiliation(s)
- Jonathan Rioual
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Célia Perret
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
- Clinical Epidemiology Unit, University Hospital, Toulouse, France
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Bergqvist L, Öhrvall AM, Peny-Dahlstrand M. The 'process of doing' in everyday occupations - a challenge for young adults with cerebral palsy. Scand J Occup Ther 2024; 31:2251528. [PMID: 37647414 DOI: 10.1080/11038128.2023.2251528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
Background: There is a lack of knowledge about how persons with cerebral palsy (CP) perceive their 'process of doing' while performing everyday occupations. As described in the Model of the Process of Doing (MPoD), performing an occupation is a complex process consisting of six phases (generate idea, plan, initiate, enact, adjust, end) and time management.Aim: To collect the experiences of young adults with CP, classified at Manual Ability Classification System (MACS) level I or II, regarding how they perceive challenges in their occupational performance in relation to the different phases of the 'process of doing'.Method: Semi-structured interviews were performed with ten participants with CP aged 19-30 years, MACS level I or II. The interview material was related to the MPoD phases using directed content analysis.Results: The participants' descriptions of how they perceived their personal 'process of doing' showed problems in all MPoD phases. All participants experienced difficulties in one or more phases, but none had difficulties in all phases. Difficulties were more frequent in some phases than in others.Conclusion/Significance: To understand the complexity of doing everyday occupations in young adults with CP, there is a need to address all phases of the 'process of doing'.
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Affiliation(s)
- L Bergqvist
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A M Öhrvall
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - M Peny-Dahlstrand
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pizzighello S, Raggi A, Vavla M, Uliana M, Pellegri A, Martinuzzi M, Martinuzzi A. The perception of disability in cerebral palsy: a cross-sectional study using the WHODAS 2.0. Dev Neurorehabil 2023; 26:302-308. [PMID: 37403444 DOI: 10.1080/17518423.2023.2232002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023]
Abstract
This observational study aims to describe the level of perceived disability in Cerebral Palsy (CP). We described the perception of adults by using the interviewer-administered version of the WHO disability assessment schedule (WHODAS 2.0). In case of intellectual disability (ID), the proxy-administered version was used, and a caregiver was asked to report the difficulties experienced by the patient; 199 patients were enrolled. The level of perceived disability was higher when referred to patients with ID (proxy report) than when referred to patients without ID (p < .001). For all patients, the level of perceived disability varied depending on the severity and the localization of motor impairment (both p < .001). No differences were observed based on the type of motor impairment. The perceived disability was correlated with age only for patients with no ID (p < .05). The WHODAS 2.0 may be a useful tool to explore the perception of disability in CP.
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Affiliation(s)
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, UOC Neurologia Salute Pubblica E Disabilità, Lombardia, Italy
| | - Marinela Vavla
- Department of Women's and Children's Health, Padoua University Hospital, Child and Adolescent Neuropsychiatry, Padoua, Italy
| | - Marianna Uliana
- Scientific Institute, IRCCS E.Medea, Conegliano, Treviso, Italy
| | - Alda Pellegri
- Scientific Institute, IRCCS E.Medea, Scientific Institute, IRCCS, Bosisio Parini, Lecco, Italy
| | - Michela Martinuzzi
- Department of medecine, King's College London GKT School of Medical Education, London, UK
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Masaki M, Uchikawa Y, Iizuka Y, Sugawara K, Isobe H, Hattori F, Okamoto M, Takahashi S, Morohashi E, Kitamura Y. Association of activities of daily living and cognitive function with thickness of the upper extremity muscles in children and adults with cerebral palsy. J Med Ultrason (2001) 2023; 50:245-252. [PMID: 36995568 DOI: 10.1007/s10396-023-01292-0] [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: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE We examined the association of activities of daily living (ADL) and cognitive function with the upper extremity muscle thickness and upper extremity range of motion (ROM) and spasticity in children and adults with cerebral palsy (CP). METHODS The subjects were 20 children and adults with CP. The ADL performed using the upper extremities and cognitive function were assessed using the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI) and the full-scale intelligence quotient (FSIQ) of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), respectively. The WISC-IV was assessed in only seven of 20 subjects able to undergo evaluation. The thickness of the upper extremity muscles was measured using an ultrasound imaging device. Moreover, ROM and spasticity of the upper extremities were assessed using the Modified Ashworth Scale (MAS). Manual manipulation ability was also assessed using the Manual Ability Classification System (MACS). RESULTS Stepwise regression analysis revealed that the extensor digitorum muscle thickness and MACS level were significant and independent factors of self-care in the PEDI. Partial correlation analysis with MACS level and age as control variables showed that the FSIQ of the WISC-IV was significantly associated with the thickness of the anterior fibers of the deltoid and flexor digitorum superficialis muscles. CONCLUSION Reduced ADL performed using the upper extremities is associated with decreased extensor digitorum muscle thickness rather than ROM and spasticity of the upper extremities in children and adults with CP.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, 501 Nakaorui-Machi, Takasaki, Gunma, 370-0033, Japan.
| | - Yuki Uchikawa
- Department of Rehabilitation, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, 300-2622, Japan
| | - Yuka Iizuka
- Department of Rehabilitation, IMS Fujimi General Hospital, 1967-1 Tsuruma, Fujimi, Saitama, 354-0021, Japan
| | - Karin Sugawara
- Department of Rehabilitation, Niigata Rehabilitation Hospital, 761 Kizaki, Kita-Ku, Niigata, Niigata, 950-3304, Japan
| | - Honoka Isobe
- Department of Rehabilitation, Ibaraki Seinan Medical Center Hospital, 2190 Sakaimachi, Sashimagun, Ibaraki, 306-0400, Japan
| | - Fuyumi Hattori
- Department of Rehabilitation, Mizuno Memorial Hospital, 6-32-10 Nishiarai, Adachi-Ku, Tokyo, 123-0841, Japan
| | - Mami Okamoto
- Musashino City Development Support Center for Children, Midori-No Kodomokan, 2-6-8 Midori-Cho, Musashino, Tokyo, 180-0012, Japan
| | - Saki Takahashi
- Department of Rehabilitation, Gunma Seishi Ryougoen, 146-1 Ashikado-Machi, Takasaki, Gunma, 370-3531, Japan
| | - Emina Morohashi
- Department of Rehabilitation, National Hospital Organization Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-Ku, Niigata, Niigata, 950-2085, Japan
| | - Yuki Kitamura
- Department of Rehabilitation, National Hospital Organization Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-Ku, Niigata, Niigata, 950-2085, Japan
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Gjesdal BE, Mæland S, Bogen B, Cumming KT, Nesse VC, Torberntsson SMR, Rygh CB. Ballistic strength training in adults with cerebral palsy may increase rate of force development in plantar flexors, but transition to walking remains unclear: a case series. BMC Sports Sci Med Rehabil 2022; 14:101. [PMID: 35659348 PMCID: PMC9166478 DOI: 10.1186/s13102-022-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
Background Persons with cerebral palsy (CP) walk with reduced ankle plantar flexor power compared to typically developing. In this study, we investigated whether a ballistic strength-training programme targeting ankle plantar flexors could improve muscle strength, muscle architecture and walking function in adults with CP. Methods Eight adults (mildly affected CP) underwent eight weeks of ballistic strength training, with two sessions per week. Before and after the intervention preferred walking speed, ankle plantar flexion rate of force development (RFD), maximal voluntary contraction (MVC), muscle thickness, pennation angle and fascicle length were measured. Data are presented for individuals, as well as for groups. Group changes were analysed using the Wilcoxon signed-rank test. Results Data were analysed for eight participants (five women, mean age 37.9 years; six GMFCS I and two GMFCS II). Two participants increased their walking speed, but there were no significant group changes. In terms of muscle strength, there were significant group changes for RFD at 100 ms and MVC. In the case of muscle architecture, there were no group changes. Conclusion In this study, we found that eight weeks of ballistic strength training improved ankle plantar flexor muscle strength but walking function and muscle architecture were unchanged. Larger studies will be needed to obtain conclusive evidence of the efficacy of this training method. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00487-1.
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Affiliation(s)
- Beate Eltarvåg Gjesdal
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway. .,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - S Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - B Bogen
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - K T Cumming
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
| | - V C Nesse
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - S M R Torberntsson
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - C B Rygh
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
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Gorter JW, Fehlings D, Ferro MA, Gonzalez A, Green AD, Hopmans SN, McCauley D, Palisano RJ, Rosenbaum P, Speller B. Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project. J Clin Med 2022; 11:jcm11113060. [PMID: 35683448 PMCID: PMC9181041 DOI: 10.3390/jcm11113060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.
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Affiliation(s)
- Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Correspondence:
| | - Darcy Fehlings
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON M4G 1R8, Canada
| | - Mark A. Ferro
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Amanda D. Green
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Sarah N. Hopmans
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Robert J. Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Brittany Speller
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
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Al Imam MH, Jahan I, Das MC, Muhit M, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Rehabilitation status of children with cerebral palsy in Bangladesh: Findings from the Bangladesh Cerebral Palsy Register. PLoS One 2021; 16:e0250640. [PMID: 33939721 PMCID: PMC8092763 DOI: 10.1371/journal.pone.0250640] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the rehabilitation status and factors associated with rehabilitation service utilisation among children with cerebral palsy (CP) in Bangladesh. MATERIALS AND METHODS This is a population-based surveillance study conducted among children with CP registered in the Bangladesh CP Register (BCPR), the first population-based register of children with CP aged <18 years (y) in Bangladesh. Children with CP were identified from the community using the key informant method and underwent a detailed neurodevelopmental assessment. Socio-demographic, clinical and rehabilitation status were documented. Unadjusted and adjusted analyses with a 95% confidence interval (CI) were used to identify potential predictors of rehabilitation service uptake. RESULTS Between January 2015 and December 2019, 2852 children with CP were registered in the BCPR (mean (standard deviation, SD) age: 7 y 8 months (mo) (4 y 7 mo), 38.5% female). Of these, 50.2% had received rehabilitation services; physiotherapy was the most common type of service (90.0%). The mean (SD) age at commencement of rehabilitation services was 3 y 10 mo (3 y 1 mo). The odds of not receiving rehabilitation was significantly higher among female children (adjusted odds ratio (aOR) 1.3 [95% CI: 1.0-1.7], children whose mothers were illiterate and primary level completed (aOR 2.1 [95% CI: 1.4-3.1] and aOR 1.5 [95% CI: 1.1-2.1], respectively), fathers were illiterate (aOR 1.9 [95% CI: 1.3-2.8]), had a monthly family income ~US$ 59-118 (aOR: 1.8 [95% CI: 1.2-2.6]), had hearing impairment (aOR: 2.3 [95% CI: 1.5-3.5]) and motor severity (i.e. Gross Motor Function Classification System level III (aOR: 0.6 [95% CI: 0.3-0.9]) and level V (aOR: 0.4 [95% CI: 0.2-0.7])). CONCLUSIONS Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement. A community-based rehabilitation model focusing on socio-demographic and clinical characteristics should be a public health priority in Bangladesh.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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Tajik-Parvinchi D, Davis A, Roth S, Rosenbaum P, Hopmans SN, Dudin A, Hall G, Gorter JW. Functional connectivity and quality of life in young adults with cerebral palsy: a feasibility study. BMC Neurol 2020; 20:388. [PMID: 33096988 PMCID: PMC7583292 DOI: 10.1186/s12883-020-01950-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is a group of disorders that affect the development of movement and posture. CP results from injuries to the immature brain during the prenatal, perinatal, or postnatal stage of development. Neuroimaging research in CP has focused on the structural changes of the brain during early development, but little is known about brain's structural and functional changes during late adolescence and early adulthood, a period in time when individuals experience major changes as they transition into adulthood. The work reported here served as a feasibility study within a larger program of research (MyStory Study). We aimed to determine whether it would be feasible to scan and obtain good quality data without the use of sedation during a resting state condition for functional connectivity (FC) analyses in young adults with CP. Second, we aimed to identify the FC pattern(s) that are associated with depressive mood ratings, indices of pain and fatigue, and quality of life in this group. METHODS Resting state functional images were collected from 9 young people with CP (18-29 years). We applied a stringent head motion correction and quality control methods following preprocessing. RESULTS We were able to scan and obtain good quality data without the use of sedation from this group of young individuals with CP who demonstrated a range of gross motor ability. The functional connectivity networks of interest were identified in the data using standard seed regions. Our analyses further revealed that higher well-being scores were associated with higher levels of FC between the Medial Pre-Frontal Cortex and the right Lateral Parietal regions, which are implicated in prosocial and emotion regulations skills. The implications of this association are discussed. CONCLUSION The findings of the present study demonstrate that it is feasible to conduct resting state functional connectivity in young adults with CP with different gross motor abilities without the use of sedation. Our results also highlight a neural circuitry that is associated with the self-report of quality of life and emotion regulation. These findings identify these regions/circuitries as important seeds for further investigations into mental health and wellbeing in CP.
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Affiliation(s)
- Diana Tajik-Parvinchi
- Department of Pediatrics and CanChild, McMaster University, Hamilton, Ontario, L8S 1C7, Canada.
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 1C7, Canada.
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Andrew Davis
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Sophia Roth
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Peter Rosenbaum
- Department of Pediatrics and CanChild, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Sarah N Hopmans
- Department of Pediatrics and CanChild, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Aya Dudin
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Geoffrey Hall
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
| | - Jan Willem Gorter
- Department of Pediatrics and CanChild, McMaster University, Hamilton, Ontario, L8S 1C7, Canada
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10
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Lee M, Heo HH. Investigating similarities and differences in health needs according to disability type using the International Classification of Functioning, Disability and Health. Disabil Rehabil 2020; 43:3723-3732. [PMID: 32525419 DOI: 10.1080/09638288.2020.1773941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: This study aimed to investigate the health needs of adults with disabilities in South Korea according to disability type using the International Classification of Functioning, Disability and Health (ICF).Materials and methods: An exploratory, qualitative approach using content analysis was employed. Five focus groups consisted of six to seven participants with visual impairment (PVI), hearing impairment (PHI), physical impairment (PPI), brain disorder (PBD), and intellectual disability (PID). Linking rules were used to identify how the health needs related to the ICF components of Body Functions, Activity & Participation, and Environmental Factors.Results: The health needs related to the Environmental Factors were the most mentioned and were frequently perceived as causes of poor health conditions related to Activities & Participation and Body Function. According to what participants perceived as main health issues in the Environmental Factors, the five groups were classified into (1) Services, systems, and policies mainly affecting type (PVI and PPI); (2) Support and relationships mainly affecting type (PHI); and (3) Attitude mainly affecting type (PBD and PID).Conclusions: Government officials and health professionals must tailor development and provision of healthcare for people with disabilities based on health need type.IMPLICATIONS FOR REHABILITATIONFew studies have investigated the health needs of people with disabilities, although many health indicators suggest that they are facing health inequalities in South Korea.The health issues related to the Environmental Factors were often perceived in this study as causes of poor health conditions related to the Activities & Participation and Body Function, indicating the need to preferentially solve the health issues related to the Environmental Factor.According to what people with each of the five types of disabilities perceived as main health issues and what kinds of actions they expected in the Environmental Factors, they could be classified into three health need types.It is recommended that government officials and health professionals develop and provide appropriate supply-side measures of healthcare considering these different demand-side health needs according to disability type.
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Affiliation(s)
- Minyoung Lee
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul, South Korea
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11
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Enemark Larsen A, Wehberg S, Christensen JR. Looking into the Content of the Canadian Occupational Performance Measure (COPM): A Danish Cross-Sectional Study. Occup Ther Int 2020; 2020:9573950. [PMID: 32565758 PMCID: PMC7285290 DOI: 10.1155/2020/9573950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/06/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To examine the content validity of the Danish version of the Canadian Occupational Performance Measure (COPM-DK). MATERIALS AND METHODS This cross-sectional study was performed in a hospital and a community rehabilitation centre. The content validity of the COPM was assessed by relating the clients' prioritized occupational performance issues (OPIs) to the conceptual model of the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the levels of the Taxonomic Code of Occupational Performance (TCOP). Six occupational therapy lecturers participated in classifying the OPIs using the TCOP. RESULTS A total of 112 clients from a regional and community-based rehabilitation participated. The 56% regional participants came from a hospital's hand and knee surgery department. The remaining 44% participants came from a community-based rehabilitation centre with in- and outpatient departments. There were 44% males, with a mean age of 65.2 years. They prioritized 495 OPIs, of which 40% concerned self-care, 32% productivity, and 28% leisure. The prioritized OPIs were divided into a total of 224 different OPIs. There were significant differences in which areas were prioritized in the various population groups. Of the OPIs, 64.3% could be classified into the TCOP levels of occupation and activity, i.e., 1/3 of the OPIs were related to tasks and actions, and thus beyond the scope of the COPM. The interrater agreement of the OPI classification was only fair (kappa 0.3). CONCLUSION The content validity of the COPM seems to depend on how and with which clients it is administered. Caution must be taken to secure OPIs on the higher levels of the TCOP, while maintaining the clients' right to nominate OPI preferences. Therefore, an introductory course and on-going support are recommendable. Bearing this in mind, the COPM seems useful to identify individual clients' prioritized OPIs in a Danish context.
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Affiliation(s)
- Anette Enemark Larsen
- Occupational Therapy, Department of Therapist and Midwifery, The Faculty of Health Sciences, Copenhagen University College, Copenhagen, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Denmark
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12
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Epidemiology of Cerebral Palsy in Adulthood: A Systematic Review and Meta-analysis of the Most Frequently Studied Outcomes. Arch Phys Med Rehabil 2020; 101:1041-1052. [PMID: 32059945 DOI: 10.1016/j.apmr.2020.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). DATA SOURCES Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes ("cerebral palsy," "adult," and "outcome assessment") in literature published between January 2000 and December 2018. STUDY SELECTION Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. DATA EXTRACTION Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. DATA SYNTHESIS Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P<.01, respectively). The Fatigue Severity Scale score was 4.1 (95% CI, 3.8-4.4). Epilepsy (28.8% [95% CI, 20.1-38.4]) and asthma (28.3% [95% CI, 18.7-38.9]) were especially prevalent comorbidities. CONCLUSIONS The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On average, adults with CP are fatigued, and a majority experience pain, are ambulant, and have little or no difficulty with manual ability. On average, 40% are employed and 30% live independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.
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13
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Jahnsen R, Ramstad K, Myklebust G, Elkjaer S, Pripp AH, Klevberg GL. Independence of young people with cerebral palsy during transition to adulthood: a population-based 3 year follow-up study. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundThis study describes developmental and service transitions during a 3-year period among young people with cerebral palsy (CP) as measured by the Rotterdam Transition Profile (RTP) and evaluates the test-retest reliability of the RTP. The RTP is a questionnaire developed to classify phases of transition across nine participation domains.MethodsA three-step design was applied: Step I consisted of a translation and test-retest reliability study of the RTP, Step II was a comparison of independence between youth with and without CP and Step III was a follow-up survey of youth with CP describing changes of independence after a 3-year transition period. A sample of 103 typically developing youth were recruited for Steps I and II, and a population-based sample of 76 (response rate = 59%) youth with CP (males = 40) from South-Eastern Norway aged 16–17 years were recruited for Steps II and III. The subtypes of CP were classified as spastic unilateral (n = 30), spastic bilateral (n = 37), dyskinetic (n = 8) and ataxic (n = 1) CP. The levels of gross motor function followed the categories of the Gross Motor Function Classification System (GMFCS) as level I (n = 30), level II (n = 17), level III (n = 6), level IV (n = 8) and level V (n = 15).ResultsTwenty-six participants had epilepsy and 13 had gastrostomy. Forty-four of the youth with CP (response rate = 58%) responded to the 3-year follow-up survey in Step III. The test-retest study of the RTP showed excellent reliability (Kw 0.76–0.93). At baseline (Step II), the reference group was significantly more independent than the youth with CP in all the participation domains. At the 3-year follow-up (Step III), the levels of independence had increased significantly for all the participation domains in the youth with CP except for transportation and leisure. Despite increased independence during the transition period regarding health services, only 25% independently formulated their own care needs or applied for services and assistance at 19–20 years of age. Youth who responded to the RTP by a caregiver proxy more often had a diagnosis of epilepsy and/or gastrostomy and higher GMFCS levels. These individuals were significantly less independent than those who self-reported, both at baseline and at follow-up.ConclusionsIn conclusion, the excellent test-retest results support the use of the RTP as a tool for classifying phases of transition among youth with CP. The youth with CP were significantly less independent than their typically developing peers at baseline, yet increased their independence during a 3-year period. Those who self-reported to the RTP were generally more independent than those who proxy-reported, which supports the need to distinguish between the service needs of subgroups during the transition phase.
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Affiliation(s)
- Reidun Jahnsen
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjersti Ramstad
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Gerd Myklebust
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Sonja Elkjaer
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Gunvor Lilleholt Klevberg
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Cerebral Palsy follow-up Program (CPOP), Department of Clinical Neurosciences for Children, Oslo University Hospital, Ullevaal, Postbox 4956 Nydalen, 0424 Oslo, Norway
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14
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Rožkalne Z, Mukāns M, Vētra A. Transition-Age Young Adults with Cerebral Palsy: Level of Participation and the Influencing Factors. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E737. [PMID: 31739609 PMCID: PMC6915393 DOI: 10.3390/medicina55110737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/26/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The aim of this study was to identify the level of participation in the context of the developmental transition from adolescence to adult life for young adults with cerebral palsy (CP) and the factors that had an influence on participation. Materials and Methods: Eighty-one young adults (16-21 years old) with CP and with normal or slightly decreased cognitive function participated in this study. Assessments were made using the Rotterdam Transition Profile (RTP) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). In the binary regression model, levels of participation (RTP scores) were set as dependents and the level of disability (WHODAS 2.0 scores), age, and level of gross motor function were set as independent variables. Results: In the age group <18 years, in three out of seven RTP domains, less than 10% of participants were in phase 2 (experimenting and orientating toward the future), i.e., finance-7%, housing-7%, sexuality-4%. In the age group ≥18 years, 21% (education and employment), 56% (intimate relationships), and 59% (sexuality) of the participants were in phase 0 (no experience). Higher scores in WHODAS 2.0 domains showed positive associations with RTP domains, i.e., cognition with social activities, mobility with transportation, self-care with sexuality and transportation, and life activities with transportation. Age was positively associated with education and employment, finance, housing, and sexuality. Low motor function according to the Gross Motor Function Classification System (GMFCS) had negative associations with autonomy in social activities, sexuality, and transportation. Conclusions: Young adults with cerebral palsy showed low levels of autonomy in all domains of participation. When addressing a person's improvement in terms of their participation, the promotion of abilities in cognition, mobility, self-care, and life activities should be attempted. Age and gross motor function influenced autonomy in participation, but not in all domains.
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Affiliation(s)
- Zane Rožkalne
- Rehabilitation Clinic, Children’s Clinical University Hospital, LV-1004 Riga, Latvia;
- Department of Doctoral Studies, Rīga Stradiņš University, LV-1007 Riga, Latvia
| | - Maksims Mukāns
- The Statistics Unit of Rīga Stradiņš University, LV-1046 Riga, Latvia;
| | - Anita Vētra
- Rehabilitation Clinic, Children’s Clinical University Hospital, LV-1004 Riga, Latvia;
- Department of Rehabilitation, Rīga Stradiņš University, LV-1067 Riga, Latvia
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15
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Bal MI, Roelofs PPDM, Hilberink SR, van Meeteren J, Stam HJ, Roebroeck ME, Miedema HS. Entering the labor market: increased employment rates of young adults with chronic physical conditions after a vocational rehabilitation program. Disabil Rehabil 2019; 43:1965-1972. [PMID: 31707868 DOI: 10.1080/09638288.2019.1687764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Employment of young adults with chronic physical conditions entering the labor market after finishing post-secondary education remains behind compared to typically developing peers. The aim of this study is to evaluate changes in their paid employment levels after following a vocational rehabilitation intervention ('At Work'). MATERIALS AND METHODS Participants aged between 16 and 27 years (n = 90) were recruited via rehabilitation physicians and a jobcoach agency and participated in a vocational rehabilitation program. Cochran's Q and McNemar tests served to test the development of intervention participants' paid employment over time. Chi-square tests were used to compare intervention participants' paid employment level with national reference data selected on age and having a self-reported chronic physical condition. RESULTS Paid employment level of the intervention cohort significantly increased from 10.0% at baseline to 42.4% at 2-years follow-up (p < 0.001). At 2-years follow-up, their employment rates approached the employment rates of national reference data (42.4% versus 52.9%, p = 0.17). CONCLUSION Starting from a disadvantaged position, the paid employment rate of the intervention cohort substantially increased over time, approaching the employment rate of reference data. 'At Work' seems to be appropriate for supporting this specific group who face obstacles to enter the labor market, to find competitive employment.IMPLICATIONS FOR REHABILITATION'At Work' is a vocational rehabilitation intervention for young adults with chronic physical conditions who experience problems with finding and maintaining competitive employment after finishing post-secondary education.The 'At Work' intervention entails a combination of group sessions and individual coaching sessions based on the supported employment methodology.Paid employment rates of the intervention cohort substantially increased on the short- and long term, and approached employment rates of reference data of persons with chronic physical conditions.The 'At Work' intervention seems appropriate to support young adults with chronic physical conditions who experience barriers for work participation, to enter the labor market and find competitive and sustainable employment.
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Affiliation(s)
- Marjolijn I Bal
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pepijn P D M Roelofs
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Sander R Hilberink
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Harald S Miedema
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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16
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Flavin M, Shore BJ, Miller P, Gray S. Hormonal Contraceptive Prescription in Young Women With Cerebral Palsy. J Adolesc Health 2019; 65:405-409. [PMID: 31248805 DOI: 10.1016/j.jadohealth.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of the study was to describe the prevalence and patterns of prescription of hormonal contraceptive medications to young women with cerebral palsy (CP) and determine if CP topography or ambulatory status was associated with the type of contraceptive prescribed. METHODS Data were extracted by manual chart review for women with CP between the ages of 15 and 25 years who were seen at a tertiary pediatric hospital and a rehabilitation hospital between the years of 2011 and 2013. CP topography was defined as the number and pattern of limbs affected (hemiplegia, diplegia, triplegia, or quadriplegia), and ambulatory status was defined as whether a wheelchair was used for community mobility. Logistic regression analysis was used to assess associations between patient age, CP topography, ambulatory status, and contraceptive prescription. RESULTS Data were collected for 483 women with CP with an average age of 19 years (standard deviation: 3 years). One hundred thirty-one patients (27%) were prescribed hormonal contraceptives. Estrogen-progestin combined oral contraceptives were most frequently prescribed (73%). Prescription of hormonal contraceptives was not associated with CP topography (p = .95) or ambulatory status (p = .44); however, older subjects were more likely to be prescribed hormonal contraceptives (p = .01). There was no association detected between CP topography and contraceptive composition (p = .09) or between ambulatory status and contraceptive composition (p = .06). There was also no association detected between CP topography (p = .18) or ambulatory status (p = .09) and depot medroxyprogesterone acetate prescription. CONCLUSION Ambulatory status and CP topography were not associated with the types of hormonal contraceptives prescribed in this cohort.
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Affiliation(s)
- Marisa Flavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts.
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patricia Miller
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Susan Gray
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Yi YG, Jung SH, Bang MS. Emerging Issues in Cerebral Palsy Associated With Aging: A Physiatrist Perspective. Ann Rehabil Med 2019; 43:241-249. [PMID: 31311245 PMCID: PMC6637058 DOI: 10.5535/arm.2019.43.3.241] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
The population of adults diagnosed with cerebral palsy (CP) is increasing along with the survival rate of children born with the disability. Adults with CP need health services for the continued monitoring and management of their condition. Moreover, the development of additional health problems in adulthood increases the need for ongoing access to health services. Adults with CP manifest a higher rate of chronic health conditions and eventual decline in strength and functional reserve, deterioration in physical activity, increased risk of musculoskeletal complications, and gradual changes in swallowing ability. They are also reported to exhibit difficulty engaging socially and have a low health-related quality of life (QOL). However, there are a large number of adults with CP who cannot access medical services adequately and are therefore not effectively treated. To overcome these apparent challenges, we need to fully comprehend the healthcare needs of adults with CP to develop adult-focused health services. Further research is needed regarding the impact of physical activity, nutrition, sarcopenia, myeloradiculopathy, and swallowing function on QOL.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
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18
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van Gorp M, E Roebroeck M, van Eck M, M Voorman J, Twisk JWR, J Dallmeijer A, van Wely L. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study. Disabil Rehabil 2019; 42:3162-3171. [PMID: 31060408 DOI: 10.1080/09638288.2019.1585971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine childhood predictors of participation in domestic life and interpersonal relationships of young adults with cerebral palsy (CP).Materials and methods: This 13-year follow-up of an existing cohort (baseline age 9-13 years) included 67 young adults with CP (age 21-27 years). The Vineland adaptive behavior scales (VABS) and Life Habits questionnaire were used to assess attendance and difficulty in participation in domestic life and interpersonal relationships. Baseline factors were categorised according to the international classification of functioning, disability, and health. Stepwise multiple linear regression analyses determined significant predictors (p < 0.05).Results: Lower manual ability, intellectual disability (ID), epilepsy and lower motor capacity predicted decreased future participation in domestic life, and/or interpersonal relationships (explained variance R2 = 67-87%), whereas no association was found with environmental and personal factors. Extending models with baseline fine motor skills, communication, and interpersonal relationships increased R2 to 79-90%.Conclusions: Childhood factors account for 79-90% of the variation in young adult participation in domestic life and interpersonal relationships of individuals with CP. Children with limited motor capacity, low manual ability, ID, or epilepsy are at risk for restrictions in participation in young adulthood. Addressing fine motor, communication, and social skills in paediatric rehabilitation might promote young adult participation.Implications for rehabilitationChildhood risk factors for limited participation in domestic life and interpersonal relationships as a young adult with CP are ID, epilepsy, low manual ability, low motor capacity, and low activity & participation levels.In line with current practice, this study confirms the importance of addressing gross and fine motor skills in children with CP for their future participation in domestic life.In addition, results suggest that addressing communication and social skills during paediatric rehabilitation may optimise future participation in interpersonal relationships.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jeanine M Voorman
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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19
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van Gorp M, Van Wely L, Dallmeijer AJ, de Groot V, Ketelaar M, Roebroeck ME. Long-term course of difficulty in participation of individuals with cerebral palsy aged 16 to 34 years: a prospective cohort study. Dev Med Child Neurol 2019; 61:194-203. [PMID: 30187926 PMCID: PMC7379932 DOI: 10.1111/dmcn.14004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To determine the long-term course of difficulty in participation of individuals with cerebral palsy (CP) without intellectual disability between 16 years and 34 years of age. METHOD One hundred and fifty-one individuals with CP aged 16 to 20 years were included (63% male, 37% female; Gross Motor Function Classification System [GMFCS] levels I-IV; without intellectual disability). The Assessment of Life Habits questionnaire 3.0 general short form was used up to three times biennially and at 13-year follow-up (13-year follow-up: n=98). Scores (range 0-10) reflect difficulty and assistance in participation in housing, education and employment, interpersonal relationships, recreation, community life, and responsibilities. Multilevel models were used to determine the course of difficulty in participation by GMFCS level. RESULTS Despite high average participation levels, 41% to 95% of adolescents and young adults with CP experienced difficulty. Difficulty in participation in housing and interpersonal relationships increased from age 16 years onwards and in most other life areas in the mid- and late 20s. In adolescents in GMFCS levels III and IV, participation in recreation and community life improved up to age 23 years. INTERPRETATION Individuals with CP experience increasing difficulties in participation in their mid- and late 20s. Clinicians should systematically check for participation difficulties in young adults with CP and offer timely personalized treatment. WHAT THIS PAPER ADDS Many individuals with cerebral palsy (CP) aged 16 to 34 years experience difficulty in participation. Difficulty in participation increases in the mid- and late 20s for individuals with CP. Participation in recreation/community life improves before age 23 years for those in Gross Motor Function Classification System levels III and IV.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Leontien Van Wely
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Vincent de Groot
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation MedicineBrain Center Rudolf MagnusUniversity Medical Center UtrechtDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation MedicineErasmus MC University Medical CenterRotterdamthe Netherlands,Rijndam Rehabilitation InstituteRotterdamthe Netherlands
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20
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Palisano RJ, Di Rezze B, Stewart D, Freeman M, Rosenbaum PL, Hlyva O, Wolfe L, Gorter JW. Promoting capacities for future adult roles and healthy living using a lifecourse health development approach. Disabil Rehabil 2019; 42:2002-2011. [PMID: 30621464 DOI: 10.1080/09638288.2018.1544670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purposes: First, to describe how young adults with cerebral palsy (CP) experience lifecourse health development, and second, to create key messages for pediatric health service providers to promote children's capacities for future adult roles and healthy adult living.Methods: Interpretive description qualitative design. Participants were a purposive sample of 23 young adults with CP, 25-33 years of age, who varied in functional abilities, education, living, and work situations. Three experienced interviewers conducted 50-60 min interviews. Transcripts were analyzed to identify themes. Subsequently, a one-day meeting was held with an advisory group to inform our interpretive description of key messages.Results: Four themes emerged from the interviews: personal lifecourse, contexts for healthy living, health development through everyday experiences, and healthy living as an adaptive process. Key messages for service providers are: (a) address healthy living across the lifecourse, (b) focus on contexts of healthy living, (c) focus on everyday experiences and experiential learning, and (d) pay attention to the timing of opportunities and experiences.Conclusion: The findings provide first steps toward adoption of an approach to lifecourse health development for individuals with CP that emphasizes physical, mental, and emotional wellbeing and goals for desired social participation over the lifecourse.Implications for rehabilitationYoung adults with cerebral palsy experience lifecourse health development as a personal ongoing and dynamic process occurring in many contexts.Individuals with cerebral palsy continually adjust to changing contexts (adaptive process).Everyday experiences and experiential learning enable individuals with cerebral palsy to develop capacities for current and future healthy living including social participation."Timing" of opportunities and experiences is important for health development.
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Affiliation(s)
- Robert J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Briano Di Rezze
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Debra Stewart
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Matthew Freeman
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Peter L Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Oksana Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Lisa Wolfe
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Roquet M, Garlantezec R, Remy-Neris O, Sacaze E, Gallien P, Ropars J, Houx L, Pons C, Brochard S. From childhood to adulthood: health care use in individuals with cerebral palsy. Dev Med Child Neurol 2018; 60:1271-1277. [PMID: 30171608 DOI: 10.1111/dmcn.14003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status. METHOD In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed. RESULTS The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition. INTERPRETATION Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies. WHAT THIS PAPER ADDS Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.
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Affiliation(s)
- Marion Roquet
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France
| | | | - Olivier Remy-Neris
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | | | - Philippe Gallien
- Médecine Physique et de Réadaptation, CMPR Notre Dame De Lourde, Rennes, France
| | - Juliette Ropars
- Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France.,Service de Pédiatrie, CHRU Brest, Brest, France
| | - Laetitia Houx
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Christelle Pons
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Sylvain Brochard
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
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22
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van Gorp M, Roebroeck ME, Swan Tan S, de Groot V, Gorter JW, Smits DW, Schmidt AK, Dallmeijer AJ. Activity Performance Curves of Individuals With Cerebral Palsy. Pediatrics 2018; 142:peds.2017-3723. [PMID: 30287591 DOI: 10.1542/peds.2017-3723] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804911840001PEDS-VA_2017-3723Video Abstract OBJECTIVES: Describe development curves of motor and daily activity performance in individuals with cerebral palsy (CP). METHODS Participants with CP aged 1 to 20 years at baseline (n = 421) and Gross Motor Functioning Classification System (GMFCS) levels I to V (27% of participants with intellectual disability [ID]) were longitudinally assessed up to a 13-year follow-up period. Motor and daily activity performance were assessed using the relevant subdomains of the Vineland Adaptive Behavior Scales survey. Nonlinear mixed effects analyses were used, estimating the limit (average maximal performance level) and the age by which individuals reached 90% of the limit (age90). RESULTS Limits of motor performance decreased with each lower functional level. Age90 for motor performance was reached at ∼6 to 8 years of age in children with GMFCS levels I to III, and at younger ages in those with lower functional levels. Limits of daily activity performance did not differ between individuals without ID with GMFCS levels I to III. The age90s of daily activities were reached between 11 and 14 (personal), 26 and 32 (domestic), and 22 and 26 years of age (community). Individuals with ID reached lower daily activity performance limits earlier. CONCLUSIONS Individuals with CP continue to develop motor performance after gross motor capacity limits are reached. For those without ID, daily activities continue to develop into their 20s. Individuals who are severely affected functionally have the least favorable development of motor performance, and those with ID have the least favorable development of daily activity performance.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; .,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Siok Swan Tan
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; and
| | - Dirk-Wouter Smits
- Center of Excellence for Rehabilitation Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Ann Katrin Schmidt
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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Liljenquist K, O'Neil ME, Bjornson KF. Utilization of Physical Therapy Services During Transition for
Young People With Cerebral Palsy: A Call for Improved Care Into Adulthood. Phys Ther 2018; 98:796-803. [PMID: 29893905 DOI: 10.1093/ptj/pzy068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/04/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many young adults with cerebral palsy (CP) face limited participation in activities, including employment and independent living. Physical therapy during the transition period can help to support participation through promotion of self-care, ambulation, and functional mobility. Thus, ensuring appropriate access to physical therapy services for young people who can benefit from them before, during, and after transition is imperative. OBJECTIVE The objective of this study was to identify factors contributing to the utilization of physical therapy services for youth with CP both during and after secondary school. DESIGN The design was a deidentified secondary analysis of the National Longitudinal Transition Study 2 (NLTS2). METHODS Multivariate regression models were run to examine demographic and disability characteristics influencing utilization of physical therapy services for youth with CP both during and after secondary school. RESULTS The total weighted population sample included 35,290 young people with CP. When all youth were in secondary school, 59.4% of the youth utilized physical therapy services; however, once all youth were out of school, only 33.7% of them were reported to have utilized physical therapy since leaving secondary school. For young people with difficulties accessing general disability support services, demographic characteristics, including sex, race, income, and parent education status, influenced use of physical therapy services in addition to disability characteristics. LIMITATIONS This population sample included only young people in special education with Individual Education Plans (IEPs) and may not generalize to young people with CP in general education settings. CONCLUSIONS Frequency of physical therapy services decreases drastically once young adults with CP leave secondary school. Future work should examine this trend in more depth to identify therapy intervention strategies to optimize participation in young adult life for persons with CP.
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Affiliation(s)
- Kendra Liljenquist
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105 (USA)
| | - Margaret E O'Neil
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Kristie F Bjornson
- University of Washington, Seattle Children's Research Institute, Seattle, Washington
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Freeman M, Stewart D, Cunningham CE, Gorter JW. Information needs of young people with cerebral palsy and their families during the transition to adulthood: a scoping review. JOURNAL OF TRANSITION MEDICINE 2018. [DOI: 10.1515/jtm-2018-0003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe transition to adulthood is a developmental phase which occurs as young people move from adolescence into adulthood. Young people with disabilities, including cerebral palsy (CP), and their families have reported challenges during the transition to adulthood because they are required to move to adult supports and services, which are often fragmented and bring about new questions and expectations to find necessary supports. Young people and their parents have been found to lack information about where to find services in adulthood, how to access the services and what to ask during the transitional process. The aim of this scoping review was to explore the information needs of young people with CP and their families during the transition to adulthood. The goal is to map the current published evidence within the transition to adulthood literature base to explore what is known about information needs during the transition to adulthood of young people with CP and their parents. This review seeks to synthesize what is known about information content, timing, methods of provision and delivery. Databases searched were OVID Medline, CINAL, ERIC, EMBASE, PsycINFO, Web of Science, Social Science Abstracts and Sociological Abstracts. Initially 675 articles were retrieved. Four hundred and forty-two articles were selected for title review. Two hundred and five articles remained for abstract review. Seventeen articles were included for full-text review. Eleven articles were included in this review. Data were organized into five themes: (1) identified information needs during the transition to adulthood (content), (2) identified recommended providers of information during the transition to adulthood (who), (3) identified delivery methods of information during the transition to adulthood (how), (4) identified timing of information delivery of information during the transition to adulthood (when) and (5) location of information provided during the transition to adulthood (where). This review found that young people with CP, their families and adult providers all possess information needs during the transition to adulthood. Young people with CP and their families seek information about what adult services will look like and how to access supports. Adult providers require information about CP. Youth with CP prefer individualized information be delivered to them when needed rather than presented in group sessions or via paper handout. Other recommendations included the development of parent support networks to assist parents in the transition to adulthood. The opportunity to learn from real-life experiences was also viewed as an important source of information as well as method to provide information.
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Affiliation(s)
- Matthew Freeman
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Debra Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Charles E. Cunningham
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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25
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Bal MI, Sattoe JN, Miedema HS, van Staa A. Social participation and psychosocial outcomes of young adults with chronic physical conditions: Comparing recipients and non-recipients of disability benefits. Ann Phys Rehabil Med 2018; 61:85-91. [DOI: 10.1016/j.rehab.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/28/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
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26
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Nguyen T, Stewart D, Rosenbaum P, Baptiste S, Kraus de Camargo O, Gorter JW. Using the ICF in transition research and practice? Lessons from a scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:225-239. [PMID: 29202331 DOI: 10.1016/j.ridd.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) and subsequent ICF-CY (child and youth version) recognize the importance of personal and environmental factors in facilitating holistic transition planning and service delivery for youth with chronic health conditions (YCHC). AIMS The objective of this scoping review is to investigate the degree to which the ICF and ICF-CY have been used in transition research and practice since its initial publication. METHODS Arksey and O'Malley's five-stage methodological framework guided the scoping review using the following databases: AMED, CINAHL, EMBASE, HealthSTAR, MEDLINE, and PsycINFO. Keywords included: 'ICF', 'ICF-CY', and 'transition', which were adapted to each database. RESULTS 25 articles met final inclusion. Two key themes emerged regarding use of the ICF: 1) the ICF enhances transdisciplinary processes to inform transition planning and interventions; and 2) the ICF facilitates comprehensive and developmentally appropriate transition services over a youth's lifecourse. The strengths and limitations of the ICF in guiding the planning and delivery of transition services are discussed. Some limitations include the large number of items inherent within the ICF and a lack of clarity between the components of activity and participation. CONCLUSION Key recommendations include: i) further explanation and development of items for quality of life and well-being, personal factors, and psychological issues; and ii) additional research to advance knowledge towards developing empirically- based evidence for the application of the ICF in clinical practice to facilitate transition.
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Affiliation(s)
- Tram Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Debra Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.
| | - Peter Rosenbaum
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
| | - Sue Baptiste
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
| | - Olaf Kraus de Camargo
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
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27
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Zhang B, Zhu Y, Jiang C, Li C, Li Y, Bai Y, Wu Y. Effects of Transcutaneous Electrical Acupoint Stimulation on Motor Functions and Self-Care Ability in Children with Cerebral Palsy. J Altern Complement Med 2017; 24:55-61. [PMID: 28767271 DOI: 10.1089/acm.2016.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) in improving motor functions and self-care abilities in children with cerebral palsy in their early childhood. DESIGN A preliminary, prospective, cohort study. SETTINGS/LOCATION Multicenter. SUBJECTS Children aged 2-6 years old. INTERVENTIONS Twenty-three children were included in the study and randomly assigned to a control group ([CG] N = 11) or a therapeutic group ([TG] N = 12). In the TG, children were treated with TEAS (Shousanli [LI10] and Waiguan [SJ5]) plus the exercise therapy, while in the control group, they were treated with sham TEAS plus exercise therapy. Therapies were performed five days per week for eight weeks. OUTCOME MEASURES The Gross Motor Function Measure (GMFM) and the Functional Independent Measurement for children (WeeFIM) were used to evaluate motor functions and self-care abilities before and after the therapies. RESULTS Greater improvements were observed in the TG concerning all the measurements, although without statistical differences. The increments of the GMFM score and the WeeFIM motor, self-care and total scores were 36.08 ± 18.34 (26%), 16.17 ± 8.21 (33%), 7.67 ± 3.42 (40%) and 20.33 ± 10.08 (28%) in the TG, while 22.73 ± 16.54 (17%), 9.09 ± 9.43 (19%), 5.64 ± 6.73 (29%) and 12.82 ± 11.77 (18%) in the CG, respectively. No statistically significant correlations were shown between functional improvements and the demographics in the TG or the CG. The GMFM improvement was not statistically correlated with the improvements of the WeeFIM motor, self-care or total scores. However, the WeeFIM motor, self-care and total score were significantly positively correlated with one another in both groups (P < 0.01). No adverse effect was recorded during the study. CONCLUSION TEAS may be effective in improving motor functions and self-care abilities in children with cerebral palsy, in addition to conventional exercise therapy. Larger samples are required to confirm the efficacies.
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Affiliation(s)
- Bei Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Yulan Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Congyu Jiang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Ce Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Yingying Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University , Shanghai, People's Republic of China
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28
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Kassee C, Hunt C, Holmes MWR, Lloyd M. Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy. J Pediatr Rehabil Med 2017; 10:145-154. [PMID: 28582885 DOI: 10.3233/prm-170439] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.
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Affiliation(s)
- Caroline Kassee
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Carolyn Hunt
- Medical Services, Grandview Children's Centre, Oshawa, ON, Canada
| | | | - Meghann Lloyd
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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29
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Palisano RJ, Di Rezze B, Stewart D, Rosenbaum PL, Hlyva O, Freeman M, Nguyen T, Gorter JW. Life course health development of individuals with neurodevelopmental conditions. Dev Med Child Neurol 2017; 59:470-476. [PMID: 28229458 DOI: 10.1111/dmcn.13402] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Abstract
The life course health development (LCHD) model by Halfon et al. conceptualizes health development occurring through person-environment transactions that enable well-being and participation in desired social roles throughout life, areas that have not received adequate attention in healthcare. The aim of this 'perspectives' paper is to apply the six core tenets of the LCHD model and the concept of health development trajectories to individuals with lifelong neurodevelopmental conditions. We share the perspective that modifiable aspects of the environment often restrict health development; we then advocate that children, beginning at a young age, should engage in 'real-world' experiences that prepare them for current and future social roles. LCHD encourages future planning from the outset, continuity of care between pediatric and adult systems, and coordination of services and supports. We believe LCHD can be transformative in enabling healthy living of individuals with neurodevelopmental conditions.
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Affiliation(s)
- Robert J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Briano Di Rezze
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Debra Stewart
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Peter L Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Oksana Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Matthew Freeman
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Tram Nguyen
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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30
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Bal MI, Sattoe JNT, van Schaardenburgh NR, Floothuis MCSG, Roebroeck ME, Miedema HS. A vocational rehabilitation intervention for young adults with physical disabilities: participants' perception of beneficial attributes. Child Care Health Dev 2017; 43:114-125. [PMID: 27704596 DOI: 10.1111/cch.12407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/09/2016] [Accepted: 08/07/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Finding and maintaining employment is a major challenge for young adults with physical disabilities and their work participation rate is lower than that of healthy peers. This paper is about a program that supports work participation amongst young adults with chronic physical disabilities. The study aims to explore their experienced barriers and facilitators for finding and maintaining employment after starting this program, the participant-perceived beneficial attributes of the program and participants' recommendations for additional intervention components. METHODS Semi-structured interviews (n = 19) were held with former intervention participations. Interviews were recorded and transcribed ad verbatim. Themes were derived using the phenomenological approach. RESULTS Physical functions and capacities, supervisor's attitude, self-esteem and self-efficacy and openness and assertiveness were experienced barriers and facilitators for finding and maintaining employment. Improvement of self-promoting skills and disclosure skills through job interview-training, increased self-esteem or self-efficacy through peer-support, a suitable job through job placement, improvement of work ability through arrangement of adjusted work conditions and change of supervisor's attitude through education provided to the supervisor were perceived as beneficial attributes of the intervention. Respondents recommended to incorporate assertiveness and openness skills training into future intervention programs. CONCLUSIONS The findings suggest that programs supporting work participation should be designed to provide challenging, real-world experiential opportunities that provide young adults with physical disabilities with new insights, self-efficacy and life skills. Also, such programs should facilitate context centered learning. Former intervention participants, therefore, evaluated job-interview training, sharing learning and social experiences with peers, job placement, arrangement of adjusted work conditions and education as beneficial attributes of the 'At Work' program. In addition, they recommended, to incorporate more training on assertiveness and disclosure. We advise professionals to include these beneficial attributes in similar interventions in other contexts.
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Affiliation(s)
- M I Bal
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands.,Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands
| | - J N T Sattoe
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands.,Erasmus University Rotterdam, Department of Health Policy & Management, Rotterdam, The Netherlands
| | | | | | - M E Roebroeck
- Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, The Netherlands.,Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - H S Miedema
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands
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Bagatell N, Chan D, Rauch KK, Thorpe D. "Thrust into adulthood": Transition experiences of young adults with cerebral palsy. Disabil Health J 2016; 10:80-86. [PMID: 27756560 DOI: 10.1016/j.dhjo.2016.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 09/12/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The transition to adulthood, the gradual change in roles and responsibilities, is identified as a challenging time for adolescents and young adults with physical disabilities, including those with cerebral palsy. Health care, education, employment, independent living, and community engagement have been identified as areas of concern. However, relatively little research has been done to understand the experiences, perceptions, and needs of individuals with cerebral palsy as they transition toward adulthood. OBJECTIVE The objective of this study was to explore the transition experiences, perceptions, and needs of young adults with cerebral palsy living in one state in the southeastern United States. METHODS Focus groups with nine young adults with cerebral palsy (19-34 years) were conducted. The focus group interview explored the preparation for transition and experiences navigating adulthood. The audio-recorded groups were transcribed and analyzed using thematic analysis. RESULTS Young adults with cerebral palsy identified numerous challenges associated with navigating adulthood. The main themes were: 1) being thrust into adulthood; 2) navigating systems and services; 3) understanding and managing my body; and 4) dealing with stereotypes and prejudice. CONCLUSIONS The findings highlight the need for a holistic approach to transition with a focus on building capacity and empowerment. To navigate complex systems of care, "navigators" or "facilitators" are needed. Additionally, practitioners and service providers in adult systems need further education about cerebral palsy.
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Affiliation(s)
| | - Dara Chan
- University of North Carolina, Chapel Hill, USA
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Lungu C, Hirtz D, Damiano D, Gross P, Mink JW. Report of a workshop on research gaps in the treatment of cerebral palsy. Neurology 2016; 87:1293-8. [PMID: 27558377 DOI: 10.1212/wnl.0000000000003116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/08/2016] [Indexed: 01/10/2023] Open
Abstract
Cerebral palsy (CP) is heterogeneous in etiology and manifestations, making research into relevant therapies difficult and limiting the generalizability of the results. We report here on the NIH CP symposium, where stakeholders from academic, clinical, regulatory, and advocacy backgrounds discussed the major challenges and needs for moving forward with clinical research in CP, and outlined priorities and action items. New information is constantly generated through research into pathogenesis and etiology. Clinical research and new therapeutic approaches need to keep pace, through large data registry integration and new research designs. Development of standardized data collection, increasing academic focus on CP research, and iterative approaches to treatment throughout the patients' lives, have all been identified as areas of focus. The workshop identified critical gaps and areas of focus to increase the evidence base for therapeutic approaches to determine which treatments work best for which patients in the near future. These include consolidation and optimization of databases and registries, updates to the research methodology, and better integration of resources and stakeholders.
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Affiliation(s)
- Codrin Lungu
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY.
| | - Deborah Hirtz
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Diane Damiano
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Paul Gross
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
| | - Jonathan W Mink
- From the Office of the Clinical Director (C.L.) and Office of Clinical Research (D.H.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda; Functional and Applied Biomechanics Section (D.D.), Clinical Center, NIH, Bethesda, MD; Cerebral Palsy Research Network (P.G.), Woodinville, WA; and Departments of Neurology, Neuroscience, and Pediatrics (J.W.M.), University of Rochester, NY
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Health Care Transition Experiences of Young Adults With Cerebral Palsy. J Pediatr Nurs 2015; 30:e157-64. [PMID: 26142160 DOI: 10.1016/j.pedn.2015.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/20/2022]
Abstract
Health care transition (HCT) describes the purposeful, planned movement of adolescents from child to adult-orientated care. The purpose of this qualitative study is to uncover the meaning of transition to adult-centered care as experienced by young adults with cerebral palsy (YA-CP) through the research question: What are the lived experiences of young adults with cerebral palsy transitioning from pediatric to adult healthcare? Six females and 3 males, aged 19-25 years of age, who identified as carrying the diagnosis of cerebral palsy without cognitive impairment, were interviewed. Giorgi's (1985) method for analysis of phenomenology was the framework for the study and guided the phenomenological reduction. The meaning of the lived experiences of YA-CPs transition to adult health care is expert novices with evidence and experience-based expectations, negotiating new systems interdependently and accepting less than was expected. More information and support is needed for the YA-CP during transition to ensure a well-organized move to appropriate adult-oriented health care that is considerate of the lifelong impact of the disorder. The nurses' role as advocate, mentor and guide can optimize the individual's response to the transition process.
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Kingsnorth S, King G, McPherson A, Jones-Galley K. A retrospective study of past graduates of a residential life skills program for youth with physical disabilities. Child Care Health Dev 2015; 41:374-83. [PMID: 25251776 DOI: 10.1111/cch.12196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Young people with physical disabilities experience issues regarding employment, schooling, independent living and establishing meaningful personal relationships. A lack of life skills has been recognized as an important factor contributing to this lag. The Independence Program (TIP) is a short-term residential life skills program that aims to equip youth with the foundational life skills required to assume adult roles. This study retrospectively examined the achievements, skills acquired and program attributions of youth and young adults who took part in this three-week immersive teen independence program over a 20-year period. METHODS A total of 162 past graduates were invited to take part, with 78 doing so (a 48% response rate). These past graduates completed an online survey assessing objective outcomes such as employment and independent living; subjective outcomes such as feeling in control and living meaningful lives; and reflections on skills acquired, opportunities experienced and attributions to TIP. RESULTS The majority of respondents were female (71%), had a diagnosis of cerebral palsy (55%) and ranged from 20 to 35 years of age (92%). Despite a range of outcomes related to the achievement of adult roles, high levels of life satisfaction and overall quality of life were reported. Nearly every respondent reported using the skills they learned at the program in their lives afterwards and a high percentage attributed the acquisition and consolidation of core life skills to participating in this intensive immersive program. CONCLUSIONS Although causality cannot be assumed, respondents reflected very positively on the opportunities provided by TIP to develop their independent living and life skills, extend their social networks and understand their strengths and weaknesses. Such findings validate the importance of targeted skill development to assist young people with physical disabilities in attaining their life goals and encourage focused investigations of key features in program design.
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Affiliation(s)
- S Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Freeman M, Stewart D, Shimmell L, Missiuna C, Burke-Gaffney J, Jaffer S, Law M. Development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT') to assist youth with disabilities in managing information. Child Care Health Dev 2015; 41:222-9. [PMID: 25338500 DOI: 10.1111/cch.12199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND This article presents findings from the development and evaluation of The KIT: Keeping It Together™ for Youth (the 'Youth KIT'). The Youth KIT is a resource intended to assist youth with disabilities during their teenage years and during the transition to adulthood to give information to others about themselves, get from others about themselves, and organize their own information to the best of their ability. METHODS Thirty-six youth between the ages of 12 and 25 with physical and developmental disabilities were active participants in the development of the Youth KIT and partnered with a multidisciplinary team to conduct the qualitative evaluation. Focus groups and individual interviews were used in three phases of evaluation. RESULTS The results of qualitative content analysis found the Youth KIT to be useful for a variety of youth in different contexts. The themes that emerged about the utility and impact of the Youth KIT were: (1) self-discovery for youth; and (2) the importance of the 'fit' between youth and mentors to support youth as they started to use the Youth KIT. CONCLUSION Clinical implications for healthcare providers working with youth during the transition to adulthood include recognition that discussions about adult goals should be a continuous dialogue throughout adolescence rather than a 'special' conversation occurring at the time of discharge from paediatric services.
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Affiliation(s)
- M Freeman
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Alford VM, Ewen S, Webb GR, McGinley J, Brookes A, Remedios LJ. The use of the International Classification of Functioning, Disability and Health to understand the health and functioning experiences of people with chronic conditions from the person perspective: a systematic review. Disabil Rehabil 2014; 37:655-66. [DOI: 10.3109/09638288.2014.935875] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
The syndrome of cerebral palsy encompasses a large group of childhood movement and posture disorders. Severity, patterns of motor involvement, and associated impairments such as those of communication, intellectual ability, and epilepsy vary widely. Overall prevalence has remained stable in the past 40 years at 2-3·5 cases per 1000 livebirths, despite changes in antenatal and perinatal care. The few studies available from developing countries suggest prevalence of comparable magnitude. Cerebral palsy is a lifelong disorder; approaches to intervention, whether at an individual or environmental level, should recognise that quality of life and social participation throughout life are what individuals with cerebral palsy seek, not improved physical function for its own sake. In the past few years, the cerebral palsy community has learned that the evidence of benefit for the numerous drugs, surgery, and therapies used over previous decades is weak. Improved understanding of the role of multiple gestation in pathogenesis, of gene environment interaction, and how to influence brain plasticity could yield significant advances in treatment of the disorder. Reduction in the prevalence of post-neonatal cerebral palsy, especially in developing countries, should be possible through improved nutrition, infection control, and accident prevention.
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Affiliation(s)
- Allan Colver
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Charles Fairhurst
- Department of Paediatric Neurosciences, Evelina Children's Hospital, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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Lemmens RJM, Janssen-Potten YJM, Timmermans AAA, Defesche A, Smeets RJEM, Seelen HAM. Arm hand skilled performance in cerebral palsy: activity preferences and their movement components. BMC Neurol 2014; 14:52. [PMID: 24646071 PMCID: PMC4000003 DOI: 10.1186/1471-2377-14-52] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Assessment of arm-hand use is very important in children with cerebral palsy (CP) who encounter arm-hand problems. To determine validity and reliability of new instruments to assess actual performance, a set of standardized test situations including activities of daily living (ADL) is required. This study gives information with which such a set for upper extremity skill research may be fine-tuned, relative to a specific research question. Aim of this study is to a) identify upper extremity related ADL children with CP want to improve on, b) determine the 10 most preferred goals of children with CP, and c) identify movement components of all goals identified. Method The Canadian Occupational Performance Measure was used to identify upper extremity-related ADL preferences (goals) of 53 children with CP encountering arm-hand problems (mean age 9 ± 4.5 year). Goals were ranked based on importance attributed to each goal and the number of times a goal was mentioned, resulting in a gross list with goals. Additionally, two studies were performed, i.e. study A to determine the 10 most preferred goals for 3 age groups (2.5-5 years; 6-11 years, 12-19 years), based on the total preference score, and study B to identify movement components, like reaching and grasping, of all goals identified for both the leading and the assisting arm-hand. Results Seventy-two goals were identified. The 10 most preferred goals differed with age, changing from dressing and leisure-related goals in the youngest children to goals regarding personal care and eating for children aged 6-11 years. The oldest children preferred goals regarding eating, personal care and computer use. The movement components ‘positioning’, ‘reach’, ‘grasp’, and ‘hold’ were present in most tasks. ‘Manipulating’ was more important for the leading arm-hand, whereas ‘fixating’ was more important for the assisting arm-hand. Conclusion This study gave insight into the preferences regarding ADL children with CP would like to improve on, and the movement components characterizing these activities. This information can be used to create a set of standardized test situations, which can be used to assess the validity and reliability of new measurement instruments to gauge actual arm-hand skilled performance.
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Affiliation(s)
- Ryanne J M Lemmens
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.
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Verhoef JAC, Roebroeck ME, van Schaardenburgh N, Floothuis MCSG, Miedema HS. Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:42-51. [PMID: 23624979 DOI: 10.1007/s10926-013-9446-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate into more detail how occupational performance of participants of a 1-year multidisciplinary vocational rehabilitation intervention changed over time, using a broad focus on three areas of occupational performance, addressing work, as well as self-care and leisure. In addition, we explored differences between employed and unemployed persons. METHODS In a pre-post-intervention design, changes in occupational performance, addressing work, self-care and leisure, were evaluated using the Canadian Occupational Performance Measure (COPM) and the Occupational Performance History Interview (OPHI-II). RESULTS Eleven young adults (median 22 years) with physical disabilities participated. Post-intervention, participants experienced fewer problems and showed improved occupational performance in work, as well as self-care and leisure, and improved satisfaction with performance. Participants also showed improved occupational identity and occupational competence, and total scores on OPHI-II. Participants who did not achieve employment did not differ in demographic characteristics. They experienced problems in all three areas of occupational performance at pre-intervention, and more difficulty in interacting in occupational settings (environment). Post-intervention, their levels of occupational identity, competence and settings were similar to those of employed persons. CONCLUSIONS Participants showed improved occupational performance after the intervention. The goal of employment and the broad integrated approach of the intervention seemed to motivate participants to resolve problems in work, as well as self-care and leisure. Unemployed persons faced problems in all three areas of occupational performance at start. Although they seemed to catch up during the intervention, they did not achieve employment within 1 year.
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Affiliation(s)
- Joan A C Verhoef
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA, Rotterdam, The Netherlands,
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Vos RC, Becher JG, Ketelaar M, Smits DW, Voorman JM, Tan SS, Reinders-Messelink HA, Dallmeijer AJ. Developmental trajectories of daily activities in children and adolescents with cerebral palsy. Pediatrics 2013; 132:e915-23. [PMID: 24019410 DOI: 10.1542/peds.2013-0499] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the developmental trajectories of mobility performance and daily activities in children and young adults with cerebral palsy (CP). To explore the influence of gross motor function and intellectual disability on these trajectories. METHODS Four hundred and twenty-four Dutch participants with CP (aged 1-20 years at study onset) were followed yearly over a period of 2 to 4 years. Developmental trajectories (from ages 1-16 years) were described for mobility performance and performance of daily activities, assessed by using the Vineland Adaptive Behavior Scale for gross motor function (classified by the Gross Motor Function Classification System) and intellectual disability (by IQ or school type). A subanalysis was done for performance of daily activities in a subgroup of participants without intellectual disability (aged 1-24 years). RESULTS The developmental trajectories of mobility performance differed according to levels of gross motor function but not levels of intellectual disability. Intellectual disability affected the performance of daily activities, with lower overall trajectory levels for participants with intellectual disabilities. For participants without intellectual disability, high-level developmental trajectories were found, with values similar to those of typically developing children despite differences in gross motor function level. CONCLUSIONS Mobility performance is determined mainly by levels of gross motor function. For performance of daily activities, intellectual disability was a more important determinant. Participants without intellectual disability showed developmental trajectories approaching values for typically developing participants. These estimated trajectories can guide rehabilitation interventions and future expectations for children and young adults with CP.
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Affiliation(s)
- Rimke C Vos
- Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Verhoef JAC, Miedema HS, Van Meeteren J, Stam HJ, Roebroeck ME. A new intervention to improve work participation of young adults with physical disabilities: a feasibility study. Dev Med Child Neurol 2013; 55:722-8. [PMID: 23621846 DOI: 10.1111/dmcn.12158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 11/26/2022]
Abstract
AIM The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness. METHOD Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years. RESULTS The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure. INTERPRETATION Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.
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Affiliation(s)
- Joan A C Verhoef
- Centre of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
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Baumann P, Newman CJ, Diserens K. Challenge of transition in the socio-professional insertion of youngsters with neurodisabilities. Dev Neurorehabil 2013; 16:271-6. [PMID: 23477487 DOI: 10.3109/17518423.2012.760118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the activities of patients with neurodisabilities and assess their insertion problems in the professional world. METHODS It is based on medical records of 267 patients (224 with neurodevelopmental diseases and 43 with neuromuscular diseases), aged 16-25 years, followed in the transition clinic of young adults in the neurorehabilitation services of a tertiary center. RESULTS Nearly half of them (46.8%) were in a protected environment, 37.08% studied and only 3.4% worked. Their studies are much longer and they are less in university than Swiss people of same age. The competitiveness criteria are no mental retardation and to be completely independent. Finally, 29.2% reported work problems, the foremost being the lack of adaptation in the workplace. CONCLUSION These results highlight the need to increase the integration of young adults with neuromotor disorders in the labor market.
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Affiliation(s)
- Pascale Baumann
- Faculty of Biology and Medicine, CHUV, Lausanne, Switzerland.
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Adults with Childhood Onset Disabilities: A Focused Review of Three Conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0012-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gimeno H, Gordon A, Tustin K, Lin JP. Functional priorities in daily life for children and young people with dystonic movement disorders and their families. Eur J Paediatr Neurol 2013; 17:161-8. [PMID: 22889754 DOI: 10.1016/j.ejpn.2012.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/19/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aims to describe the most prevalent functional concerns of a group of young people with dystonia and their primary carers, and to explore the relationship between concerns, aetiology, severity of motor disability and manual ability. METHOD The Canadian Occupational Performance Measure (COPM) was completed with 57 children with dystonic movement disorders (65% males/35% females, mean 11.2 years (3.5-18.1)): 25% had primary dystonia, 75% secondary dystonia. Gross motor and manual function were classified using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). COPM concerns were analysed with respect to aetiology and severity of motor disability. RESULTS Almost three quarters of the respondents were GMFCS/MACS IV-V. All respondents had at least one concern around self-care. Other concerns included access to assistive technology, pain, dressing activities, use of tools and social participation. The nature and presence of concerns did not statistically differ according to the severity of gross motor or manual function impairment, though qualitative differences were noted. No statistical difference was found in relation to aetiology. INTERPRETATION Children and young people with dystonia have common functional concerns and priorities independent of the cause of dystonia, gross motor severity or manual function ability.
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Affiliation(s)
- Hortensia Gimeno
- Complex Motor Disorders Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
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Wang HY, Chen CC, Hsiao SF. Relationships between respiratory muscle strength and daily living function in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1176-1182. [PMID: 22502843 DOI: 10.1016/j.ridd.2012.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/04/2012] [Accepted: 02/06/2012] [Indexed: 05/31/2023]
Abstract
Cerebral palsy (CP) is a common childhood disorder characterized by motor disability. Children with CP are at risk of developing significant respiratory problems associated with insufficient respiratory muscle strength. It is crucial to identify important factors which are associated with the limitations in daily living function in such children. Hence, the aim of this study was to investigate the relationship between respiratory muscle strength and daily living function in children with CP. The participants were 30 children with CP (M±SD age, 8.7±2.1 years) and 30 children with typical development (M±SD age, 8.3±0.9 years). Respiratory muscle strength was measured by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) for the both groups of children. Children with CP were also assessed on daily living function with the subscales of Pediatric Evaluation of Disability Inventory (PEDI), the Functional Skills Scales (PEDI-FSS) and the Caregiver Assistance Scale (PEDI-CAS). Results show that, compared to the children with typical development, the MIP and MEP in the CP group were significantly lower (p=.003 and p=.001, respectively). In the CP group, MIP and MEP were correlated to two of the three PEDI-FSS domain scores (r=.43-.53, p<.05) but not with the three PEDI-CAS domain scores. MET explained 19% of the variance in the self-care domain score of PEDI-FSS. MEP also explained 15% of the variance in the social domain score of PEDI-FSS. The results of this study demonstrate that respiratory muscle strength in children with CP is correlated positively to their capability levels of daily living self-care and social function, and we suggest this should be taken into account when planning intervention to improving ability of daily living function for children with CP.
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Affiliation(s)
- Hui-Yi Wang
- Department of Physical Therapy, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung, Taiwan.
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Cussen A, Howie L, Imms C. Looking to the future: adolescents with cerebral palsy talk about their aspirations--a narrative study. Disabil Rehabil 2012; 34:2103-10. [PMID: 22510161 DOI: 10.3109/09638288.2012.672540] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore the future hopes and aspirations of adolescents with cerebral palsy (CP) with a particular focus on their reflections on engagement in leisure activities. METHOD This qualitative study used narrative inquiry methodology. Ten adolescents, aged 14-16 years with CP and Manual Ability Classification System levels ranging from I-IV, were purposively sampled from a longitudinal study of leisure participation. Data were gathered during two face-face interviews conducted approximately 1 month apart. Between interviews, photographs were taken by the adolescents to represent their visions of their future aspirations. In accordance with narrative inquiry methodology, the results were presented as individual stories constructed by the researcher. These narratives were subsequently analysed to produce themes representing the participants' reflections on their future. RESULTS Three themes were developed: (i) Keeping close relationships, (ii) Choosing a future life of one's own, (iii) Leisure in the years ahead. All the adolescents had aspirations for education, work, leisure and living situation. CONCLUSION This study highlights the value of seeking information from adolescents with CP and suggests clinicians be aware of, and work to support their expectations for future study, employment and recreational engagement.
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Affiliation(s)
- Amy Cussen
- Department of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia
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Wiegerink DJHG, Stam HJ, Ketelaar M, Cohen-Kettenis PT, Roebroeck ME. Personal and environmental factors contributing to participation in romantic relationships and sexual activity of young adults with cerebral palsy. Disabil Rehabil 2012; 34:1481-7. [PMID: 22324562 DOI: 10.3109/09638288.2011.648002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study determinants of romantic relationships and sexual activity of young adults with cerebral palsy (CP), focusing on personal and environmental factors. METHOD A cohort study was performed with 74 young adults (46 men; 28 women) aged 20-25 years (SD 1.4) with CP (49% unilateral CP, 76% GMFCS level I, 85% MACS level I). All participants were of normal intelligence. Romantic relationships, sexual activity (outcome measures), personal and environmental factors (associated factors) were assessed. Associations were analyzed using logistic regression analyses. RESULTS More females than males with CP were in a current romantic relationship. Self-esteem, sexual esteem and feelings of competence regarding self-efficacy contributed positively to having current romantic relationships. A negative parenting style contributed negatively. Age and gross motor functioning explained 20% of the variance in experience with intercourse. In addition, sexual esteem and taking initiative contributed significantly to intercourse experience. CONCLUSIONS For young adults with CP personal factors (20-35% explained variances) seem to contribute more than environmental factors (9-12% explained variances) to current romantic relationships and sexual experiences. We advice parents and professionals to focus on self-efficacy, self-esteem and sexual self-esteem in development of young adults with CP. [ IMPLICATIONS FOR REHABILITATION • The severity of gross motor functioning contributed somewhat to sexual activities, but not to romantic relationships.• High self-efficacy, self-esteem and sexual self-esteem can facilitate involvement in romantic and sexual relationships for young adults with CP.]
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Tedroff K, Löwing K, Jacobson DNO, Åström E. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol 2011; 53:724-9. [PMID: 21585367 DOI: 10.1111/j.1469-8749.2011.03969.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP). METHOD Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR. RESULTS Baseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common. INTERPRETATION The spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.
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Affiliation(s)
- Kristina Tedroff
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
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Cerniauskaite M, Quintas R, Boldt C, Raggi A, Cieza A, Bickenbach JE, Leonardi M. Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil 2010; 33:281-309. [PMID: 21073361 DOI: 10.3109/09638288.2010.529235] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001. METHOD The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application. RESULTS A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009. CONCLUSIONS The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.
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Affiliation(s)
- Milda Cerniauskaite
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
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Development of Romantic Relationships and Sexual Activity in Young Adults With Cerebral Palsy: A Longitudinal Study. Arch Phys Med Rehabil 2010; 91:1423-8. [DOI: 10.1016/j.apmr.2010.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/14/2010] [Accepted: 06/21/2010] [Indexed: 11/19/2022]
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