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Gerritsen A, Hulst RY, van Rijssen IM, Obeid J, Pillen S, Gorter JW, Verschuren O. The temporal and bi-directional relationship between physical activity and sleep in ambulatory children with cerebral palsy. Disabil Rehabil 2024; 46:2821-2827. [PMID: 37424307 DOI: 10.1080/09638288.2023.2232720] [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: 03/24/2022] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Exploring the temporal and bi-directional relationship between device-based measures of physical activity and sleep in ambulatory children with cerebral palsy (CP). MATERIALS AND METHODS 24-hour activity data were collected from children with CP (n = 51, 43% girls, mean age (range); 6.8 (3-12) years; Gross Motor Function Classification System levels I to III). Nocturnal sleep parameters and daily physical activity were measured for seven consecutive days and nights using ActiGraph GT3X accelerometers. Linear mixed models were constructed to explore the relationships between sleep and activity. RESULTS Light and moderate-to-vigorous activity were negatively associated with sleep efficiency (SE) (resp. p = 0.04, p = 0.010) and total sleep time (TST) (resp. p = 0.007, p = 0.016) the following night. Sedentary time was positively associated with SE and TST the following night (resp. p = 0.014, p = 0.004). SE and TST were positively associated with sedentary time (resp. p = 0.011, p = 0.001) and negatively with moderate-to-vigorous physical activity (resp. p < 0.001, p = 0.002) the following day. Total bedtime and TST were negatively associated with light physical activity (resp. p = 0.046, p = 0.004) the following day. CONCLUSIONS The findings from this study suggest that ambulatory children with CP may not sleep better after physical activity, and vice versa, indicating that the relationship is complex and needs further investigation.
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Affiliation(s)
- Anke Gerritsen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Faculty of Health and Physical Activity, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Raquel Y Hulst
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ilse M van Rijssen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Joyce Obeid
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Sigrid Pillen
- Kinderslaapexpert BV (Pediatric Sleep Expert LTd), Mook, The Netherlands
- Department of Electrical Engineering, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Jan Willem Gorter
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med 2024; 20:719-726. [PMID: 38169433 PMCID: PMC11063692 DOI: 10.5664/jcsm.10980] [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: 06/05/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Sleep quality is important during childhood and adolescence. Given the high prevalence of pain in children/youth with cerebral palsy, we aimed to measure the association between short-term pain trajectories and sleep disturbance in these individuals. METHODS We accrued the cohort between November 2019 and October 2020 and recruited children/youth who (1) were 8-18 years old; (2) had cerebral palsy with any Gross Motor Function Classification System level; and (3) could self-report pain and sleep disturbance. We collected self-reported baseline and weekly follow-up data using electronic questionnaires completed every week for 5 weeks. Sleep disturbance at 5 weeks was the primary outcome (pediatric Patient-Reported Outcomes Measurement Information System short form, v1.0-4a). We used general linear regression to assess the association between pain intensity trajectory group and sleep disturbance controlling for confounders. RESULTS A total of 190 individuals were eligible; 102 were enrolled and 89 were included in our final analysis. Pain trajectory groups had estimated crude mean sleep disturbance scores at 5 weeks ranging from 56.0 (95% confidence interval, 51.8, 60.8) to 61.8 (55.7, 67.9). Compared to those with stable, no/very mild pain, those in the stable, high-pain group had the greatest sleep disturbance (adjusted β = 5.7; 95% confidence interval, 1.2, 10.2). CONCLUSIONS Irrespective of pain trajectory, children and youth with cerebral palsy reported sleep disturbances. Those with a stable, high pain intensity in the previous 5 weeks reported the greatest sleep disturbance. The results highlight the importance of considering pain trajectories and their impact on sleep in children with cerebral palsy. CITATION Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med. 2024;20(5):719-726.
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Affiliation(s)
- Heather M. Shearer
- Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Darcy L. Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Hartman AG, Caspero K, Bodison SC, Soehner A, Akcakaya M, DeAlmeida D, Bendixen R. Pediatric Occupational Therapists' Perspectives on Sleep: A Qualitative Descriptive Study. Am J Occup Ther 2024; 78:7803205010. [PMID: 38512128 DOI: 10.5014/ajot.2024.050352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
IMPORTANCE Insufficient sleep is common among children seeking occupational therapy services but is rarely a focus of therapy despite sleep's critical impact on health. OBJECTIVE To examine pediatric occupational therapists' experiences, views, and confidence in addressing sleep concerns in their practice as well as barriers to and supports for doing so. DESIGN A qualitative descriptive study with thematic analysis of data from 1-hr virtual interviews. Rapport building, multiple-coder analysis, and member checking were used to ensure reliability and validity. SETTING Interviews were conducted remotely at each participant's preferred time and location. PARTICIPANTS Pediatric occupational therapists (N = 20) practicing across multiple settings in the United States were recruited through emails directed to their place of work and social media posts. A goal of 20 participants was set a priori with the goal of thematic saturation. OUTCOMES AND MEASURES A semistructured interview guide. RESULTS Participants were predominately cisgender (95%), female (85%), and White, non-Hispanic (90%). Overall, they voiced the importance of sleep but reported almost never writing sleep-related goals. Reported barriers that affected the participants' ability to fully address sleep in practice included therapists' lack of confidence and knowledge and low caregiver buy-in. CONCLUSIONS AND RELEVANCE The findings identify themes on the basis of which actionable steps toward promoting occupational therapists as sleep champions can be developed. Future implications include increasing sleep education opportunities, enhancing awareness of sleep health's impact on goal areas, and facilitating discussions about occupational therapy's role within the medical system and family system in supporting sleep. Plain-Language Summary: This qualitative study identifies what helps and hinders occupational therapists in addressing the sleep health concerns of their clients. We give occupational therapy clinicians and educators key supports to seek out or barriers to address.
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Affiliation(s)
- Amy G Hartman
- Amy G. Hartman, PhD, OTR/L, is Postdoctoral Fellow, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA;
| | - Kaitlyn Caspero
- Kaitlyn Caspero, MS, OTR/L, is Occupational Therapist and Founder, OT Graphically, Frederick, MD
| | - Stefanie C Bodison
- Stefanie C. Bodison, OTD, OTR/L, FAOTA, is Assistant Professor, Department of Occupational Therapy, University of Florida, Gainesville
| | - Adriane Soehner
- Adriane Soehner, PhD, is Assistant Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Murat Akcakaya
- Murat Akcakaya, PhD, is Associate Professor, Department of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Dilhari DeAlmeida
- Dilhari DeAlmeida, PhD, is Associate Professor and Program Director, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | - Roxanna Bendixen
- Roxanna Bendixen, PhD, OTR/L, FAOTA, is Associate Professor and Division Director, Department of Occupational Therapy, Medical University of South Carolina, Charleston
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Almeida MFD, Mello S, Zonta MB, Crippa AC. Cerebral palsy and sleep: nonpharmacological treatment and impact on the life of caregivers - an integrative review. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38467393 PMCID: PMC10927367 DOI: 10.1055/s-0044-1781464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/20/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Children with cerebral palsy have a higher prevalence of sleep disorders, with numerous factors associated with a negative impact on the quality of life of caregivers. OBJECTIVE To identify factors related to sleep disorders, nonpharmacological treatment, and the impact on the lives of caregivers. METHODS The present literature review was carried out in the Latin American and Caribbean Center on Health Sciences Information (BIREME), the Cochrane Library, Scopus, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, WorldCat, Web of Science, Latin American Literature on Health Sciences (LILACS), and Excerpta Medica Database (EMBASE), with the descriptors sleep, child, cerebral palsy, parents, and nursing. Studies available in Portuguese, English, or Spanish, published between 2010 and 2020, were our inclusion criteria. A total of 29 articles were included in the present review. RESULTS We considered nonpharmacological interventions effective support measures to drug-based treatments. The main sleep disorders in children with cerebral palsy are insomnia, parasomnias, nightmares, sleep bruxism, sleepwalking, sleep talking, disorders of initiation and maintenance of sleep, and sleep hyperhidrosis. Most studies point to a reduction in the quality of life of caregivers whose children have sleep disorders. CONCLUSION Our review suggests the effectiveness of nonpharmacological treatments combined with the use of medications. Measures such as changes in sleep environment and routine are favorable strategies to improve sleep quality. In addition, children with sleep disorders negatively impact the quality of life of their caregivers.
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Affiliation(s)
| | - Suzane Mello
- Universidade Federal do Paraná, Curitiba PR, Brazil.
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van Rijssen IM, Hulst RY, Gorter JW, Gerritsen A, Visser-Meily JMA, Dudink J, Voorman JM, Pillen S, Verschuren O. Device-based and subjective measurements of sleep in children with cerebral palsy: a comparison of sleep diary, actigraphy, and bed sensor data. J Clin Sleep Med 2023; 19:35-43. [PMID: 35975545 PMCID: PMC9806786 DOI: 10.5664/jcsm.10246] [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: 04/22/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES To investigate how subjective assessments and device-based measurements of sleep relate to each other in children with cerebral palsy (CP). METHODS Sleep of children with CP, classified at Gross Motor Function Classification System levels I-III, was measured during 7 consecutive nights using 1 subjective (ie, sleep diary) and 2 device-based (ie, actigraphy and bed sensor) instruments. The agreement between the instruments was assessed for all nights and separately for school- and weekend nights, using intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS A total of 227 nights from 38 children with CP (53% male; median age [range] 6 [2-12] years), were included in the analyses. Sleep parameters showed poor agreement between the 3 instruments, except for total time in bed, which showed satisfactory agreement between (1) actigraphy and sleep diary (ICC > 0.86), (2) actigraphy and bed sensor (ICC > 0.84), and (3) sleep diary and bed sensor (ICC > 0.83). Furthermore, agreement between sleep diary and bed sensor was also satisfactory for total sleep time (ICC > 0.70) and wakefulness after sleep onset (ICC = 0.55; only during weekend nights). CONCLUSIONS Researchers and clinicians need to be aware of the discrepancies between instruments for sleep monitoring in children with CP. We recommend combining both subjective and device-based measures to provide information on the perception as well as an unbiased estimate of sleep. Further research needs to be conducted on the use of a bed sensor for sleep monitoring in children with CP. CITATION van Rijssen IM, Hulst RY, Gorter JW, et al. Device-based and subjective measurements of sleep in children with cerebral palsy: a comparison of sleep diary, actigraphy, and bed sensor data. J Clin Sleep Med. 2023;19(1):35-43.
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Affiliation(s)
- Ilse Margot van Rijssen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Raquel Yvette Hulst
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jan Willem Gorter
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Anke Gerritsen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna Maria Augusta Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jeanine M. Voorman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sigrid Pillen
- Kinderslaapexpert BV (Pediatric Sleep Expert LTd), Mook, The Netherlands
- Department of Electrical Engineering, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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McCabe SM, Abbiss CR, Libert JP, Bach V. Functional links between thermoregulation and sleep in children with neurodevelopmental and chronic health conditions. Front Psychiatry 2022; 13:866951. [PMID: 36451768 PMCID: PMC9703054 DOI: 10.3389/fpsyt.2022.866951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The bi-directional relationship between sleep and wake is recognized as important for all children. It is particularly consequential for children who have neurodevelopmental disorders (NDDs) or health conditions which challenge their sleep and biological rhythms, and their ability to maintain rhythms of participation in everyday activities. There are many studies which report the diverse reasons for disruption to sleep in these populations. Predominantly, there is focus on respiratory, pharmaceutical, and behavioral approaches to management. There is, however, little exploration and explanation of the important effects of body thermoregulation on children's sleep-wake patterns, and associated behaviors. Circadian patterns of sleep-wake are dependent on patterns of body temperature change, large enough to induce sleep preparedness but remaining within a range to avoid sleep disturbances when active thermoregulatory responses against heat or cold are elicited (to maintain thermoneutrality). Additionally, the subjective notion of thermal comfort (which coincides with the objective concept of thermoneutrality) is of interest as part of general comfort and associated behavioral responses for sleep onset and maintenance. Children's thermoregulation and thermal comfort are affected by diverse biological functions, as well as their participation in everyday activities, within their everyday environments. Hence, the aforementioned populations are additionally vulnerable to disruption of their thermoregulatory system and their capacity for balance of sleep and wakefulness. The purpose of this paper is to present hitherto overlooked information, for consideration by researchers and clinicians toward determining assessment and intervention approaches to support children's thermoregulation functions and promote their subjective thermal comfort, for improved regulation of their sleep and wake functions.
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Affiliation(s)
- Susan M McCabe
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Chris R Abbiss
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Véronique Bach
- PeriTox UMR_I 01, University of Picardie Jules Verne, Amiens, France
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Hulst RY, Gorter JW, Voorman JM, Kolk E, Van Der Vossen S, Visser‐Meily JMA, Ketelaar M, Pillen S, Verschuren O. Sleep problems in children with cerebral palsy and their parents. Dev Med Child Neurol 2021; 63:1344-1350. [PMID: 33990937 PMCID: PMC8597175 DOI: 10.1111/dmcn.14920] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
AIM To describe: (1) the frequency and types of sleep problems, (2) parent-rated satisfaction with their child's and their own sleep, and (3) child factors related to the occurrence of sleep problems in children with cerebral palsy (CP) and their parents. The secondary objective was to compare the sleep outcomes of children with CP with those from typically developing children and their parents. METHOD The Sleep section of the 24-hour activity checklist was used to assess the sleep of children with CP and their parents and the sleep of typically developing children and their parents. RESULTS The sleep outcomes of 90 children with CP (median age 5y, range 0-11y, 53 males, 37 females, 84.4% ambulatory) and 157 typically developing peers (median age 5y, range 0-12y; 79 males, 78 females) and their parents were collected. Children with CP were more likely to have a sleep problem than typically developing children. Non-ambulatory children with CP were more severely affected by sleep problems than ambulatory children. The parents of non-ambulatory children were less satisfied about their child's and their own sleep. Waking up during the night, pain/discomfort in bed, and daytime fatigue were more common in children with CP and more prevalent in children who were non-ambulatory. INTERPRETATION These findings highlight the need to integrate sleep assessment into routine paediatric health care practice. What this paper adds Children with cerebral palsy (CP) are more likely to have a sleep problem than typically developing peers. Non-ambulatory children with CP are more severely affected by sleep problems. One-third of parents of children with CP report feeling sleep-deprived often or always compared to a quarter of parents of typically developing children.
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Affiliation(s)
- Raquel Y Hulst
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht University and De Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Jan Willem Gorter
- Department of PediatricsCanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonONCanada
| | - Jeanine M Voorman
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht University and De Hoogstraat RehabilitationUtrechtthe Netherlands,Department of Rehabilitation, Physical Therapy Science & SportsUMC Utrecht Brain CenterUniversity Medical CenterUtrechtthe Netherlands
| | - Eveline Kolk
- Department of Child and YouthDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | | | - Johanna M A Visser‐Meily
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht University and De Hoogstraat RehabilitationUtrechtthe Netherlands,Department of Rehabilitation, Physical Therapy Science & SportsUMC Utrecht Brain CenterUniversity Medical CenterUtrechtthe Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht University and De Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Sigrid Pillen
- Sleep Medicine CenterKempenhaegheHeezethe Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation MedicineUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht University and De Hoogstraat RehabilitationUtrechtthe Netherlands
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Hosley SN, Fortney C, Harrison T, Steward D. Documentation of Sleep Hygiene With Melatonin Use in Management of Sleep Disturbance in Children With Neurodevelopmental Disorders: A Quality Improvement Project. J Pediatr Health Care 2021; 35:354-361. [PMID: 33549411 DOI: 10.1016/j.pedhc.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this quality improvement project was to improve health-care provider consistency in addressing and documenting the use of sleep hygiene in children with neurodevelopmental disorders in alignment with evidence-based strategies. METHOD The project took place over 12 weeks and used a parent-completed screening tool and SmartPhrase technology incorporated into the patient note and discharge summary. A preimplementation and postimplementation query of the electronic medical record was used to determine change effectiveness. RESULTS The postimplementation query found a 42% increase in documentation of sleep hygiene. In addition, a 55% increase in documentation of sleep hygiene with the initiation of melatonin was noted. DISCUSSION The increase in documentation supports success of this initial practice change and demonstrates adherence to evidence-based sleep hygiene strategies. The project provided evidence of a significant improvement in electronic medical record documentation, highlighting an increased awareness of sleep issues in children with neurodevelopmental disorders.
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Visser SSM, van Diemen WJM, Kervezee L, van den Hoogen A, Verschuren O, Pillen S, Benders MJNL, Dudink J. The relationship between preterm birth and sleep in children at school age: A systematic review. Sleep Med Rev 2021; 57:101447. [PMID: 33611088 DOI: 10.1016/j.smrv.2021.101447] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/29/2022]
Abstract
Premature birth (before 37 weeks of gestation) has been linked to a variety of adverse neurological outcomes. Sleep problems are associated with decreased neurocognitive functioning, which is especially common in children born preterm. The exact relationship between prematurity and sleep at school age is unknown. A systematic review is performed with the aim to assess the relationship between prematurity and sleep at school age (5th to 18th year of life), in comparison to sleep of their peers born full-term. Of 347 possibly eligible studies, nine were included. The overall conclusion is that prematurity is associated with earlier bedtimes and a lower sleep quality, in particular more nocturnal awakenings and more non-rapid eye movement stage 2 sleep. Interpretations and limitations of the review are discussed. Moreover, suggestions for future research are brought forward, including the need for a systematic approach with consistent outcome measures in this field of research. A better understanding of the mechanisms that influence sleep in the vulnerable group of children born preterm could help optimize these children's behavioral and intellectual development.
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Affiliation(s)
- Simone S M Visser
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Laura Kervezee
- Department of Cell and Chemical Biology, Leiden University Medical Care, Leiden, the Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sigrid Pillen
- Sleep Medicine Center, Kempenhaeghe, Heeze, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
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Verschuren O, Hulst RY, Voorman J, Pillen S, Luitwieler N, Dudink J, Gorter JW. 24-hour activity for children with cerebral palsy: a clinical practice guide. Dev Med Child Neurol 2021; 63:54-59. [PMID: 32852777 PMCID: PMC7754464 DOI: 10.1111/dmcn.14654] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 12/28/2022]
Abstract
The association between physical activity and health has been clearly established, and the promotion of physical activity should be viewed as a cost-effective approach that is universally prescribed as a first-line treatment for nearly every chronic disease. Health care providers involved in the care for individuals with cerebral palsy (CP) are encouraged to take an active role in promoting their health and well-being. Balancing activity behaviours across the whole day, with improved physical activity, reduced sedentary time, and healthy sleep behaviours, can set up infants, preschool-, and school-aged children with CP for a healthy trajectory across their lifetime. However, most clinicians do not apply a systematic surveillance, assessment, and management approach to detect problems with physical activity or sleep in children with CP. Consequently, many children with CP miss out on an important first line of treatment. This article presents an evidence-informed clinical practice guide with practical pointers to help practitioners in detecting 24-hour activity problems as a critical step towards adoption of healthy lifestyle behaviours for children with CP that provide long-term health benefits.
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Affiliation(s)
- Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Raquel Y Hulst
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Jeanine Voorman
- Department of RehabilitationPhysical Therapy Science & SportsUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtthe Netherlands,Wilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Sigrid Pillen
- Sleep Medicine CenterKempenhaeghe, Heezethe Netherlands,Department of Electrical EngineeringTechnical University EindhovenEindhoventhe Netherlands
| | - Nicole Luitwieler
- OuderInzichtParent Organization for Improvement of Parent Involvement in ResearchAmsterdamthe Netherlands,Rijndam RehabilitationRotterdamthe Netherlands
| | - Jeroen Dudink
- Department of NeonatologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,UMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability ResearchDepartment of PediatricsMcMaster UniversityHamiltonOntarioCanada
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Hulst RY, Pillen S, Voorman JM, Rave N, Visser‐Meily JM, Verschuren O. Sleep health practices and sleep knowledge among healthcare professionals in Dutch paediatric rehabilitation. Child Care Health Dev 2020; 46:703-710. [PMID: 32706911 PMCID: PMC7589250 DOI: 10.1111/cch.12799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleep disorders are highly prevalent in children with neurodisabilities, yet they seem under-recognized in paediatric rehabilitation settings. The aim of this study was to assess among two groups of healthcare professionals (HCPs) working in paediatric rehabilitation: (1) sleep health practices and (2) knowledge about sleep physiology, sleep disorders and sleep hygiene. METHODS We performed a cross-sectional sleep survey among medical and non-medical HCPs and the general population. Participants (30 rehabilitation physicians [RPs], 54 allied health professionals [AHPs] and 63 controls) received an anonymous 30-item survey consisting of three domains: (1) general information, (2) application of sleep health practices and (3) sleep knowledge. RESULTS RPs address sleep issues more frequently in clinical practice than AHPs. Sleep interventions mostly consist of giving advice about healthy sleep practices and are given by the majority of HCPs. While RPs demonstrated the highest scores on all knowledge domains, total sleep knowledge scores did not exceed 50% correct across groups, with AHPs and controls showing equal scores. Sleep hygiene rules closest to bedtime and related to the sleep environment were best known, whereas those related to daytime practices were rarely mentioned across all groups. A small minority of HCPs (RPs 20%; AHPs 15%) believed to possess sufficient sleep knowledge to address sleep in clinical practice. No association was found between self-perceived knowledge and sleep knowledge scores among HCPs. CONCLUSIONS Sleep should become a standard item for review during routine health assessments in paediatric rehabilitation settings. HCPs' limited exposure to sleep education may result in feelings of incompetence and inadequate sleep knowledge levels, affecting their sleep health practices. Appropriate sleep training programs should be implemented to empower HCPs with knowledge, skills and confidence, needed to recognize and treat sleep disorders in children with neurodisabilities, as well as to be able to guide parents.
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Affiliation(s)
- Raquel Y. Hulst
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht University and De Hoogstraat RehabilitationUtrechtThe Netherlands
| | - Sigrid Pillen
- Sleep Medicine CenterKempenhaegheHeezeThe Netherlands,Department of Electrical EngineeringTechnical University EindhovenEindhovenThe Netherlands
| | - Jeanine M. Voorman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht University and De Hoogstraat RehabilitationUtrechtThe Netherlands,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Neele Rave
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht University and De Hoogstraat RehabilitationUtrechtThe Netherlands
| | - Johanna M.A. Visser‐Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht University and De Hoogstraat RehabilitationUtrechtThe Netherlands,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CenterUniversity Medical Center Utrecht, Utrecht University and De Hoogstraat RehabilitationUtrechtThe Netherlands
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12
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Smit DJM, Zwinkels M, Takken T, Hulst RY, de Groot JF, Lankhorst K, Verschuren O. Sleep quantity and its relation with physical activity in children with cerebral palsy; insights using actigraphy. J Paediatr Child Health 2020; 56:1618-1622. [PMID: 32627283 PMCID: PMC7689710 DOI: 10.1111/jpc.15055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 01/21/2023]
Abstract
AIM To objectively assess the sleep quantity, and explore the relationships between sleep quantity and quality, and physical activity and sedentary behaviour in children and adolescents with cerebral palsy (CP). METHODS An observational cross-sectional study was conducted. In total, 36 children with spastic CP (mean age 15y 4mo, SD 2y 6mo; classified as Gross Motor Function Classification System levels I (25), II (9), III (1) and IV (1)) were included. Active time, sedentary time and sleep quantity were measured using an activity monitor for 7 consecutive days. RESULTS Total sleep duration of children with CP ranged between 7.2 and 11.2 h. No significant correlations were found between active time and sleep quantity for total week, weekdays, and weekend days. Moderate negative correlations were found between sedentary time and sleep quantity during total week (r = -0.456, P = 0.005), weekdays (r = -0.453, P = 0.006) and weekend days (r = -0.48, P = 0.003). CONCLUSIONS Our findings suggest that children with CP are getting the recommended sleep duration, and that sedentary behaviour is correlated with sleep quantity in children with CP and may be more applicable to children with better motor functions. Future studies using more elaborate, objective sleep quantity and quality measures are recommended.
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Affiliation(s)
- Denise J M Smit
- UMC Utrecht Hersencentrum, Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Maremka Zwinkels
- UMC Utrecht Hersencentrum, Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Tim Takken
- UMC UtrechtChild Development and Exercise CenterUtrechtThe Netherlands
| | - Raquel Y Hulst
- UMC Utrecht Hersencentrum, Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Janke F de Groot
- UMC UtrechtChild Development and Exercise CenterUtrechtThe Netherlands
- Hogeschool Utrecht, Research Group Lifestyle and HealthInstitute of Human Movement StudiesUtrechtThe Netherlands
| | - Kristel Lankhorst
- Hogeschool Utrecht, Research Group Lifestyle and HealthInstitute of Human Movement StudiesUtrechtThe Netherlands
| | - Olaf Verschuren
- UMC Utrecht Hersencentrum, Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtThe Netherlands
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13
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Löwing K, Gyllensvärd M, Tedroff K. Exploring sleep problems in young children with cerebral palsy - A population-based study. Eur J Paediatr Neurol 2020; 28:186-192. [PMID: 32669213 DOI: 10.1016/j.ejpn.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/01/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe and explore sleep problems in a population-based cohort of young children with cerebral palsy (CP) in Stockholm, Sweden. METHODS All children with CP, aged 5-10 years, and living in the Northern Karolinska University Hospital's catchment area were invited to participate in a cross-sectional study. Medical records obtained in the previous two-year period were reviewed, and a pre-planned parental telephone interview that included five structured questions and the Insomnia Severity Index (ISI) was conducted. RESULTS In total, 118 children, with a mean age of 7.4 years (SD 1.5), were included. Bilateral CP was present in 45%, unilateral in 37%, dyskinetic in 15%, and ataxic CP in 3%. Parents of 81% of the children participated in the interview. They reported sleep problems in 41% of their children, and in 80% of these children, night-time sleep was negatively affected by pain. Differences between the ISI total score in relation to CP subtypes (p < 0.025) and levels in GMFCS-E&R (p < 0.001) were detected, with increasing sleep problems for children with dyskinetic CP and children in GMFCS-E&R V. Sleep problems affected by pain were associated to the total score at ISI (rs = 0.83, p < 0.001, n = 95). CONCLUSION The results identified that sleep problems were present in more than 40% of children with CP. Sleep problems were more frequently and extensively present in children with dyskinetic CP and children in GMFCS-E&R level V. Sleep problems were associated with the presence of pain and, in particular, in the most severely affected children.
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Affiliation(s)
- Kristina Löwing
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Mirja Gyllensvärd
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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14
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McPhee PG, Verschuren O, Peterson MD, Tang A, Gorter JW. The Formula for Health and Well-Being in Individuals With Cerebral Palsy: Cross-Sectional Data on Physical Activity, Sleep, and Nutrition. Ann Rehabil Med 2020; 44:301-310. [PMID: 32721989 PMCID: PMC7463117 DOI: 10.5535/arm.19156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/23/2019] [Indexed: 01/02/2023] Open
Abstract
Objective To determine physical activity, sleep, and nutrition patterns in individuals with cerebral palsy (CP) and investigate the association of Gross Motor Function Classification System (GMFCS) and age with these health behaviors. Methods A cross-sectional study was conducted in an outpatient setting. Participants included adolescents and adults with CP (n=28; GMFCS level I–V; mean age 35.1±14.4 years). An Exercise Questionnaire or Leisure Time Physical Activity Questionnaire was used to measure physical activity in adolescents and adults, respectively. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). An adapted version of the PrimeScreen questionnaire was used to assess nutrition. Linear regression analyses were performed to investigate the association between GMFCS and age with physical activity, sleep, and nutrition. Results The average total physical activity was 29.2±30.0 min/day. Seventy-five percent of the participants had poor sleep quality (PSQI score >5). Seventy-one percent reported “fair” eating behaviors; none reported “excellent” eating behaviors. Neither GMFCS nor age were significantly associated with PSQI score, PrimeScreen score, or total physical activity. A negative correlation existed between sleep quantity (hr/night) and PSQI score (r=-0.66, p=0.01). Conclusion The triad of health components, consisting of physical activity, sleep, and nutrition, was not associated with GMFCS or age in our sample of 28 individuals with CP, suggesting that these three health behaviors should be assessed during clinical encounters of CP in adolescents and adults at all levels of the GMFCS.
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Affiliation(s)
- Patrick G McPhee
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Olaf Verschuren
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, MI, USA
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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15
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Hulst RY, Voorman JM, Pillen S, Ketelaar M, Visser-Meily JM, Verschuren O. Parental perspectives on care for sleep in children with cerebral palsy: a wake-up call. Disabil Rehabil 2020; 44:458-467. [DOI: 10.1080/09638288.2020.1770873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Raquel Y. Hulst
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jeanine M. Voorman
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht Utrecht, The Netherland
| | - Sigrid Pillen
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht Utrecht, The Netherland
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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16
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Hartman AG, Terhorst L, Little N, Bendixen RM. Uncovering sleep in young males with Duchenne muscular dystrophy. Eur J Paediatr Neurol 2020; 26:20-28. [PMID: 32165079 DOI: 10.1016/j.ejpn.2020.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Sleep health in rare disease is often overlooked due to the complex nature of the disease. For males with Duchenne muscular dystrophy, sleep assessment is typically focused on pulmonary function and identification of sleep disordered breathing. Unfortunately for young boys with Duchenne muscular dystrophy, sleep assessment is often neglected, resulting in a dearth of knowledge on sleep health in this population. This study describes sleep quantity and quality in both younger (4-9 years) and older (10-17 years) males with Duchenne muscular dystrophy (n = 19) and compares these characteristics with sleep characteristics of unaffected peers (n = 17). METHODS This study was a longitudinal, observational study. Sleep measures were collected using the parent-proxy Children's Sleep Habits Questionnaire-Abbreviated version and objective sleep measures from actigraphy (sleep efficiency, awakenings, and awakening duration) over 30 days for all participants. Means and standard deviations were examined, and effect sizes were computed to quantify the magnitude of difference between the Duchenne muscular dystrophy and unaffected groups. RESULTS Overall, boys with Duchenne muscular dystrophy were found to experience worse sleep than their unaffected peers as measured by parent report and actigraphy. Effect sizes of both measures demonstrated moderate to large magnitudes of difference in many of the sleep variables. Parents of boys with Duchenne muscular dystrophy reported higher scores (indicating worse sleep) in all subsections and total score of the Children's Sleep Habits Questionnaire - Abbreviated version. Actigraphy data indicated that the Duchenne muscular dystrophy group had lower percent sleep efficiency, more night awakenings and longer duration of night awakenings than their unaffected peers. CONCLUSION Our findings offer a novel look into sleep in young boys with Duchenne muscular dystrophy. Both parent-report and actigraphy data indicate poor sleep health in this population compared with age-matched unaffected peers. Actigraphy was found to align with parent-report of sleep in this population, supporting the use of these two different ways to measure sleep in Duchenne muscular dystrophy. Results from this study should encourage clinicians and researchers alike to further explore sleep and its impact on disease in young boys with Duchenne muscular dystrophy.
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Affiliation(s)
- Amy G Hartman
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States.
| | - Lauren Terhorst
- University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
| | - Natalie Little
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
| | - Roxanna M Bendixen
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
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17
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van Gorp M, Dallmeijer AJ, van Wely L, de Groot V, Terwee CB, Flens G, Stam HJ, van der Slot W, Roebroeck ME. Pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy. Disabil Rehabil 2019; 43:2164-2171. [PMID: 34275407 DOI: 10.1080/09638288.2019.1694998] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Investigate pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy compared to references. MATERIALS AND METHODS Young adults with cerebral palsy (n = 97, aged 21-34 years) and age-matched references from the general population (n = 190) rated pain using a numeric rating scale and fatigue, depressive symptoms, sleep disturbance and global health using Patient-Reported Outcomes Measurement Information System® short forms. Scores were compared between cerebral palsy subgroups and the reference population. Correlation coefficients and linear regression analyses assessed interrelationships of health issues and associations with global health. RESULTS Individuals with Gross Motor Function Classification System level I had less pain, fatigue and depressive symptoms, while individuals with levels II and III-V had more pain (53% and 56%, p < 0.001) and those with levels III-V more fatigue (39%, p = 0.035) than references (pain: 26%, fatigue: 14%). Pain and fatigue were more interrelated (correlation coefficients: 0.71 vs. 0.41) and stronger associated with global mental health in individuals with cerebral palsy. CONCLUSIONS Young adults with Gross Motor Function Classification System levels II-V report more pain and those with levels III-V report more fatigue than references. Pain and fatigue are highly interrelated and specifically relate to mental health in individuals with cerebral palsy.Implications for rehabilitationExcept for those in the highest level of motor function, young adults with cerebral palsy report higher levels of pain and fatigue compared to the general population of the same age.Pain and fatigue are strongly interrelated and associated with mental health in young adults with cerebral palsy.The present study recommends to monitor pain and fatigue in young adults with cerebral palsy with low levels of gross motor function.We advise rehabilitation professionals to consider combined treatment for both pain and fatigue.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, 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, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerard Flens
- Akwa GGZ (Alliance for Quality in Mental Health Care), Utrecht, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilma van der Slot
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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18
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Brunton LK, McPhee PG, Gorter JW. Self-reported factors contributing to fatigue and its management in adolescents and adults with cerebral palsy. Disabil Rehabil 2019; 43:929-935. [PMID: 31361159 DOI: 10.1080/09638288.2019.1647294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore the self-reported factors that generate fatigue and to describe fatigue self-management strategies from the perspectives of adolescents and adults with cerebral palsy (CP). MATERIALS AND METHODS Text responses to open-ended questions of the Fatigue Impact and Severity Self-Assessment from 160 participants (mean age 22.4 years) across all GMFCS levels were coded using inductive line-by-line coding and then grouped together to generate larger categories for each question. Frequency counts associated with each category were then summarized descriptively by Gross Motor Function Classification System level. RESULTS The most commonly reported contributors to fatigue included the following: activity-related factors, general demands of life, sleep/rest, general health concerns, CP-related factors, mental health concerns, and environmental factors. The top five strategies participants reported to manage fatigue included rest or relaxation, sleeping or napping, changing or limiting their activities, being physically active, or using specific adaptations or assistive devices. CONCLUSIONS Results from this study suggest that there are potentially modifiable factors, including activity level and sleep, that significantly contribute to fatigue for persons with CP; these could form the basis of interventions targeted at the prevention and management of fatigue.Implications for RehabilitationAs individuals with cerebral palsy who are physically active experience significant fatigue, clinicians need to address fatigue to enable these individuals to reap the health benefits of physical activity.Providing education and support to integrate self-management techniques, such as planning and pacing, may be an effective long-term strategy to support individuals to complete highly valued tasks.Interventions targeting modifiable fatigue-generating factors such as activity level, sleep, and mental health concerns are needed.
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Affiliation(s)
- Laura K Brunton
- School of Physical Therapy, Western University, London, Canada
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19
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Bartlett DJ, Gorter JW, Jeffries LM, Avery L, Hanna SE. Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy. Dev Med Child Neurol 2019; 61:469-476. [PMID: 30353544 DOI: 10.1111/dmcn.14080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
AIM First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels. METHOD A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression. RESULTS Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed. INTERPRETATION Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities. WHAT THIS PAPER ADDS For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.
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Affiliation(s)
- Doreen J Bartlett
- School of Physical Therapy, Western University, London, ON, Canada.,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
| | - Lynn M Jeffries
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lisa Avery
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Avery Information Services Ltd., Orillia, ON, Canada
| | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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20
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Yeh N, Slomine BS, Paasch V, McLean HB, Suskauer SJ. Rehabilitation in Children with Disorder of Consciousness. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Jacquier D, Newman CJ. Parent-reported sleep disorders in children with motor disabilities: a comparison with the Sleep Disturbance Scale for Children's new norms. Sleep Med 2018; 55:26-32. [PMID: 30743207 DOI: 10.1016/j.sleep.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Children with motor disabilities such as cerebral palsy or neuromuscular diseases present more sleep disorders than their typically developing (TD) peers. However, research on these populations has always been performed using historical normative datasets or controls such as siblings. Therefore, we assessed the sleep quality of children with motor disabilities in comparison with a large, contemporary, general population sample. METHODS Demographic, medical, and the Sleep Disturbance Scale for Children (SDSC) questionnaires were sent to parents of children aged 4-18 years and followed by our tertiary pediatric neurorehabilitation clinic, and to those of school-aged children in regional primary and secondary schools. TD participant data allowed us to set pathological sleep score thresholds (T score ≥70). RESULTS We collected 245 responses for children with motor disabilities and 2891 for those from the general population (37% and 26% response rates, respectively). Cerebral palsy was the most frequent diagnosis (N = 109, 44.5%). Children with motor disabilities had significantly more frequent pathological sleep reported in their total SDSC score (7% vs 1.9%, odds ratio (OR) 3.98, 95% confidence interval (CI) 2.17-7.27, p < 0.001) and in five subscores. Single-parent households and drug-resistant epilepsy showed significant positive associations with pathological sleep among children with motor disabilities. For TD peers, parental unemployment and parental nationality were positively associated with pathological sleep. CONCLUSION This population-based study robustly estimated the prevalence of sleep disorders in children with motor disabilities. Sleep disorders were significantly more frequent in children with motor disabilities, but at a lower frequency than previously reported.
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Affiliation(s)
- David Jacquier
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Christopher John Newman
- Pediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
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22
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Sleep in children with epilepsy: the role of maternal knowledge of childhood sleep. Sleep 2018; 41:5077591. [DOI: 10.1093/sleep/zsy157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Indexed: 12/27/2022] Open
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23
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Barbeau DY, Weiss MD. Sleep Disturbances in Newborns. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E90. [PMID: 29053622 PMCID: PMC5664020 DOI: 10.3390/children4100090] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environment, and the amplitude integrated EEG can be a useful tool in evaluating sleep, and sleep disturbances, in neonates. Finally, there are protective factors for infant sleep that are still being studied.
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Affiliation(s)
| | - Michael D Weiss
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA.
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