Determinants of life quality in school-age children with cerebral palsy

Individual, family, and environmental determinants of vision-related quality of life of children and young people with visual impairment

Childhood visual impairment can have a significant impact on an individual's development. To improve clinical care and develop appropriate psychosocial interventions of these patients, it is necessary to understand the contributing and modifiable factors that both identify individuals in greater need and could be targeted in interventions. Here we investigate the broader individual, family, and environmental factors associated with vision-related quality of life (VQoL) of children and young people with visual impairment (CYP-VI). Data for this cross-sectional study were collected from September 2014 to May 2017 to develop and validate two vision-specific patient-reported outcome measures (PROMs) for CYP-VI. Patients were recruited from 22 hospitals in the United Kingdom and were aged 7-18 years with visual impairment as per WHO criteria. Participants self-completed the two PROMs, VQoL and Functional Vision Questionnaires. Clinical characteristics were extracted from medical records. Their carers provided information on family sociodemographic backgrounds. Associations between the VQoL scores and other factors were examined using Spearman's correlation, Kruskal-Wallis, Wilcoxon rank-sum tests, and quantile regression models. The sample consisted of 152 CYP-VI (67 females). Better VQoL was significantly associated with better functional vision overall (rSpearman = -0.52), parent-reported absence of additional chronic conditions (dCohen = 0.46), attending mainstream (versus other) school (dCohen = 0.44), higher socio-economic status (rSpearman = 0.17) and higher parental education level (rSpearman = 0.20). No other investigated factors were significantly associated with VQoL. The final quantile regression model included functional vision scores and the presence of additional health condition. Variation in self-reported VQoL in CYP-VI can be partly accounted for by factors relating to the clinical status of the affected child and, more importantly, by non-health-related factors. This needs to be considered in clinical practice when assessing vision-specific outcomes and providing support to CYP-VI, as well as in the development of future interventions.

Prevalence of knee contractures is high in children with cerebral palsy in Denmark

INTRODUCTION

Cerebral palsy (CP) is a neurological disease occurring in children at early gestation, often resulting in pronounced functional limitations. A Swedish cross-sectional study (Cloodt, et al., 2018) discovered that 22% of children with CP had a knee contracture, which was associated with higher levels of Gross Motor Function Classification System (GMFCS), higher age, and higher levels of spasticity measured by the Modified Ashworth Scale (MAS). The current study investigated these associations in a Danish population.

METHODS

This is a cross-sectional study including 1,163 children with CP aged 0-15 years, registered in the Danish National Cerebral Palsy Registry between 2017 and 2019. Prevalence of knee contracture was estimated, and logistic regression analysis was applied with results presented as odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

A total of 511 children with CP had knee contracture resulting in a prevalence of 44%. Age groups 4-6 years (OR: 1.73, CI: 1.19; 2.52), 7-9 years (OR: 1.85, CI: 1.29; 2.66) and 10-12 years (OR: 2.12, CI: 1.39; 3.24) were significantly associated with a higher prevalence of knee contractures compared to age group 0-3 years. Knee contractures were significantly more frequent at GMFCS levels IV (OR: 1.9, CI: 1.21; 2.97) and V (OR: 3.62, CI: 2.36; 5.55) compared to level I. Knee contractures were not associated with higher levels of MAS.

CONCLUSIONS

Knee contractures are highly prevalent and significantly associated with high levels of GMFCS and increased age until 12 years, but not with high levels of spasticity in children with CP in Denmark.

White matter microstructure and receptive vocabulary in children with cerebral palsy: The role of interhemispheric connectivity

BACKGROUND

Communication and cognitive impairments are common impediments to participation and social functioning in children with cerebral palsy (CP). Bilateral language networks underlie the function of some high-level language-related cognitive functions.

PURPOSE

To explore the association between receptive vocabulary and white-matter microstructure in the temporal lobes and the central part of the temporo-temporal bundles in children with CP.

MATERIALS AND METHODS

37 children with spastic motor type CP (mean age 9.6 years, 25 male) underwent a receptive vocabulary test (Peabody Picture Vocabulary Test, PPVT-IV) and 3T MRI. Mean fractional anisotropy (FA) and mean diffusivity (MD) were calculated for the temporal lobes and the interhemispheric bundles traversing the splenium of the corpus callosum and the anterior commissure. Associations between microstructure and receptive vocabulary function were explored using univariable linear regression.

RESULTS

PPVT-IV scores were significantly associated with mean white matter MD in the left temporal lobe, but not the right temporal lobe. There was no association between PPVT-IV and mean white matter FA in the temporal lobes. PPVT-IV scores were not significantly associated with the laterality of these diffusion tensor metrics. Within the corpus callosum, FA, but not MD of the temporo-temporal bundles was significantly associated with the PPVT-IV scores. Within the anterior commissure no equivalent relationship between diffusion metrics and PPVT-IV was found.

CONCLUSION

Our findings add further understanding to the pathophysiological basis underlying receptive vocabulary skills in children with CP that could extend to other patients with early brain damage. This study highlights the importance of interhemispheric connections for receptive vocabulary.

Determinants of Quality of Life of Children and Adolescents with Cerebral Palsy: A Systematic Review

OBJECTIVE

To summarize research findings on the determinants of Quality of Life (QoL) in children with cerebral palsy based on the International Classification of Functioning, Disability, and Health (ICF).

METHODS

The protocol of the review was registered in the International Prospective Register of The Systematic Reviews PROSPERO (CRD42021261966). A PubMed, Web of Science, MEDLINE complete, and CINAHL Plus search was conducted between January 2020 and October 2021 to identify studies that examined determinants of QoL. Inclusion criteria for the studies were children between the ages of birth and 20 years with cerebral palsy. The data extraction and quality evaluation of studies were carried out independently by two reviewers.

RESULTS

A total of 664 studies were identified in the search, of which 23 studies were included in the review. The majority of the studies were conducted in high-income countries. According to the ICF, 48% of the studies examined body function determinants, 52% examined activities determinants, and 26% examined environmental determinants. In contrast, 13% of the studies examined determinants related to participation and 13% examined determinants related to personal factors.

CONCLUSIONS

Based on our findings, most of the determinants identified in the literature are related sequentially to functional activities, body functions and structures, and environmental factors. Researchers should focus on assessing the determinants of QoL related to participation and personal characteristics for children with cerebral palsy in order to improve their QoL.

Functional and environmental predictors of health-related quality of life of school-age children with cerebral palsy: A cross-sectional study of caregiver perspectives

BACKGROUND

Caregivers' reports often serve as a decision-making guide in the treatment and rehabilitation of children with cerebral palsy (CP). This study identified predictors of the caregiver-reported health-related quality of life (HRQoL) of school-age children with CP.

METHODS

A cross-sectional study was conducted using the convenience sample of 108 children with CP (60 males; aged 7-18 years; mean age 12 years 8 months [SD 3 years 5 months]). Caregivers reported their child's HRQoL using KIDSCREEN-27. Standard multiple regression analyses were conducted to test if the child characteristics (gender, age, Gross Motor Function Classification System-Expanded & Revised [GMFCS-E&R], Manual Ability Classification System [MACS], intellectual disability, health problems, communication, social skills, behavioural difficulties); family characteristics (income, type, home adaptation); physical, social and attitudinal barriers; environmental features; and family-centeredness of service delivery significantly predicted HRQoL.

RESULTS

Fine manual abilities, home adaptation and the magnitude of barriers predicted physical well-being. The child's challenging behaviour, the magnitude of barriers and the barriers related to different policies predicted psychological well-being. The home adaptation level and provision of general information about the child's disability and available types of services predicted HRQoL domain related to interactions and relationships with parents. Children with behavioural difficulties and more severe limitations in communication had less social support from friends and peers. The social skills and intellectual functioning combined with the parental ratings of the child's behaviour, other people's attitudes towards the child and the lack of support predicted HRQoL in the School Environment domain. The magnitude and frequency of barriers were the strongest predictors of general HRQoL.

CONCLUSION

From the caregivers' perspective, home adaptation, supportive laws and policies and family-centred rehabilitation care that meets the family needs may promote children's HRQoL. Specific interventions addressing modifiable environmental features and continuous support to children in improving their fine motor abilities, communication and social skills and families in managing behavioural difficulties may be relevant for HRQoL of school-age children with CP.

Parent-report health-related quality of life in school-aged children with cerebral palsy: A cross-sectional study

Quality of life is both a goal and an outcome in Cerebral Palsy (CP) rehabilitation. Children with CP may show impaired health-related quality of life (HRQoL) compared to their typical peers. Parents' perceptions of HRQoL of their children could help rehabilitation professionals to identify areas for intervention aiming to improve health and wellbeing. This study aims to compare the proxy HRQoL of Portuguese school-aged children with CP and the general population, and to analyze child and family correlation. Differences were examined using European normative data for children from 8 to 18 years. Correlation and regression analysis examined the association between child and family variables in the CP group with statistically significant low scores. Sixty-eight parents of children and adolescents with CP (12.5 ± 2.91 years) answered the KIDSCREEN-52 parent version. We identified clinically significantly lower HRQoL in four out of ten HRQoL domains (Physical well-being, Autonomy, Moods & Emotions, and Bullying) than the norm peers. Correlations were found between the number of siblings and Autonomy (r = .315), meaning that having more siblings was associated with greater autonomy, and between mobility and Moods & Emotions (r = -.261), where children with impaired mobility shown low scores as perceived by their parents. Age, sex, mobility and cognitive impairment explained 32% of Physical well-being scores (p < .001). Mobility and cognitive impairment explained 16% of Bullying scores (p = .001). Although the family and child variables identified in this study are non-modifiable, they can help in the identification and early intervention aimed at improving HRQoL. Rehabilitation professionals should assess parent perceptions, extending the HRQoL assessment to children who can report and other informants, aiming at fostering wellbeing in children and adolescents with CP.

Antenatal Assessment of the Prognosis of Congenital Diaphragmatic Hernia: Ethical Considerations and Impact for the Management

Congenital diaphragmatic hernia (CDH) is associated with abnormal pulmonary development, which is responsible for pulmonary hypoplasia with structural and functional abnormalities in pulmonary circulation, leading to the failure of the cardiorespiratory adaptation at birth. Despite improvement in treatment options and advances in neonatal care, mortality remains high, at close to 15 to 30%. Several risk factors of mortality and morbidities have been validated in fetuses with CDH. Antenatal assessment of lung volume is a reliable way to predict the severity of CDH. The two most commonly used measurements are the observed/expected lung to head ratio (LHRo/e) and the total pulmonary volume (TPV) on MRI. The estimation of total pulmonary volume (TPVo/e) by means of prenatal MRI remains the gold standard. In addition to LHR and TPV measurements, the position of the liver (up, in the thorax or down, in the abdomen) also plays a role in the prognostic evaluation. This prenatal prognostic evaluation can be used to select fetuses for antenatal surgery, consisting of fetoscopic endoluminal tracheal occlusion (FETO). The antenatal criteria of severe CDH with an ascended liver (LHRo/e or TPVo/e < 25%) are undoubtedly associated with a high risk of death or significant morbidity. However, despite the possibility of estimating the risk in antenatal care, it is difficult to determine what is in the child’s best interest, as there still are many uncertainties: (1) uncertainty about individual short-term prognosis; (2) uncertainty about long-term prognosis; and (3) uncertainty about the subsequent quality of life, especially when it is known that, with a similar degree of disability, a child’s quality of life varies from poor to good depending on multiple factors, including family support. Nevertheless, as the LHR decreases, the foreseeable “burden” becomes increasingly significant, and the expected benefit is increasingly unlikely. The legal and moral principle of the proportionality of medical procedures, as well as the prohibition of “unreasonable obstinacy” in all investigations or treatments undertaken, is necessary in these situations. However, the scientific and rational basis for assessing the long-term individual prognosis is limited to statistical data that do not adequately reflect individual risk. The risk of self-fulfilling prophecies should be kept in mind. The information given to parents must take this uncertainty into account when deciding on the treatment plan after birth.

Cognitive, academic, executive and psychological functioning in children with spastic motor type cerebral palsy: Influence of extent, location, and laterality of brain lesions

PURPOSE

To investigate, in spastic motor-type cerebral palsy, the association between 1) the location and extent of brain lesions and numerous psychological outcomes; 2) the laterality of brain lesions and performance of verbal-related cognitive functions.

METHODS

The semi-quantitative scale for MRI (sqMRI) was scored for 101 children with cerebral palsy. Non-verbal and verbal proxy intelligence quotients (IQ), word reading, spelling, numerical operations skills, executive functioning, and psychological adjustment were assessed. Relationships between global and regional sqMRI scores and clinical scores were examined. The best multivariable linear regression model for each outcome was identified using the Bayesian Information Criteria. Regional sqMRI scores, gross motor functioning, manual ability, and epilepsy status were considered for inclusion as covariables. Where sqMRI scores made statistically significant contributions to models of verbal-related functioning, data were reanalysed including these sqMRI scores' laterality index. Verbal-related outcomes were compared between participants with left-sided versus bilateral brain lesions.

RESULTS

Medial dorsal thalamus and parietal lobe lesions significantly accounted for poorer verbal proxy-IQ. Left-hemisphere lateralization of temporal lobe lesions was associated with poorer verbal proxy-IQ. Participants with bilateral lesions performed significantly better than those with unilateral left-sided lesions in verbal cognitive functions. Controlling for epilepsy diagnosis, participants with ventral posterior lateral thalamus lesions presented with better Behaviour Rating Inventory of Executive Function scores, although within the normal range. sqMRI scores were not significantly associated with some psychological outcomes or these only bordered on significance after accounting for relevant control variables.

CONCLUSION

The laterality of early-life lesions influences the development of verbal-related cognitive functions.

Parenting and Child Personality as Modifiers of the Psychosocial Development of Youth with Cerebral Palsy

This two-year longitudinal study addressed the joint contribution of parent-rated parenting behaviors and child personality on psychosocial outcomes in 118 families of children with Cerebral Palsy (M age Time 1 = 10.9 years old, 64.4% boys). Latent change modeling revealed intra-individual changes in children's psychosocial development as internalizing and externalizing behaviors increased from the first to the second assessment and psychosocial strengths increased from the second to the third assessment, whereas externally controlling and autonomy-supportive parenting behavior remained stable over time. Externally controlling parenting related to higher levels of, and increases in behavioral problems, with these associations being most pronounced among children low on Extraversion, Conscientiousness, or Imagination. Autonomy-supportive parenting related to higher levels of psychosocial strengths, with this association being most pronounced among children high on Emotional Stability.

Does spasticity affect the postural stability and quality of life of children with cerebral palsy?

OBJECTIVES

Cerebral palsy is a unique physical disability that primarily affects children's gross motor functions and postural control. Cerebral palsy has a direct impact on children's daily activities and quality of life. This study aims to determine the relationship between spasticity, motor function, postural stability, and the quality life of children with cerebral palsy.

METHODS

Forty-five children (age range 4-6 years) diagnosed with spasticity from cerebral palsy participated in this study. Spasticity was evaluated by the modified Ashwarth scale; the children's functions were evaluated by gross motor functional measures, postural stability was evaluated by biodex balance system, and quality of life was measured with the pediatric quality of life inventory.

RESULTS

There was a strong positive correlation between the degree of spasticity and quality of life. Additionally, there was a significantly strong association between spasticity and gross motor function. In contrast, there was no correlation between spasticity and postural stability indices. Moreover, there was a strong positive correlation between quality of life and gross motor function. Lastly, there was no association between quality of life and the postural stability index.

CONCLUSION

The findings highlight the impact of spasticity on motor function and the quality of life of a cohort of children with cerebral palsy. These findings may determine therapeutic interventions and priorities to plan physical therapy programs. Such measures may overcome the main cause of disorders that delay and undermine the daily routines of the affected children.

Ankle contractures are frequent among children with cerebral palsy and associated with lower gross motor function and degree of spasticity

AIM

To estimate yearly prevalence of ankle contractures among children with cerebral palsy (CP). Moreover, to investigate whether age, gross motor function or spasticity are associated with ankle contracture.

METHODS

We examined yearly prevalence of ankle contractures among 933 children based on data from a national clinical quality database from 2012 to 2019. We used the Gross Motor Function Classification System (GMFCS) and the Modified Ashworth Scale (MAS) to assess gross motor function and spasticity in the plantar flexors. Ankle contracture was defined as dorsiflexion with an extended knee equal to or below 0 degrees. Associations between age, GMFCS, spasticity and ankle contractures were analysed using multivariable regression and presented as odds ratios (OR) with 95% confidence intervals (95%CI).

RESULTS

The prevalence of ankle contracture was 32% and did not change with calendar year. GMFCS IV-V compared to I-III (40.6% vs. 28.9%, OR = 1.5 (95%CI: 1.07-2.11) and MAS 2-4 compared to 0 (44.6% vs. 24.4%, OR = 2.5 (95%CI: 1.59-3.91) were associated with a higher prevalence of ankle contracture. Age was not associated with ankle contracture.

CONCLUSION

Ankle contractures are frequent among children with CP. Lower gross motor function and severe spasticity were associated with ankle contracture.

Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal

Parenting a child with neurodevelopmental disorder (NDD) is related to a higher rate of anxiety and depression, increased stress, and reduced quality of life. Although there is reason to believe that parenting children with NDD in low- and middle-income countries (LMIC) can be challenging, there is a lack of knowledge on the psychological distress among these caregivers, especially in rural areas. The aim of the study was to examine the psychological distress among caregivers having children with NDD in rural Nepal. Sixty-three caregivers were visited in their homes and interviewed by experienced mental health professionals. This study examined demographic information, severity of disability, perceived caregiver burden, and psychological distress, measured by the General Health Questionnaire-12 (GHQ-12). The study found a high level of psychological distress in the caregivers (M = 5.38, SD = 2.8). A majority (90.5%) scored two or higher, indicating the presence of a common mental disorder (CMD). Almost half (46%) scored six or higher, indicating a high level of distress. A majority of the caregivers reported that caring for their disabled child had a negative effect on the caregiver’s economy (70%), physical health (65%), social life (64%), and dreams and expectations for the future (81%). There was a significant relationship between the caregiver’s psychological distress (GHQ-12) and degree of disability in the child (Gross Motor Function Classification System), degree of caregiver burden, feeding problems, having health workers as a possible source of help, receiving incentive from the government, having somebody to confide in, and caregiver illiteracy. A forward regression analysis entering the significant factors indicated that caregiver burden, having someone to confide in, and having health workers as a possible source of help were significant related to psychological distress. The final step of the model explained 42.4% of the variance in psychological distress among the caregivers. The study indicates a high level of psychological distress and high overall burden in caregivers of children with NDD in rural Nepal. Further implications for research and service development are discussed.

Complex Comorbid Presentations are Associated with Harmful Behavior Problems among Children and Adolescents with Cerebral Palsy

Aim: Frequency and relationship between gastrointestinal symptoms, sleep problems, internalizing and externalizing symptoms, behavior problems and autism spectrum disorder (ASD) symptoms, and predictors of behavior problems were examined in children and adolescents with Cerebral Palsy (CP). Method: Parents of 104 children and adolescents with CP completed the Gastrointestinal Symptom Inventory, Children's Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire and the Behavior Problem Inventory-Short Form. Results: High frequency of behavior problems (88.5%), gastrointestinal symptoms (81.7%), sleep problems (81%) ASD symptoms (48%) and internalizing and externalizing symptoms (31.7%) were found. Relationships were found between gastrointestinal symptoms and sleep problems, and gastrointestinal symptoms and internalizing and externalizing symptoms. Relationships were found between sleep problems and behavior problems. Intellectual disability, sleep problems, internalizing and externalizing symptoms, and ASD symptoms predicted behavior problems. Conclusion: Findings highlights the frequency of comorbidities that exist in CP and how these comorbidities affect one another.

Risk models for predicting the health-related quality of life of caregivers of youth with gastrointestinal concerns

PURPOSE

To determine the usefulness of cumulative and additive risk models in predicting the healthy-related quality of life (HRQOL) of caregivers of youth with chronic gastrointestinal conditions.

METHODS

203 caregivers (82.8% mothers; 77.3% white) of youth (M = 11.27 years; 44.3% female; 78.8% White) completed self-report questionnaires focused on potential environmental, child health, and family risk factors that could impact caregiver HRQOL. Cumulative risk models, evaluating overall combined risk level, as well as an additive risk model, exploring individual risk variables, were evaluated.

RESULTS

Higher levels of cumulative risk were associated with poorer caregiver HRQOL after controlling for child and caregiver sex. A linear cumulative risk model was a better fit than a quadratic cumulative risk model for predicting caregiver HRQOL, while an additive model identified child HRQOL, child pain interference and family functioning as the most individually impactful risk variables.

CONCLUSION

This study illustrates the usefulness of both additive and cumulative risk approaches in identifying caregivers at risk for poor HRQOL. Provision of appropriate referrals and interventions based on the caregiver's risk factors can help protect caregiver quality of life and, in turn, benefit the care children with chronic conditions receive at home.

Executive behavior and functional abilities in children with perinatal stroke and the associated caregiver impact

Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers' perception of executive behavior and functional abilities among children with perinatal stroke, and how these outcomes impact the caregivers. We administered three questionnaires to primary caregivers of children with perinatal stroke to obtain caregiver-reported measures of (1) executive behavior of their child (Behavior Rating Inventory of Executive Function, Second Edition), (2) the functional abilities of their child (Pediatric Evaluation of Disability Inventory Computer Adaptive Test), and (3) the psychosocial impact experienced by the caregiver themselves (Parental Outcome Measure). Participants included 20 children (mean age = 9.3 years, range = 6-16 years) with perinatal stroke and their primary caregivers. Functional abilities in the children were rated as clinically impaired in the domains of daily activities and mobility. Half of the children exhibited clinically impaired ratings on at least one executive behavior domain, but the mean scores for these domains did not reach clinically impaired levels. Greater ratings of problems in daily activities for the child was associated with greater caregiver guilt (r = -0.55, p = 0.02). Caregivers of children with perinatal stroke who experience limitations in performing daily activities should be more closely monitored for adverse impact and be provided the necessary support and education to alleviate the associated guilt.

Daily parenting of children with cerebral palsy: The role of daily child behavior, parents' daily psychological needs, and mindful parenting

The purpose of this study was to advance the current understanding of the daily dynamics that are involved in raising a child with Cerebral Palsy (CP). Specifically, we examined the role of mindful parenting and of day-to-day variation in parents' psychological needs and child behavior in explaining day-to-day variation in parents' autonomy-supportive, psychologically controlling, and responsive parenting behavior. Parents (N = 58) of children with CP (Mage = 12.68 years) participated in a 7-day diary study. Multilevel analyses indicated that parents' autonomy-supportive, psychologically controlling, and responsive behaviors fluctuate considerably between days. Further, daily fluctuations in both child behavior and parents' own psychological needs were found to be associated with this daily variability in parenting. In addition, interindividual differences in mindful parenting were associated positively with parents' responsiveness and negatively with psychologically controlling parenting across the week. These findings point towards the changeability of parenting behavior among parents of a child with CP and suggest that interventions targeting parenting behavior in the context of CP will be most effective when taking into account both the parents' and the child's functioning.

What predicts the proxy-reported health-related quality of life of adolescents with cerebral palsy in Bangladesh?

BACKGROUND

The health-related quality of life (HRQoL) of adolescents with CP in low and middle-income countries is often poor, as is the case in Bangladesh. This exploratory study examined what factors predict the proxy-reported HRQoL of adolescents with CP in rural Bangladesh, a typical low- and middle-income country (LMIC).

METHODS

Adolescents with CP (10 to 18y) were identified using the Bangladesh Cerebral Palsy Register. HRQoL was assessed using the Cerebral Palsy Quality of Life-Teens proxy-report questionnaire (CPQoL-Teens), adolescent mental health using the Strengths and Difficulty Questionnaire (SDQ) and caregiver mental health using the Depression, Anxiety and Stress Scale (DASS-21). Theoretical and statistical interests (i.e. bivariate analysis, p < 0.05) identified potential predictors which were entered into hierarchical multiple linear regression (HMLR) models in order of clinical significance; HMLR related adolescent clinical characteristics, adolescent and caregiver mental health and proxies of socioeconomic status to CPQoL-Teens dimensions.

RESULTS

One hundred fifty-four adolescents with CP (mean age 15y 1mo, SD 1y 8mo, female 31.2%) participated in this study. Twenty-four factors were identified to explore for relationship to adolescent proxy-reported HRQoL. Fifteen of the factors correlated to one or more CPQoL-Teens dimension; strongest correlation was between 'feelings about functioning' and motor impairment (r = 0.545). Nine were predictive of CPQoL-Teens dimensions; adolescent sex, school attendance, severity of motor impairment, hearing and speech impairment, mother's education, primary caregiver depression and stress, and having a sanitary latrine at home resulting in score changes of between 0.79 (95% CI 0.24 to 1.35) to 35.1 (95% CI 6.03 to 64.22).

CONCLUSIONS

Many of the factors predicting the proxy-reported HRQoL of adolescents with CP are amenable to intervention, and have the potential to improve adolescent wellbeing. Several determinants are priorities of the sustainable development goals (SDGs); these findings should inform resource prioritization to improve the wellbeing of adolescents with CP in Bangladesh and other LMICs.

Behavioral difficulties, sleep problems, and nighttime pain in children with cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) may be at risk of behavioral difficulties.

AIMS

1) Determine the prevalence of behavioral difficulties in preschool- and school-aged children with CP and 2) Assess the association between behavioral difficulties and a) sleep problems, b) nighttime pain and c) child characteristics (age, CP phenotype, comorbidities).

METHODS AND PROCEDURES

Caregivers of 113 children with CP aged 4-12 years [mean (SD) age = 7.4 (2.5) years; 61.9% male] completed the Strengths and Difficulties Questionnaire, Sleep Disturbance Scale for Children and a sleep quality questionnaire to assess child behavior, sleep and nighttime pain, respectively.

OUTCOMES AND RESULTS

25.6% of children (17.6% preschool-aged; 29.1% school-aged) had behavioral difficulties. Sleep problems (odds ratio [OR] 9.1, 95% confidence interval [CI] 3.4-24.4) and nighttime pain (OR 4.1, 95% CI 1.5-11.5) were associated with behavioral difficulties. Sleep problems remained significantly associated with behavioral difficulties (adjusted OR 7.5, 95% CI 2.6-21.4) when adjusted for nighttime pain, age and non-ambulatory status.

CONCLUSIONS AND IMPLICATIONS

Behavioral difficulties were reported in one in four children with CP and were associated with sleep problems and nighttime pain. Identifying and treating behavioral difficulties, sleep problems or nighttime pain is important in the care of children with CP.

A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability

BACKGROUND

This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD).

METHODS

This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded.

RESULTS

Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost.

CONCLUSIONS

Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities.

Efeito da intervenção com videogame ativo sobre o autoconceito, equilíbrio, desempenho motor e sucesso adaptativo de crianças com paralisia cerebral: estudo preliminar

RESUMO Crianças com paralisia cerebral (PC) comumente são identificadas como diferentes de seus pares típicos devido à sua condição neuromotora, o que afeta a motivação e consequentemente o desempenho em atividades. A realidade virtual (RV) pode ser uma ferramenta potencial para melhora de aspectos motivacionais e desempenho motor durante a reabilitação. O objetivo deste estudo foi verificar o efeito de um programa de intervenção fundamentado em RV utilizando um videogame ativo no autoconceito, equilíbrio, desempenho motor e sucesso adaptativo de crianças PC. Participaram do estudo oito crianças entre 5 e 14 anos (10,37±3,29), com diagnóstico de PC, níveis I e II no GMFCS. O autoconceito foi avaliado com a Escala Infantil de Autoconceito Piers-Harris, o equilíbrio por meio do domínio quociente motor 3 da Escala de Desenvolvimento Motor. Para avaliação do desempenho motor foi utilizado o quociente motor geral, e as pontuações dos jogos avaliaram o sucesso adaptativo no ambiente virtual. A intervenção aconteceu durante oito semanas, sendo duas sessões semanais de 45 minutos cada. Foram utilizados quatro jogos ativos com demandas de equilíbrio, coordenação motora, saltos, agachamentos e deslocamento lateral do corpo. O teste de Wilcoxon foi usado para verificar as diferenças pré e pós-intervenção. Constatou-se diferença após a intervenção nos domínios: ansiedade, intelectual, popularidade, aparência física, satisfação, felicidade, equilíbrio, desempenho motor, e pontuação dos jogos. Conclui-se que a RV pode influenciar na forma com que essas crianças se enxergam quanto ao autoconceito, equilíbrio, desempenho motor geral e sucesso adaptativo, ajudando os profissionais a desenvolver formas de terapia que possam melhorar tais aspectos.

The effects of bone marrow mononuclear cell transplantation on the quality of life of children with cerebral palsy

Background

Quality of life (QOL) is an important factor in evaluating the effectiveness of treatment in children with cerebral palsy (CP). The aim of this study was to evaluate the effects of autologous bone marrow mononuclear cells (BM MNCs) on the QOL of children with CP.

Methods

From December 2015 to December 2016, 30 children with CP aged from 2 to 15 years received two intrathecal infusions of BM MNCs, one at baseline and the other 3 months later, at Vinmec International Hospital. The motor function and muscle tone of the patients were evaluated using the Gross Motor Function Measure (GMFM)-88 and Modified Ashworth Score, respectively. Their QOL was assessed at baseline and 6 months after the first BM MNC transplant using the Vietnamese version of the Cerebral Palsy Quality of Life Questionnaire for children (CP QOL-Child)–the parental proxy report, which comprises seven domains. Nineteen mothers (mean age: 32.9±4.9 years) and 11 fathers (mean age: 36.1±6.8 years) were invited to complete the CP QOL-Child assessment before and after the transplantations, Paired t-tests and multivariate regression analyses were used to evaluate the changes in QOL and GMFM scores and to identify the key factors correlated with the QOL score.

Results

Significant changes were observed in the children’s gross motor function and muscle spasticity, as evidenced by the GMFM-88 total score, scores for each of its domains, the GMFM-66 percentile and the muscle tone (P < 0.001). Six months after the transplantations, the QOL scores of children with CP were markedly increased (P < 0.001) for all the domains, except for the domain of access to services. In the multivariate regression analysis, significant associations were found between higher age of children and higher QOL except for feeling about functioning and pain and impact of disability domains. Gross Motor Function Classification System (GMFCS) level was negatively correlated with the score of pain and impact of disability domain, while the GMFM-88 scores were positively correlated with the QOL in terms of feelings about functioning and family health domain (P < 0.05).

Conclusion

The QOL of the children with CP was noticeably improved 6 months after BM MNC transplantation and was accompanied by improvements in gross motor function and muscle tone.

Trial registration

ClinicalTrials.gov Identifier: NCT02574923. Registered on October 14, 2015.

Path analysis of strength, spasticity, gross motor function, and health-related quality of life in children with spastic cerebral palsy

Background

Measures of health-related quality of life may predict the future status of individuals with illnesses, and could therefore be a good indicator in children with cerebral palsy (CP). This study examines the causal relationship between spasticity, weakness, gross motor function, and health-related quality of life (QOL) in school-aged children with spastic CP and tests models of functional outcome mediated by gross motor function.

Methods

A total of 62 children (44 males, 18 females) with spastic CP were recruited. Strength was assessed with the Manual Muscle Test, spasticity with the Modified Ashworth Scale, and the Gross Motor Function Measure was also employed. Health-related QOL was assessed using the Korean version of the Childhood Health Assessment Questionnaire. Physical therapists interviewed the parents and assessed the children.

Results

The proposed path model showed good fit indices. The direct effects were significant between spasticity and gross motor function, strength and gross motor function, gross motor function and health-related QOL, and strength and health-related quality of life. Spasticity had a significant positive indirect effect and strength a significant negative indirect effect on health-related QOL through gross motor function.

Conclusion

This is an initial study of the causal relationship between strength, spasticity, gross motor function, and health-related QOL.

Quality of life and habitual physical activity in children with cerebral palsy aged 5 years: A cross-sectional study

OBJECTIVE

To compare quality of life (QOL) according to ambulatory status and to investigate association with habitual physical activity (HPA) in children with cerebral palsy (CP) aged 5 years.

METHODS

Fifty-eight participants were classified using Gross Motor Function Classification System (GMFCS) as level I = 33, II = 8, III = 6, IV = 3 and V = 8 and assessed for motor function using 66-item Gross Motor Function Measure (GMFM-66). Participants wore an ActiGraph^® triaxial accelerometer for 3 days to measure HPA. Parents completed the parent proxy Cerebral Palsy Quality of Life questionnaire for Children (CP QOL-Child). Linear regression analyses were performed.

RESULTS

Ambulant children with CP (GMFCS I-III) had better parent-reported QOL than non-ambulant children (GMFCS IV-V) in domains of feelings about functioning (mean difference (MD) = 20.0; 95% confidence interval (CI) = 11.7, 28.2), participation and physical health (MD = 14.5; 95%CI = 4.7, 24.4), and emotional well-being and self-esteem (MD = 12.5; 95%CI = 4.8, 20.1). HPA was not associated with QOL domains after controlling for motor function. GMFM scores accounted for 39% of variation for feelings about functioning domain (MD = 0.4; 95%CI = 0.2, 0.6).

CONCLUSIONS

In children with CP aged 5 years, HPA was not associated with parent-reported QOL. Gross motor function contributed to QOL domains of feelings about functioning.

The quality of life of children with severe developmental disabilities

BACKGROUND

Research examining the quality of life (QoL) of children with severe developmental disabilities (SDD) is limited. The present study examines parent perceptions of child QoL in children with SDD compared with typically developing (TD) children and then examines predictors of QoL for the SDD group.

METHOD

Parents of 246 children with SDD (aged 4 to 19 years) and 210 TD children (aged 4 to 18 years) responded to an online survey. QoL was measured using a composite variable composed of the child's happiness, achievement of potential and friendship quality.

RESULTS

Children with DD had lower QoL ratings than TD children. In children with DD, higher QoL was related to younger age, higher adaptive skills, lower maladaptive behaviour, lower parent psychological distress and higher satisfaction with the child's education.

CONCLUSIONS

Interventions to promote positive outcomes for children with SDD should target both characteristics of the individual and the environment.

Post-transplant adaptive function in childhood cerebral adrenoleukodystrophy

Objective

Hematopoietic stem cell transplantation (HSCT) is the only treatment known to slow or halt inflammatory demyelination among boys with the cerebral form of X‐linked adrenoleukodystrophy (cALD), a devastating childhood condition affecting the central nervous system. HSCT can lead to a range of adverse outcomes including fatality. Previous studies have examined the potential predictors of post‐HSCT survival and neurologic functioning. However, little is known about patients' daily‐life adaptive functional outcomes (i.e., ability to communicate, maintain social relationships, and independently execute tasks of daily living). The purpose of this retrospective cohort study was to identify which patient characteristics and treatment‐related variables predict long‐term adaptive function among the survivors of HSCT for cALD.

Methods

We obtained caregiver ratings of adaptive functioning of 65 transplant survivors at an average of 4.6 years (range: 1.0–24.1 years) post‐HSCT. Using linear regression with penalized maximum likelihood estimation, we modeled the relative contribution of pre‐transplant neurocognitive test performance, MRI severity, transplant regimen, and length of time since transplant on patient adaptive functioning outcomes.

Results

Higher radiographic disease severity and poorer performance on baseline neurocognitive tests requiring fine motor skills and visual perception were associated with inferior adaptive functioning after HSCT. Use of radiation during the transplant preparative regimen also predicted poorer adaptive outcomes.

Interpretation

In addition to radiological disease severity, baseline neurocognitive test performance is associated with post‐transplant adaptive functional outcomes. Neurocognitive measures may play an important role in prognostic counseling and post‐transplant treatment planning for patients considering HSCT for cALD.

Multivariate Analysis and Machine Learning in Cerebral Palsy Research

Cerebral palsy (CP), a common pediatric movement disorder, causes the most severe physical disability in children. Early diagnosis in high-risk infants is critical for early intervention and possible early recovery. In recent years, multivariate analytic and machine learning (ML) approaches have been increasingly used in CP research. This paper aims to identify such multivariate studies and provide an overview of this relatively young field. Studies reviewed in this paper have demonstrated that multivariate analytic methods are useful in identification of risk factors, detection of CP, movement assessment for CP prediction, and outcome assessment, and ML approaches have made it possible to automatically identify movement impairments in high-risk infants. In addition, outcome predictors for surgical treatments have been identified by multivariate outcome studies. To make the multivariate and ML approaches useful in clinical settings, further research with large samples is needed to verify and improve these multivariate methods in risk factor identification, CP detection, movement assessment, and outcome evaluation or prediction. As multivariate analysis, ML and data processing technologies advance in the era of Big Data of this century, it is expected that multivariate analysis and ML will play a bigger role in improving the diagnosis and treatment of CP to reduce mortality and morbidity rates, and enhance patient care for children with CP.

Profile of children with developmental disabilities attending a complex pain clinic of a children's hospital in Australia

AIM

To document the profile and management of children with developmental disabilities (DD) attending an outpatient complex pain clinic at a Children's Hospital in Sydney, Australia.

METHODS

Children with DD from 2011 to 2014 were identified from a clinic database, and pain relevant data was collected.

RESULTS

A total of 107 (19.6%) of 544 children were identified with DD, and accounted for one-third of clinic attendances. The median age was 14 years (interquartile range: 11-16) and females were slightly over-represented (62, 57.9%). About one-third of children had cerebral palsy (CP) from a variety of prenatal, natal and post-neonatal causes. The lower limb was the most common site for pain in children with CP, while back pain was more frequent in children with other disabilities. Comorbid emotional disorders were significantly associated with the non-CP disabilities. Children who required more than four clinic attendances were more likely to have comorbid anxiety/depression and to be reviewed by multiple specialists.

CONCLUSIONS

Long-term persistent pain in children with DD forms a significant cohort of children requiring tertiary level paediatric pain services. Multisystem comorbidities and emotional disorders predict greater service utilisation. Further research into the effectiveness of multidisciplinary pain teams and interventions in this cohort of children is required.

Accuracy of administrative claims data for cerebral palsy diagnosis: a retrospective cohort study

BACKGROUND

Cerebral palsy is the most common cause of childhood physical disability, with multiple associated comorbidities. Administrative claims data provide population-level prevalence estimates for cerebral palsy surveillance; however, their diagnostic accuracy has never been validated in Quebec. This study aimed to assess the accuracy of administrative claims data for the diagnosis of cerebral palsy.

METHODS

We conducted a retrospective cohort study of children with cerebral palsy born between 1999 and 2002 within 6 health administrative regions of Quebec. Provincial cerebral palsy registry data (reference standard) and administrative physician claims were linked. We explored differences between true-positive and false-negative cases using subgroup sensitivity analysis.

RESULTS

A total of 301 children were identified with confirmed cerebral palsy from the provincial registry, for an estimated prevalence of 1.8 (95% confidence interval [CI] 1.6-2.1) per 1000 children 5 years of age. The sensitivity and specificity of administrative claims data for cerebral palsy were 65.5% (95% CI 59.8%-70.8%) and 99.9% (95% CI 99.9%-99.9%), respectively, yielding a prevalence of 2.0 (95% CI 1.9-2.3) per 1000 children 5 years of age. The positive and negative predictive values were 58.8% (95% CI 53.3%-64.1%) and 99.9% (95% CI 99.9%-99.9%), respectively. The κ value was 0.62 (95% CI 0.57-0.67). Administrative claims data were more sensitive for children from rural regions, born preterm, with spastic quadriparesis and with higher levels of motor impairment.

INTERPRETATION

Administrative claims data do not capture the full spectrum of children with cerebral palsy. This suggests the need for a more sensitive case definition and caution when using such data without validation.

Proxy-reported quality of life in adolescents and adults with dyskinetic cerebral palsy is associated with executive functions and cortical thickness

PURPOSE

Quality of life (QOL) is a key outcome for people with cerebral palsy (CP), and executive functioning is an important predictor of QOL in other health-related conditions. Little is known about this association in CP or about its neural substrate. We aim to analyze the influence of executive functioning (including cognitive flexibility) as well as that of other psychological, motor, communication and socioeconomic variables on QOL and to identify neuroanatomical areas related to QOL in adolescents and adults with CP.

METHODS

Fifty subjects diagnosed with dyskinetic CP (mean age 25.96 years) were recruited. Their caregivers completed the primary caregiver proxy report version of the CP QOL-Teen questionnaire. Motor status, communication, IQ, four executive function domains, anxiety/depression and socioeconomic status were evaluated. Correlations and multiple linear regression models were used to relate CP QOL domains and total score to these variables. Thirty-six participants underwent an MRI assessment. Correlations were examined between cortical thickness and CP QOL total score and between cortical thickness and variables that might predict the CP QOL total score.

RESULTS

Executive functions predict scores in four domains of CP QOL (General well-being and participation, Communication and physical health, Family health and Feelings about functioning) in the regression model. Among the cognitive domains that comprise executive function, only cognitive flexibility measured in terms of performance on the Wisconsin card sorting test (WCST) predicts the CP QOL total score. Monthly income, fine motor functioning and communication ability predict scores on the domains Access to services and Family Health, Feelings about functioning and School well-being, respectively. The clusters resulting from the correlation between cortical thickness and both CP QOL total score and WCST performance overlapped in the posterior cingulate and precuneus cortices.

CONCLUSIONS

Cognitive flexibility predicts proxy report CP QOL-Teen total score in dyskinetic CP. This relationship has its anatomical correlate in the posterior cingulate and precuneus cortices.

d. Putten AAJ. Pain and hospital admissions are important factors associated with quality of life in nonambulatory children

AIM

This was the first study to investigate the factors associated with health-related quality of life (HRQoL) in nonambulatory children with cerebral palsy (CP), based on a HRQoL measure specifically developed for this population.

METHODS

The Dutch version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD-DV) was used to measure HRQoL. It was completed by 66 parents of 47 boys and 19 girls with nonambulatory CP aged between five and 18 years with gross motor function classification system (GMFCS) levels of IV and V. Factors measured were the child's motor and cognitive impairments, comorbidities, pain, parents' education and occupations and family structure. Multiple linear regression analyses were used to determine the significant factors and the relative contribution of these factors to the CPCHILD-DV scores.

RESULTS

The most important factors associated with poorer HRQoL scores were pain and hospital admissions in the previous six months. Other factors were as follows: increased GMFCS level, feeding by gastrostomy tube, inability to communicate verbally, cognitive impairment, poor seizure control and higher parents' educational qualifications.

CONCLUSION

Pain and hospital admissions were the most important factors that were negatively associated with HRQoL in nonambulatory children with CP between five to 18 years.

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.

Quality of life in young adults with cerebral palsy

BACKGROUND

Little is known about the quality of life (QOL) of young adults with cerebral palsy.

OBJECTIVE/HYPOTHESIS

This cross-sectional analysis compares the QOL of a cohort of young Australian adults with CP with a cohort of able-bodied peers to explore the relationship between QOL and impairments, functioning, and social participation.

METHODS

Young adults identified from the Victorian Cerebral Palsy Register were invited to complete a survey about QOL, gross motor function, independence in self-care, and social participation. QOL was assessed with the Quality of Life Instrument for Young Adults (YAQOL). A general population sample of young North American adults, who had completed the YAQOL was selected for comparison.

RESULTS

Surveys and consent forms were completed by 335 young adults or their proxies, an overall participation rate of 63% of those located. The mean age of the study participants was 24.7 [s.d = 2.8] years; 51% were male and 49% female. Two hundred and seven (62%) of the 335 participants self-reported their QOL. When compared with the general population sample, self-reporting participants had similar QOL scores for the social relationship and environmental context domains (p > 0.05), while QOL scores were lower for the physical health, psychological well-being, and role function domains (p < 0.001). There was no association between psychological well-being and variables related to body structure and gross motor function in young adults with CP.

CONCLUSIONS

Contrary to the assumption that young adults with severe CP have low psychosocial well-being, it is apparent that these individuals can have good psychosocial well-being regardless of their disability.

Impact of Symptoms of Maternal Anxiety and Depression on Quality of Life of Children with Cerebral Palsy

INTRODUCTION

Cerebral palsy (CP) interferes with the quality of life (QOL) of children with CP, and given that parents report having to often guide their children's decision making, it is important to understand the psychosocial factors that have a potential influence on parent-proxy reports. The purpose of this study was to investigate the impact of maternal anxiety and depression symptoms on parent proxy-reported health-related QOL (HRQOL) for children with CP, while controlling other clinical and demographical variables that may have affect HRQOL.

METHODS

The HRQOL scores of 97 outpatients with CP, aged 7-18 years, were assessed using the Pediatric QOL Inventory, Parent version (PedsQL-P). Each patient's type of CP, gross and fine motor function levels, severity of intellectual disability (ID), and other clinical variables were recorded. The levels of depression symptoms in each mother were assessed using the Beck Depression Inventory (BDI), and the levels of anxiety symptoms were assessed with the Beck Anxiety Inventory (BAI).

RESULTS

According to regression analyses, male gender, severity of ID, and higher mothers' BAI scores had negative effects on the PedsQL-P physical scores, and severity of ID and higher mothers' BDI scores had negative effects on the PedsQL-P psychosocial scores. Regarding the determinants of total HRQOL, severity of ID, GMFCS score, and higher mothers' BDI scores negatively impacted the PedsQL-P total scores.

CONCLUSION

Our findings show significant predictor effects of the mothers' anxiety and depressive symptoms, independent from other clinical variables, on the mother-rated HRQOL scores in children with CP.

Behavioral and emotional problems in children and adults with cerebral palsy

OBJECTIVE

In patients with cerebral palsy (CP), psychological problems influence their participation in society. Little is known about the persistence of behavioral and social problems into adulthood.

MATERIALS AND METHODS

In a two-center cross-sectional study, caregivers of 121 adults and 88 children were ask to assess behavior of the patients through the parent/caregiver forms of the Child Behavior Checklist (CBCL), the Strengths and Difficulties Questionnaire (SDQ), and the Vineland Adaptive Behavior Scale II (VABS). Questionnaires were returned from 43 adults and 39 children.

RESULTS

In both groups we found the same frequency of abnormalities in attention problems (32.4 vs. 36.1%, p = 0.826) and social interaction problems (32.3 vs. 33.3%; p = 0.926) in the CBCL, and peer problems (38.9 vs. 75.7%; p = 0.115) in the SDQ. Children show a lower percentage of abnormal prosocial behavior (41.7 vs. 16.2%, p = 0.016) and lower abnormal rates of communication (88.2 vs. 61.5; p = 0.01) and daily living skills (90.0 vs. 71.8; p = 0.041), whereas the level of abnormalities in both groups in these dimensions of VABS notably high.

CONCLUSION

The persistence of psychological and social problems from childhood into adulthood underlines the importance of focusing on early intervention.

Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy?

Physical, social, and attitudinal environment may affect the quality of life (QoL) of children and adolescents with cerebral palsy (CP). Participants in this study included parents of 206 children and adolescents with CP (55.8% males) aged 8-18 years (M=11.96, SD=3). Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% level I, 18% level II, 18% level III, 12.6% level IV, and 27.2 level V. Environmental barriers were assessed with the Spanish version of the European Child Environment Questionnaire (ECEQ), and QoL was assessed with the KIDSCREEN parents' version. The results of the correlation analysis revealed that GMFCS level, IQ, and type of schooling are significantly correlated with QoL. Barriers were also associated with QoL. A series of hierarchical regression analyses indicated that, after controlling for the effect of child and parent's variables, barriers at home and at school significantly contribute to QoL. These findings underscore the importance of providing interventions to produce environmental changes that contribute to the improvement of QoL.

Quality of Life of Children with Cystic Periventricular Leukomalacia - A Prospective Analysis with the Child Health Questionnaire-Parent Form 50

OBJECTIVE

Cystic periventricular leukomalacia (PVL) is associated with moderate to severe physical and mental handicaps in preterm infants. We hypothesized whether or not those handicaps were associated with a poorer quality of life (QOL) of affected children and their families compared to matched controls.

PATIENTS AND METHODS

All children with the diagnosis PVL collected from a local database of the Division of Neonatology of the Medical University of Graz, Austria, and born between 1997 and 2008 were included in the study group. Preterm infants matched for gestational age, birth weight, year of birth, and gender without PVL served as controls. Selected perinatal data and neurological outcome were documented. The interview of the parents was conducted using the Child Health Questionnaire-Parent Form 50 (CHQ-PF50), German version. The CHQ-PF50 consists of 50 items divided over 11 multi-item scales and 2 single-item questions.

RESULTS

The CHQ-PF50 was answered by 21 parents of the study (26%) and 44 of the control (39%) group. Cases were diagnosed as having developmental delay, dystonia, strabismus, central visual impairment, seizures, and cerebral palsy (81 vs. 7%, p < 0.001) more common than controls. Analysis of the CHQ-PF 50 revealed significantly poorer results for cases regarding physical health (physical functioning: p < 0.001, physical social limitations: p < 0.001, and physical summary score: p < 0.001). Several psychosocial categories (behavior, mental health, and self-esteem) and the psychosocial summary score did not differ between groups. Only two categories (parental impact concerning time p = 0.004 and family activities: p = 0.026) revealed significantly poorer results in the cases as it was for the global category for health (p = 0.009).

CONCLUSION

Children with PVL had an overall poorer QOL regarding physical aspects. However, PVL was not generally associated with a poorer QOL regarding psychosocial aspects.

Factors associated with caregiver experience in families with a child with cerebral palsy

PURPOSE

Managing the stresses of parenting a child with cerebral palsy (CP) can be challenging. This study sought to identify factors that are associated with higher levels of caregiver stress.

METHODS

A retrospective review of data from the Learn From Every Patient™ project conducted in an interdisciplinary CP clinic were used to compare caregiver responses on 2 subsets (financial and time/emotional) of the Assessment of Caregiver Experience in Neuromuscular Disorders (ACEND) and physical and medical characteristics of the child.

RESULTS

The range of scores in both the financial and emotional subset was large. The presence of behavior problems, seizures, and severity of CP showed the strongest associations with emotional stress and accounted for 14% of the variance in scaled scores (r= 0.392, adj R2= 14.3, p< 0.01). The child's age was not significantly related to parental stress. The most highly reported areas of stress were worry about the child's pain, and the financial impact of lost wages.

CONCLUSION

Caregiver experience varied widely and is associated with a range of factors among families caring for a child with CP. Further research is needed to test whether interventions to minimize the areas of greatest stress could make a meaningful difference in family functioning.

Growing Up With Cerebral Palsy: Contemporary Challenges of Healthcare Transition

Cerebral palsy is traditionally known as a major cause of chronic disability in childhood. With advances in neonatal care and improved survival, the majority of adolescents with cerebral palsy require ongoing services into adulthood. This paper highlights some of the challenges in their transition from pediatric to adult healthcare and proposes key elements to ensure a smooth transition process.

Self-reported quality of life of young children with conditions from early infancy: a systematic review

CONTEXT

There is little consistency in the use of instruments for measuring self-reported quality of life (QoL) in young children.

OBJECTIVE

To systematically review studies of self-reported QoL in children aged <12 years with congenital health conditions, and to examine the agreement between self- and proxy-reports.

DATA SOURCES

Literature databases (MEDLINE, EMBASE, Web of Science, PsychINFO) were systematically searched, reference lists of eligible studies were scanned.

STUDY SELECTION

We included studies published in English between January 1989 and June 2013 which used validated instruments to assess self-reported QoL in children aged <12 years with a distinct congenital health condition identified in early infancy.

DATA EXTRACTION

We extracted data on study design, objective, sample characteristics, QoL assessment instrument, statistical techniques and results.

RESULTS

From 403 full-text articles assessed for eligibility, 50 studies underwent detailed review, and 37 were included in a narrative synthesis. Children's self-reported QoL was assessed by using a variety of generic and/or condition-specific instruments, with the Pediatric Quality of Life Inventory being the most frequently used (25% [9 studies]). Regardless of the condition or the instrument used, children often reported QoL similar to the reference population, except for lower scores in the physical functioning/health domain. There were differences between younger and older age groups according to QoL domain. The child's perception of QoL differed from that of his or her parents, in particular for subjective domains such as emotional functioning, and these differences were age related. The main limitation of the review resulted from the lack of published studies on self-reported QoL in young children, in particular, lacking both self-reports and proxy reports. Existing studies demonstrated wide variability in the QoL instruments used and approaches to statistical analyses, lack of information about the formation of the study sample (response rate; comparison of responders and nonresponders) and low sample sizes in the age group of interest.

CONCLUSIONS

The reviewed studies demonstrated that, even for younger children, both child and parent perspectives are essential to understanding the impact of a condition on a child's QoL.

Quality of life in children with cerebral palsy: implications for practice

The ability to assess the quality of life of children with cerebral palsy to inform and evaluate individual care plans, service planning, interventions, and policies is crucial. In this article, the recent evidence on quality of life in children with cerebral palsy is reviewed, with attention to the determinants of quality of life and role of this construct as a practical outcome indicator in clinical trials. Quality of life measurement advances for children with cerebral palsy are discussed with a focus on condition-specific quality of life measures, particularly, the Cerebral Palsy Quality of Life-Child, which is the first condition-specific quality of life measure for children with cerebral palsy. The article presents an overview for clinicians and researchers intending to use quality of life measures on children with cerebral palsy and provides recommendations for future research that will better inform practice in the field.

The concept of a toolbox of outcome measures for children with cerebral palsy: why, what, and how to use?

Accurate and well-targeted measurement of a child's abilities and participation in daily activities pre- and post-intervention is essential to understanding the effects of therapies provided by pediatric practitioners. There is growing interest in identification of outcome core sets for specified client groups. This article elaborates on the concepts to consider when selecting and interpreting measures from an outcomes toolbox for children with cerebral palsy. Principles discussed include use of self-report measures to open a dialogue with the child/parent; a holistic assessment approach to identify a child's challenges, strengths, and contextual factors that can influence functioning; links between measurement and heightened engagement of the child/family in the rehabilitation process and goals; and the need to plan the evaluation and dialogue aspects of the assessment process. If clinicians across the international rehabilitation community draw from the same toolbox, the end result could be a cohesive approach and common language to outcome measurement.

Long-term trajectories of health-related quality of life in individuals with cerebral palsy: a multicenter longitudinal study

OBJECTIVES

To (1) determine the long-term trajectory of health-related quality of life (HRQOL) for the dimensions of physical complaints and motor, psychological, and social functioning for groups of individuals with cerebral palsy (CP) aged 1 to 24 years; (2) assess the variability in HRQOL within individuals with CP over time; (3) assess the variability in HRQOL between individuals with CP; and (4) compare the HRQOL in individuals with CP to reference data of typically developing individuals.

DESIGN

Multicenter prospective longitudinal study.

SETTING

Rehabilitation departments of 3 university medical centers and various rehabilitation centers in The Netherlands.

PARTICIPANTS

Dutch individuals with CP (N=424; age, 1-24y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The HRQOL dimensions of physical complaints and motor, psychological, and social functioning. Each individual visited the rehabilitation department for 3 or 4 measurements. The time between measurements was 1 or 2 years.

RESULTS

Individuals with CP experience an HRQOL that, on average, remains fairly stable over time. Variability in HRQOL within individuals with CP was similar to that within typically developing individuals. Variability between individuals with CP could be explained by type of CP (motor functioning), Gross Motor Function Classification System level (physical complaints and motor and social functioning), and intellectual disability (physical complaints and social functioning). Finally, individuals with CP experienced a lower HRQOL than did typically developing individuals, especially for the dimensions of motor and social functioning.

CONCLUSIONS

Many changes take place in the psychosocial development of the individual with CP, which accordingly change their expectations and those of their caregivers, peers, and professionals. As a result, perceived physical complaints and motor, psychological, and social functioning remain fairly stable over many years.

Rehabilitation service utilization in children and youth with cerebral palsy

AIM

To describe the pattern of use of rehabilitation services in children and adolescents with cerebral palsy (CP), and to identify factors associated with use.

METHODS

In this study, parents of 91 school-age children and 167 adolescents with CP completed a questionnaire regarding educational and rehabilitation resources received within the last 6 months. Rehabilitation services included occupational therapy (OT), physical therapy (PT), speech language pathology (SLP), psychology and special education. Demographic characteristics were documented and developmental and functional status was assessed. Relationships between service utilization and sociodemographic factors, functioning and school setting were determined.

RESULTS

Over half of children (53.2%) and adolescents (57.5%) were in regular schools; however, 41% of these required special education resources. The remainder (42.5-46.8%) was in special schools. The majority of children (84.6%) were receiving at least one rehabilitation service although this decreased (68.1%) in adolescence. PT and OT were most common and services were provided predominantly in the school setting. Services were primarily weekly direct interventions at school age, with weekly interventions or consultations most common for adolescents. Younger age was associated with service receipt at school age only. Children with greater motor limitations, lower IQ and greater activity limitations were more likely to receive OT, PT, SLP or special education. Children in segregated schools were significantly more likely to receive rehabilitation services, when compared with children in regular schools.

CONCLUSIONS

The majority of children and youth received one or more services. Individuals with greater motor or cognitive challenges were more likely to receive a range of school-based services from rehabilitation specialists. When compared with children of school age, adolescents were less likely to receive services and when provided, services were more likely to be consultative. Services may need to be more optimally organized through childhood to enhance benefits to children with CP across activity limitation profiles.

A systematic review of clinimetric properties of measurements of motivation for children aged 5-16 years with a physical disability or motor delay

The purpose of this systematical review was to appraise the clinimetric properties of measures of motivation in children aged 5-16 years with a physical disability or motor delay. Six electronic databases were searched. Studies were included if they reported measuring motivation in school-aged children across occupational performance areas. Two reviewers independently identified measures from included articles. Evaluation of measures was completed using the COSMIN (consensus-based standards for the selection of health measurement instruments) checklist. A total of 13,529 papers were retrieved, 15 reporting measurement of motivation in this population. Two measures met criteria: Dimensions of Mastery Questionnaire (DMQ) and Pediatric Volitional Questionnaire (PVQ). There was evidence of adequate validity for DMQ, and preliminary evidence of test-retest reliability. Psychometric evidence for PVQ was poor. Both measures demonstrated good clinical utility. The large number of retrieved papers highlights the importance being attributed to motivation in clinical studies, although measurement is seldom performed. Both identified measures show promise but further psychometric research is required.

Determinants of quality of life in children with cerebral palsy: a comprehensive biopsychosocial approach

This study investigated the determinants of quality of life (QOL) of children with cerebral palsy (CP) considering possible variables comprehensively from a biopsychosocial perspective by adopting the International Classification of Functioning, Disability and Health (ICF) and using a CP-specific QOL questionnaire. A total of 167 children with CP (mean age 9.06 years, SD 2.61 years) and their caregivers participated in this study. Children's QOL was measured by the Cerebral Palsy Quality of Life for Children (CP QOL-Child) - primary caregiver proxy-report form. The potential determinants of QOL were collected based on all ICF dimensions. Results of seven multiple regression models showed that the determinants of QOL in children with CP were multidimensional and biopsychosocial in nature, i.e., encompassing the domains of health condition, body functions and structures, and contextual factors of the ICF. Children's behavioral and emotional problems as well as caregiver's psychological and family-related factors were important determinants of QOL in children with CP. Knowledge of the determinants of QOL could serve as a guide in a holistic approach to evaluation and intervention targeted at these determinants to improve the QOL of children with CP.

Mastery motivation in adolescents with cerebral palsy

The aim of this study is to describe motivation in adolescents with cerebral palsy (CP) and factors associated with motivation level. The Dimensions of Mastery Questionnaire (DMQ) measures motivation in mastering challenging tasks and expressive elements. It was completed by 153 parents and 112 adolescents with CP. Adolescents (GMFCS in n=146 - I:50, II:43, III:13, IV:15, V:25) were assessed using the Leiter IQ and Gross Motor Function Measure. Parents completed the Vineland Adaptive Behavior Scale and the Strengths and Difficulties Questionnaire. Motivation scores were highest for mastery pleasure and social persistence with adults and lowest for gross motor and object-oriented persistence. Socio-demographic factors were not strongly correlated with DMQ. Higher gross motor ability (r=0.24-0.52) and fewer activity limitations (r=0.30-0.64, p<.001) were associated with persistence in cognitive, motor and social tasks, but not mastery pleasure. Higher IQ was associated with persistence in object-oriented tasks (r=0.42, p<.001). Prosocial behaviors correlated with high motivation (r=0.39-0.53, p<.001). Adolescents' motivation scores were higher than parents' scores. Adolescents with CP express high mastery pleasure, not related to abilities. High motivation was associated with fewer activity limitations and prosocial behaviors and aspects of family environment. Findings elucidate those at-risk for low motivation, which can influence treatment adherence and participation in challenging but meaningful activities.

Comparison of Health-Related Quality of Life between children with cerebral palsy and spina bifida

This study has two aims-the first is to compare the Health Related Quality of Life (HRQoL) between children with cerebral palsy (CP) and children with spina bifida (SB); the second is to investigate the relationship between HRQoL and age, sex, body mass index (BMI), level of ambulation, cooperation, family income and the mother's education level in both groups of children. The study included 96 children with CP and 70 children with SB (aged 5-18) who attended a physiotherapy and rehabilitation program at an institute of special training and rehabilitation. Socio-demographic information was obtained within the study. The Child Health Questionnaire (CHQ-PF50) was used to evaluate HRQoL. A significant difference was found in terms of age and BMI between children with CP and SB (p<0.05). HRQoL was lower for children with CP. There was a significant difference between the two groups in terms of role/social limitations - emotional behavioral, behavior, global behavior, parental impact-emotional and parental impact-time (p<0.05). A positive correlation was found between BMI and self-esteem in children with SB, unlike children with CP. The HRQoL of children with CP was lower than children with SB. The parameters of behavior and parental impact were particularly affected in the children with CP. Minimizing behavioral problems (which can improve with advancing age) of the children with CP and reducing parental impact are important for improving the HRQoL of both the child and parents. There is a need for further studies on this issue.