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Brown A, Tornberg ÅB, Kristensson Hallström I. Parents' lived experience of early risk assessment for cerebral palsy in their young child using a mobile application after discharge from hospital in the newborn period. Ann Med 2024; 56:2309606. [PMID: 38300887 PMCID: PMC10836479 DOI: 10.1080/07853890.2024.2309606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore parents' lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period. METHODS An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans' lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents' lived experience. RESULTS The overall understanding of the parents' experience was 'Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future. CONCLUSIONS The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.
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Affiliation(s)
- Annemette Brown
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Pediatrics and Adolescence Medicine, Nordsjælland University Hospital, Capital Region of Denmark, Denmark
- Department of Neurology and Physiotherapy, Nordsjællands Hospital, Capital Region of Denmark, Denmark
| | - Åsa B. Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Adde L, Åberg KB, Fjørtoft T, Grunewaldt KH, Lade R, Osland S, Piegsa F, Sandstrøm PG, Støen R, Størvold GV, Eriksen BH. Implementation of remote general movement assessment using the in-motion instructions in a high-risk norwegian cohort. BMC Pediatr 2024; 24:442. [PMID: 38987721 PMCID: PMC11234780 DOI: 10.1186/s12887-024-04927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND General Movement Assessment (GMA) is recommended for early detection of risk for cerebral palsy but requires trained clinical experts. We aimed to implement home- and hospital-based filming for remote GMA in a Norwegian high-risk infant cohort, as well as evaluating parents' experiences in filming their infant at home. METHODS This knowledge translational study used a prospective cohort design including participants referred to neurodevelopmental follow-up across three sites in the Central Norway Regional Health Authority. Two home films of the fidgety type of general movements were collected between 12+1-14+6 and 15+1-17+6 weeks after term by parents. An additional film was collected at the hospital between 12+1 and 17+6 weeks after term. The instructional guide for all filming was the In-Motion App standards. Videos were transferred to a remote GMA team and classified as either "GMA scorable" or "GMA not scorable" based on Prechtl's GMA standards. Parents responded to an online survey using a 5-point Likert scale to collect information about their perspectives, experiences, and possible worries by filming their infant at home. RESULTS One-hundred-and-two infants from 95 families participated. Ninety-two (96.8%) families transferred 177 home-based videos. Eighty-four (92%) of these had 95 videos taken in their local hospital. All 177 home-videos were "GMA scorable" and three (3,1%) out of 95 hospital-based videos were classified as "GMA not scorable". Eight families did not respond to the survey and two families did not receive the survey due to a technical error. Seventy-eight (91.7%) respondents agreed or strongly agreed that it was easy to perform home filming and five (5.9%) agreed that they were more worried about their child`s development after filming at home. Almost 80% of respondents agreed that a video for GMA can be taken at home instead of in hospital. CONCLUSIONS This study strengthens the clinical implementation of home filming by parents and remote GMA for early detection of CP in high-risk follow-up programs. The implementation of remote GMA has the potential to facilitate early intervention to improve function in children with CP in line with international recommendations. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04287166 Date of registration: 27/02/2020.
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Affiliation(s)
- Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | | | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristine Hermansen Grunewaldt
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Lade
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Siril Osland
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Frank Piegsa
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | | | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Panda S, Singh A, Kato H, Kokhanov A. Cerebral Palsy: A Current Perspective. Neoreviews 2024; 25:e350-e360. [PMID: 38821909 DOI: 10.1542/neo.25-6-e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024]
Abstract
Cerebral palsy (CP) is the most common cause of motor disability in children. Insults to the brain at different times lead to diverse injuries. As a result, CP is an extremely heterogeneous clinical diagnosis, presenting differently in each individual and at various ages. With improving survival rates of preterm newborns, increasing active resuscitation of extremely preterm newborns, and widespread availability of extensive genetic testing soon after birth, it is imperative to focus on earlier diagnosis and long-term outcomes of CP. CP is primarily classified into 4 categories based on type of motor impairment, functional ability, distribution, and etiology. As the understanding of CP has evolved significantly in the last 2 decades, the methods of early detection of CP have consequently advanced. Appropriate diagnosis is essential for proper education and counseling of affected families, and introduction of therapeutic interventions as early as possible. In this review, we focus on early brain development and provide an overview of the etiology, classification, diagnosis, early therapeutic options, and prognosis of CP.
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Affiliation(s)
- Sanjeet Panda
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Ajay Singh
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX
| | - Hugo Kato
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Artemiy Kokhanov
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
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Forth FA, Hammerle F, König J, Urschitz MS, Neuweiler P, Mildenberger E, Kidszun A. Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants: The COPE Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240105. [PMID: 38393728 PMCID: PMC10891472 DOI: 10.1001/jamanetworkopen.2024.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/03/2024] [Indexed: 02/25/2024] Open
Abstract
Importance In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents. Objective To examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication. Design, Setting, and Participants This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022. Interventions Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing). Main Outcomes and Measures The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates. Results Of 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16). Conclusions and Relevance When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment. Trial Registration German Clinical Trials Register (DRKS): DRKS00024466.
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Affiliation(s)
- Fiona A. Forth
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael S. Urschitz
- Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp Neuweiler
- Journalistisches Seminar, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - André Kidszun
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Dickinson C, Sheffield J, Mak C, Boyd RN, Whittingham K. When a baby is diagnosed at high risk of cerebral palsy: understanding and meeting parent need. Disabil Rehabil 2023; 45:4016-4024. [PMID: 36373179 DOI: 10.1080/09638288.2022.2144491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment Therapy; PACT). MATERIALS AND METHODS Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10-24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews. RESULTS Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery. CONCLUSIONS Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care.IMPLICATIONS FOR REHABILITATIONParents want clinicians to be honest, supportive and to normalise their griefClinicians in rehabilitation would benefit from up-skilling in grief supportParental support should be built into systems of care for children with cerebral palsy.
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Affiliation(s)
- Corrine Dickinson
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Faculty of Medicine, Child Health Research Centre, Brisbane, Australia
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Jeanie Sheffield
- The School of Psychology, The University of Queensland, Brisbane, Australia
| | - Catherine Mak
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Faculty of Medicine, Child Health Research Centre, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Faculty of Medicine, Child Health Research Centre, Brisbane, Australia
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Faculty of Medicine, Child Health Research Centre, Brisbane, Australia
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Ermarth A, Brinker K, Ostrander B. Feeding dysfunction in NICU patients with cramped synchronized movements. Early Hum Dev 2023; 187:105879. [PMID: 37875030 DOI: 10.1016/j.earlhumdev.2023.105879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
Patients admitted to the neonatal intensive care unit (NICU) have higher association for neurodevelopment deficits, specifically cerebral palsy (CP). We identified patients with risk for CP using abnormal Pretchl's General Movement Assessment (GMA) and sub-category of cramped synchronized movements (CSM) and reported their feeding outcomes at discharge. Over 75 % of these patients required either nasogastric (NGT) or gastrostomy tube (GT) at discharge. Of these, 57 % weaned off their NGT or GT at home and 43 % of patients still needed a GT one year after discharge. Of those that could not wean off their NGT or GT, these patients had longer hospital stay, took lower percentage by mouth, and an older post-menstrual age at discharge. We did not find a difference in NGT or GT use between patients with IVH, ELBW, nor between their birthweight or gestation age at birth. This study provides further clinical characteristics in NICU patients who have higher risk of CP, and supports the need for skilled feeding therapy and resources both during and after NICU admission.
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Affiliation(s)
- Anna Ermarth
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, USA.
| | - Kristin Brinker
- Primary Children's Hospital, Intermountain Health, Salt Lake City, UT, USA
| | - Betsy Ostrander
- University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Pediatric Neurology, Department of Pediatrics, USA
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Guttmann KF, Raviv GN, Fortney CA, Weintraub AS. Parent Perspectives on Defining Neonatal Serious Illness. J Palliat Med 2023; 26:1529-1534. [PMID: 37327045 DOI: 10.1089/jpm.2023.0051] [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] [Indexed: 06/17/2023] Open
Abstract
Objectives: We hoped to understand (1) how parents of seriously ill neonatal intensive care unit patients conceptualize neonatal serious illness, and (2) how parent and physician perspectives on neonatal serious illness might differ. Design: This was a prospective survey study. Setting/Subjects: Parent members of the Courageous Parents Network. Measurements: We circulated a modified version of a previously developed survey. Participants were presented with a list of potential definition components and asked to rank components by importance and suggest modifications to the definition as needed. Thematic analysis of free-text responses was conducted to identify key themes in parent responses Results: Eighty-eight percent of parent participants agreed or strongly agreed with our working definition of neonatal serious illness. Parents agreed with the content of the definition but suggested using different language (especially less jargon) when using the definition to inform conversations with parents. Conclusions: The majority of parents surveyed for this study supported our definition of neonatal serious illness, which suggests that it may be useful for clinical and research applications. At the same time, parent responses revealed important differences in perceptions about serious illness between parents and physicians. In addition, parents will likely use any definition of neonatal serious illness differently than clinicians. We therefore propose that our definition be used to identify neonates with serious illness for the purposes of research and clinical care, but should not be used verbatim for communication with parents.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gabriella N Raviv
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christine A Fortney
- The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio, USA
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Verhage CH, Gorter JW, Takken T, Benders MJNL, de Vries LS, van der Aa NE, Wagenaar N. Detecting Asymmetry of Upper Limb Activity with Accelerometry in Infants at Risk for Unilateral Spastic Cerebral Palsy. Phys Occup Ther Pediatr 2023; 44:1-15. [PMID: 37318108 DOI: 10.1080/01942638.2023.2218478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
AIMS To examine whether accelerometry can quantitate asymmetry of upper limb activity in infants aged 3-12 months at risk for developing unilateral spastic cerebral palsy (USCP). METHOD A prospective study was performed in 50 infants with unilateral perinatal brain injury at high risk of developing USCP. Triaxial accelerometers were worn on the ipsilateral and contralesional upper limb during the Hand Assessment for Infants (HAI). Infants were grouped in three age intervals (3-5 months, 5-7.5 months and 7.5 until 12 months). Each age interval group was divided in a group with and without asymmetrical hand function based on HAI cutoff values suggestive of USCP. RESULTS In a total of 82 assessments, the asymmetry index for mean upper limb activity was higher in infants with asymmetrical hand function compared to infants with symmetrical hand function in all three age groups (ranging from 41 to 51% versus - 2-6%, p < 0.01), while the total activity of both upper limbs did not differ. CONCLUSIONS Upper limb accelerometry can identify asymmetrical hand function in the upper limbs in infants with unilateral perinatal brain injury from 3 months onwards and is complementary to the Hand Assessment for Infants.
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Affiliation(s)
- Cornelia H Verhage
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Gorter
- Pediatric Rehabilitation Medicine, Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Takken
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke Wagenaar
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Jawed A, Mowry M. Strengthening Equitable Access to Care and Support for Children with Cerebral Palsy and Their Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:994. [PMID: 37371227 DOI: 10.3390/children10060994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cerebral palsy is one of the most prevalent groups of motor disorders affecting children and adults across the world. As increasingly more children with cerebral palsy are living longer into adulthood, it is ever more crucial to ensure access to timely and needed early intervention from the onset of diagnosis, on a continuum, to optimize medical, developmental, socio-emotional, and academic outcomes for these children over time. The American Academy of Pediatrics (AAP), in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), substantially revised the clinical practice guidelines for cerebral palsy in 2022, after their prior publication of the guidelines in 2006. The revised guidelines account for a range of considerations that are in line with the biopsychosocial, risk and resilience, and family-centered care models as well as promote a more strengths-based approach to care. Furthermore, there is increased emphasis in the guidelines on promoting equitable access to care as part of contributing towards health equity for all children with cerebral palsy. In addition, the 2022 guidelines clearly present recommendations for earlier diagnosis of cerebral palsy, potentially as early as infancy, as the basis for activating access to early intervention services for children that can bolster their neuroplasticity and global development from an earlier age onward. We consolidate the existing literature on caregiver perceptions, beliefs and concerns surrounding earlier diagnosis of cerebral palsy and connect them to the recommendations in the revised guidelines. We also delineate several considerations surrounding education for healthcare providers and caregivers of children in navigating the chronicity of cerebral palsy in both community and healthcare contexts. There is a scant amount of literature on cerebral palsy across traditional and nontraditional sources of media in published studies, which we also review. Lastly, we present a wealth of recommendations for further research and practice that account for the revised 2022 guidelines, caregiver preferences and acceptability of care, and health equity as the bases for strengthening equitable access to care for children with cerebral palsy on a continuum as they transition into adulthood.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Social Work, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
| | - Michelle Mowry
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Nursing, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
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Oliver H, Seccurro D, Dorich J, Rice M, Schwartz T, Harpster K. "Even though a lot of kids have it, not a lot of people have knowledge of it": A qualitative study exploring the perspectives of parents of children with cerebral/cortical visual impairment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104443. [PMID: 36753819 DOI: 10.1016/j.ridd.2023.104443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Cerebral/Cortical Visual Impairment (CVI) is the leading cause of visual impairment in children and can negatively impact participation in daily activities. METHODS AND PROCEDURE This qualitative study used virtual focus groups and an online questionnaire to understand the perspectives of families with children who have CVI. Constant comparison analysis was used to analyze focus group transcripts and extract themes. The PEDI-CAT and an online questionnaire were administered to characterize the study population. OUTCOMES AND RESULTS Four themes were identified: (1) Awareness of CVI and its effect on the child and family, (2) Parent experiences, (3) Child factors and functional implications, and (4) Supports that enhance child development/vision. CONCLUSIONS AND IMPLICATIONS Findings from this study highlight the substantial impact that lack of CVI awareness had on parent experiences. Lack of awareness led to late diagnosis, missed intervention opportunities, and caregiver burden. Due to insufficient resources, parents had to educate themselves and service providers about CVI and advocate for their child's needs. Healthcare and educational providers who work with pediatric neurodevelopmental populations must be knowledgeable about clinical features of CVI, task and environmental adaptations to support vision and implementation of family-centered care.
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Affiliation(s)
- Haley Oliver
- Division of Occupational Therapy, The Ohio State University, 453 West 10th Avenue, Columbus, OH 43210, United States.
| | - Daria Seccurro
- University of Indianapolis, School of Occupational Therapy, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States
| | - Jenny Dorich
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3430 Burnet Avenue, MLC 4007, Cincinnati, OH 45229, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, United States
| | - Melissa Rice
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States; Department Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0527, Cincinnati, OH 45267-0527, United States
| | - Terry Schwartz
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States; Department Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0527, Cincinnati, OH 45267-0527, United States
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3430 Burnet Avenue, MLC 4007, Cincinnati, OH 45229, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, United States
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Pekeles H, Al Amrani F, Perez-Morgui M, Wintermark P, Shevell M. Characteristics of Children With Cerebral Palsy in the Post-Therapeutic Hypothermia Era. J Child Neurol 2023; 38:130-136. [PMID: 36872628 DOI: 10.1177/08830738231159162] [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] [Indexed: 03/07/2023]
Abstract
Objectives: To explore the profile of children with cerebral palsy secondary to intrapartum asphyxia treated with therapeutic hypothermia after birth and to compare characteristics of children treated with therapeutic hypothermia with mild vs severe cerebral palsy outcome. Study Design: We identified all children treated with therapeutic hypothermia for intrapartum asphyxia in a single-center tertiary-level neonatal intensive care unit from 2008 to 2018 with a cerebral palsy outcome. We collected perinatal and outcome measures from patient charts. We searched the literature for characteristics of children with cerebral palsy prior to therapeutic hypothermia (historical cohort) to compare to our cohort. We subdivided our cohort into mild vs severe cerebral palsy and compared neonatal characteristics to identify predictors of severe phenotype. Results: Thirty of 355 cooled neonates (8%) developed cerebral palsy. More children had spastic quadriparesis and epilepsy, and fewer had visual impairment in the post-therapeutic hypothermia era compared to the historical cohort, but had similar Gross Motor Function Classification System scores. In our cohort, more children had severe (19 of 30, 63%) compared to mild cerebral palsy (11 of 30, 37%). The severe group had higher mean birth weight, lower 5- and 10-minute Apgar scores, and more often white matter injury with associated deep gray matter injury or near-total injury pattern (P < .05). Conclusions: Our data demonstrated more infants with severe rather than mild cerebral palsy in our cohort treated with therapeutic hypothermia. Birthweight, 5- and 10-minute Apgar scores, and magnetic resonance imaging (MRI) findings were significantly different between mild and severe phenotype groups. Our findings can guide clinicians how to better weigh these factors, when counseling parents in the neonatal period.
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Affiliation(s)
- Heather Pekeles
- Division of Pediatric Neurology, 10040Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Fatema Al Amrani
- Pediatric Neurology Unit, Department of Child Health, 194179Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, 5620McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, 5620McGill University, Montreal, QC, Canada
| | - Michael Shevell
- Departments of Pediatrics and Neurology/Neurosurgery, 5620McGill University, Montreal, QC, Canada
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Morgan C, Badawi N, Novak I. "A Different Ride": A Qualitative Interview Study of Parents' Experience with Early Diagnosis and Goals, Activity, Motor Enrichment (GAME) Intervention for Infants with Cerebral Palsy. J Clin Med 2023; 12:jcm12020583. [PMID: 36675512 PMCID: PMC9866599 DOI: 10.3390/jcm12020583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Cerebral palsy is the most common physical disability of childhood, and early diagnosis followed by best practice early intervention is important for optimizing child and family outcomes. We investigated parents' views of an early diagnosis of cerebral palsy (CP), followed by Goals, Activity, Motor Enrichment (GAME) intervention. Semi-structured interviews were conducted within a pilot randomised clinical trial. Transcriptions were analyzed using grounded theory. Participants were nine mothers whose infants had received GAME intervention because they were identified as being at high risk for cerebral palsy early in infancy. The parenting experience was described as a "different ride". The diagnosis was devastating with many time-consuming challenges, but acceptance ensued. Parents wanted an early diagnosis, prognosis, and early intervention, despite the anxiety and workload, because it meant they could help. Parents perceived that GAME was beneficial because they were taught how to help; it was goal-based and home-based. They believed the collaboration and communication skills of the therapist shaped success. Future research should focus on a broader range of participants to understand parent's experiences with key aspects of early intervention more fully.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Correspondence: ; Tel.:+61-408-205-542
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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13
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Auditory Stimulation Improves Gait and Posture in Cerebral Palsy: A Systematic Review with Between- and Within-Group Meta-Analysis. CHILDREN 2022; 9:children9111752. [DOI: 10.3390/children9111752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
The past decade has seen an increased interest in the implementation of auditory stimulation (AStim) for managing gait and postural deficits in people with cerebral palsy. Although existing reviews report beneficial effects of AStim on the spatiotemporal and kinematic parameters of gait, there are still numerous limitations that need to be addressed to correctly interpret these results. For instance, existing reviews have failed to characterize the effects of AStim by conducting separate between and within-group meta-analyses, these reviews have not evaluated the influence of AStim on postural outcomes, and nor have included several high-quality existing trials. In this study, we conducted between- and within-group meta-analyses to establish a state of evidence for the influence of AStim on gait and postural outcomes in people with cerebral palsy. We searched the literature according to PRISMA-P guidelines across 10 databases. Of 1414 records, 14 studies, including a total of 325 people with cerebral palsy, met the inclusion criterion. We report a significant enhancement in gait speed, stride length, cadence, and gross motor function (standing and walking) outcomes with AStim compared to conventional physiotherapy. The findings from this analysis reveal the beneficial influence of AStim on the spatiotemporal and kinematic parameters of gait and postural stability in people with cerebral palsy. Furthermore, we discuss the futurized implementation of smart wearables that can deliver person-centred AStim rehabilitation in people with cerebral palsy.
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14
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Marcroft C, Dulson P, Dixon J, Embleton N, Basu AP. The predictive ability of the Lacey Assessment of Preterm Infants (LAPI), Cranial Ultrasound (cUS) and General Movements Assessment (GMA) for Cerebral Palsy (CP): A prospective, clinical, single center observational study. Early Hum Dev 2022; 170:105589. [PMID: 35690549 DOI: 10.1016/j.earlhumdev.2022.105589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIM The LAPI, cUS and GMA are assessments used clinically in the UK to identify preterm infants at high risk of neurodevelopmental disabilities such as cerebral palsy. This study investigated the ability of these assessments to predict cerebral palsy at 2 years corrected gestational age. METHODS Design: Prospective longitudinal cohort study including infants born <30 weeks' gestation from a single tertiary neonatal intensive care unit. The LAPI and cUS were undertaken as part of routine care before term equivalent age and the GMA was undertaken at 11-18 weeks corrected gestational age. RESULTS There were 123 eligible infants and 95 infants (77.2%) were included. Thirteen infants (13.7%) had a diagnosis of CP at 2 years. There was no significant difference in gestational age, gender, or birth weight between the groups with and without a diagnosis of CP. The highest accuracy of prediction of CP was achieved by an aberrant, absent fidgety general movements classification with a sensitivity of 92.3% and specificity of 98.9%. Combining the GMA to include the cUS or LAPI did not increase the predictive accuracy. CONCLUSION The GMA when undertaken in clinical practice had high accuracy for predicting CP at 2 years corrected age in infants born <30 weeks gestation; LAPI and cUS did not improve this accuracy.
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Affiliation(s)
- Claire Marcroft
- Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH), Newcastle Neonatal Service, Ward 35 Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, England, UK; Newcastle University, Population Health Sciences Institute, Faculty of Medical Sciences, Level 3 Sir James Spence Institute (Child Health), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
| | - Patricia Dulson
- Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH), Newcastle Neonatal Service, Ward 35 Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, England, UK
| | - Jennifer Dixon
- Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH), Newcastle Neonatal Service, Ward 35 Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, England, UK
| | - Nicholas Embleton
- Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH), Newcastle Neonatal Service, Ward 35 Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, England, UK; Newcastle University, Population Health Sciences Institute, Faculty of Medical Sciences, Level 3 Sir James Spence Institute (Child Health), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Anna Purna Basu
- Newcastle University, Population Health Sciences Institute, Faculty of Medical Sciences, Level 3 Sir James Spence Institute (Child Health), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Paediatric Neurology, Great North Childrens Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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15
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Groos D, Adde L, Aubert S, Boswell L, de Regnier RA, Fjørtoft T, Gaebler-Spira D, Haukeland A, Loennecken M, Msall M, Möinichen UI, Pascal A, Peyton C, Ramampiaro H, Schreiber MD, Silberg IE, Songstad NT, Thomas N, Van den Broeck C, Øberg GK, Ihlen EA, Støen R. Development and Validation of a Deep Learning Method to Predict Cerebral Palsy From Spontaneous Movements in Infants at High Risk. JAMA Netw Open 2022; 5:e2221325. [PMID: 35816301 PMCID: PMC9274325 DOI: 10.1001/jamanetworkopen.2022.21325] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Early identification of cerebral palsy (CP) is important for early intervention, yet expert-based assessments do not permit widespread use, and conventional machine learning alternatives lack validity. OBJECTIVE To develop and assess the external validity of a novel deep learning-based method to predict CP based on videos of infants' spontaneous movements at 9 to 18 weeks' corrected age. DESIGN, SETTING, AND PARTICIPANTS This prognostic study of a deep learning-based method to predict CP at a corrected age of 12 to 89 months involved 557 infants with a high risk of perinatal brain injury who were enrolled in previous studies conducted at 13 hospitals in Belgium, India, Norway, and the US between September 10, 2001, and October 25, 2018. Analysis was performed between February 11, 2020, and September 23, 2021. Included infants had available video recorded during the fidgety movement period from 9 to 18 weeks' corrected age, available classifications of fidgety movements ascertained by the general movement assessment (GMA) tool, and available data on CP status at 12 months' corrected age or older. A total of 418 infants (75.0%) were randomly assigned to the model development (training and internal validation) sample, and 139 (25.0%) were randomly assigned to the external validation sample (1 test set). EXPOSURE Video recording of spontaneous movements. MAIN OUTCOMES AND MEASURES The primary outcome was prediction of CP. Deep learning-based prediction of CP was performed automatically from a single video. Secondary outcomes included prediction of associated functional level and CP subtype. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed. RESULTS Among 557 infants (310 [55.7%] male), the median (IQR) corrected age was 12 (11-13) weeks at assessment, and 84 infants (15.1%) were diagnosed with CP at a mean (SD) age of 3.4 (1.7) years. Data on race and ethnicity were not reported because previous studies (from which the infant samples were derived) used different study protocols with inconsistent collection of these data. On external validation, the deep learning-based CP prediction method had sensitivity of 71.4% (95% CI, 47.8%-88.7%), specificity of 94.1% (95% CI, 88.2%-97.6%), positive predictive value of 68.2% (95% CI, 45.1%-86.1%), and negative predictive value of 94.9% (95% CI, 89.2%-98.1%). In comparison, the GMA tool had sensitivity of 70.0% (95% CI, 45.7%-88.1%), specificity of 88.7% (95% CI, 81.5%-93.8%), positive predictive value of 51.9% (95% CI, 32.0%-71.3%), and negative predictive value of 94.4% (95% CI, 88.3%-97.9%). The deep learning method achieved higher accuracy than the conventional machine learning method (90.6% [95% CI, 84.5%-94.9%] vs 72.7% [95% CI, 64.5%-79.9%]; P < .001), but no significant improvement in accuracy was observed compared with the GMA tool (85.9%; 95% CI, 78.9%-91.3%; P = .11). The deep learning prediction model had higher sensitivity among infants with nonambulatory CP (100%; 95% CI, 63.1%-100%) vs ambulatory CP (58.3%; 95% CI, 27.7%-84.8%; P = .02) and spastic bilateral CP (92.3%; 95% CI, 64.0%-99.8%) vs spastic unilateral CP (42.9%; 95% CI, 9.9%-81.6%; P < .001). CONCLUSIONS AND RELEVANCE In this prognostic study, a deep learning-based method for predicting CP at 9 to 18 weeks' corrected age had predictive accuracy on external validation, which suggests possible avenues for using deep learning-based software to provide objective early detection of CP in clinical settings.
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Affiliation(s)
- Daniel Groos
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sindre Aubert
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lynn Boswell
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Raye-Ann de Regnier
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Deborah Gaebler-Spira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Shirley Ryan AbilityLab, Chicago, Illinois
| | - Andreas Haukeland
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Loennecken
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Msall
- Section of Developmental and Behavioral Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
- Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Unn Inger Möinichen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Colleen Peyton
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Heri Ramampiaro
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michael D. Schreiber
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | | | - Nils Thomas Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Gunn Kristin Øberg
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Espen A.F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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16
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Haffner DN, Sankovic A. A Neurologist's Guide to Neonatal Neurodevelopmental Assessments and Preterm Brain Injury. Semin Pediatr Neurol 2022; 42:100974. [PMID: 35868724 DOI: 10.1016/j.spen.2022.100974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
Despite advances in medical care and improved survival of extremely preterm infants, rates of neurodevelopmental impairment remain high. Outcomes are significantly improved with early intervention, but infants must be appropriately identified to facilitate services. Neuroimaging provides important information regarding neurodevelopmental outcomes but prognosticating and communicating risk remains challenging. Standardized neonatal neurodevelopmental assessments provide supplemental information to aid in the identification of high-risk infants and counseling for their families.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States.
| | - Alexandra Sankovic
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States
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17
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Battin MR, Williams SA, Mackey A, Alzaher W, Sorhage A, Stott NS. Neonatal Neuroimaging in Neonatal Intensive Care Graduates Who Subsequently Develop Cerebral Palsy. J Clin Med 2022; 11:jcm11071866. [PMID: 35407475 PMCID: PMC9000159 DOI: 10.3390/jcm11071866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy is a common cause of physical disability. The New Zealand Cerebral Palsy Register (NZCPR) was established in 2015 and reports national data. Internationally, an early CP diagnosis has been a focus, with imaging and clinical tools used to enable early accurate detection. Accordingly, guidelines are being developed for New Zealand, including a specific pathway for high-risk neonatal intensive care (NICU) graduates, reflecting the high rate of CP in this group. To inform this work, we reviewed imaging data from a retrospective NICU cohort identified from the NZCPR. In these 140 individuals with CP and a confirmed NICU admission during 2000–2019 inclusive, imaging frequency, modality, and rate of abnormality was determined. Overall, 114 (81.4%) had imaging performed in the NICU, but the frequency and modality used varied by gestational subgroup. For infants born at less than 32 weeks gestation, 53/55 had routine imaging with ultrasound, and IVH was graded as none or mild (grade 1–2) in 35 or severe (grade 3–4) in 18 infants. For the 34 infants born between 32–36 weeks gestation, only 13/19 imaged in the NICU were reported as abnormal. For 51 term-born infants, 41/42 imaged in the NICU with MRI had abnormal results.
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Affiliation(s)
- Malcolm R. Battin
- Newborn Services, Auckland City Hospital, Park Road, Grafton, Auckland 1023, New Zealand
- Correspondence:
| | - Sîan A. Williams
- Liggins Institute, University of Auckland, Park Road, Grafton, Auckland 1142, New Zealand;
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Woroud Alzaher
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (A.M.); (W.A.); (A.S.)
| | - N. Susan Stott
- Department of Paediatric Orthopaedics, Starship Child Health, Auckland 1023, New Zealand;
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand
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18
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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19
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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; 175:846-858. [PMID: 33999106 PMCID: PMC9677545 DOI: 10.1001/jamapediatrics.2021.0878] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic and Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Roslyn N. Boyd
- The University of Queensland, St Lucia, Queensland, Australia
| | | | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda S. de Vries
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hans Forssberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Catherine Mak
- The University of Queensland, St Lucia, Queensland, Australia
| | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Angela Morgan
- The Royal Children’s Hospital, Melbourne, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Katherine Sanchez
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Alicia Spittle
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Marelle Thornton
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Valentine
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | | | - Koa Whittingham
- The University of Queensland, St Lucia, Queensland, Australia
| | - Alieh Zamany
- Eugene Child Development and Rehabilitation Center, Oregon Health and Science University, Eugene
| | - Iona Novak
- The University of Sydney, Sydney, Australia
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Menici V, Antonelli C, Beani E, Mattiola A, Giampietri M, Martini G, Rizzi R, Cecchi A, Cioni ML, Cioni G, Sgandurra G. Feasibility of Early Intervention Through Home-Based and Parent-Delivered Infant Massage in Infants at High Risk for Cerebral Palsy. Front Pediatr 2021; 9:673956. [PMID: 34350144 PMCID: PMC8328146 DOI: 10.3389/fped.2021.673956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Infant massage (IM) can be considered an early intervention program that leads to the environmental enrichment framework. The effectiveness of IM to promote neurodevelopment in preterm infants has been proved, but studies on infants with early brain damage are still lacking. The main aim of this study was to assess the feasibility, acceptability and usability of IM, carried out by parents at home, on infants at high risk for Cerebral Palsy. An IM daily diary and an ad hoc questionnaire, called Infant Massage Questionnaire Parent-Infant Experiences (IMQPE), were developed. IMQPE consisted of a total of 30 questions, divided into 5 areas. The parents were trained to carry out the IM with a home-based course, conducted by an expert therapist. The intensive IM program was set according to a defined daily length of at least 20 min, with a frequency of at least 5 days per week for a total of 8 weeks. Data collection consisted in the selection of the variables around the characteristics, both of the infants and the mothers, IM dosage and frequency, different body parts of the infants involved and IMQPE scores. Variable selection was carried out by minimizing the Bayesian Information Criteria (BIC) over all possible variable subsets. Nineteen high-risk infants, aged 4.83 ± 1.22 months, received IM at home for 8 weeks. The massage was given by the infants' mothers with a mean daily session dose of 27.79 ± 7.88 min and a total of 21.04 ± 8.49 h. 89.74% and 100% of mothers performed the IM for the minimum daily dosage and the frequency recommended, respectively. All the families filled in the IMQPE, with a Total mean score of 79.59% and of 82.22% in General Information on IM, 76.30% in Infant's intervention-related changes, 76.85% in IM Suitability, 79.07% in Infant's acceptance and 83.52% in Time required for the training. Different best predictors in mothers and in infants have been found. These data provide evidence of the feasibility of performing IM at home on infants at high risk for CP. Study registration: www.clinicaltrial.com (NCT03211533 and NCT03234959).
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Affiliation(s)
- Valentina Menici
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Camilla Antonelli
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Alessandra Mattiola
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Matteo Giampietri
- Neonatal Intensive Care Unit, Pisa University Hospital Santa Chiara, Pisa, Italy
| | - Giada Martini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Riccardo Rizzi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Tuscan Ph.D. Programme of Neuroscience, University of Florence, Florence, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Maria Luce Cioni
- Neonatal Intensive Care Unit, Children's Hospital A. Meyer, Florence, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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21
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Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
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22
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Glass HC, Li Y, Gardner M, Barkovich AJ, Novak I, McCulloch CE, Rogers EE. Early Identification of Cerebral Palsy Using Neonatal MRI and General Movements Assessment in a Cohort of High-Risk Term Neonates. Pediatr Neurol 2021; 118:20-25. [PMID: 33714922 DOI: 10.1016/j.pediatrneurol.2021.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common motor disability of childhood. Its early identification is an important priority for parents and is critical for access to early intervention resources, which may optimize function. METHODS A prospective cohort of term neonates at high risk for CP was assessed by neonatal magnetic resonance imaging (MRI) to determine myelination of the posterior limb of the internal capsule, General Movements Assessment to assess typical fidgety movements at age three months, and followed to at least age two years to determine diagnosis of CP based on neurological examination. RESULTS Seven of 58 children developed CP (12%), two with moderate/severe CP. Sensitivity and specificity for abnormal myelination of the posterior limb of the internal capsule were (PLIC) was 29% and 94%, and for absent fidgety movements, 29% and 98%, respectively. Negative predictive value of both absent myelination of the PLIC and absent fidgety movements was 90% (79% to 96%) for any CP and 98% (90% to 100%) for moderate/severe CP cerebral palsy. None of the children with both normal PLIC and normal fidgety movements had moderate/severe CP. CONCLUSION Normal neonatal MRI and General Movements Assessment at age three months are reassuring that a high-risk term-born child is at low risk for moderate/severe CP. These results are important for counseling parents and individualizing therapy resources in the community.
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Affiliation(s)
- Hannah C Glass
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
| | - Yi Li
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Marisa Gardner
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Benioff Children's Hospital, Oakland, California
| | - A James Barkovich
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Williams SA, Alzaher W, Mackey A, Hogan A, Battin M, Sorhage A, Stott NS. "It Should Have Been Given Sooner, and We Should Not Have to Fight for It": A Mixed-Methods Study of the Experience of Diagnosis and Early Management of Cerebral Palsy. J Clin Med 2021; 10:jcm10071398. [PMID: 33807393 PMCID: PMC8036895 DOI: 10.3390/jcm10071398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/31/2023] Open
Abstract
Listening to the family experience is integral to identifying areas of strength and for improvement in health service delivery around diagnosis and early management of cerebral palsy (CP). Families of children with a diagnosis of CP were invited to complete a purpose-developed electronic survey that included items around the timing of diagnosis, their experiences and satisfaction. It also allowed families to expand on their experiences through free text. Of the 57 families responding, 49% of children functioned at Gross Motor Function Classification System (GMFCS) levels I or II, 8% at GMFCS level III and 23% at GMFCS levels IV or V. 51% of participants were satisfied or very satisfied with the diagnosis experience, 18% were neutral about the experience and 31% were dissatisfied or very dissatisfied. Though the findings of this study may be subject to selection bias, perceived delays in the receipt of diagnosis of CP appeared common with 60% of participants indicating concerns about their child by <6 months of age but only 21% provided with a diagnosis of CP <6 months of age. Approximately 18% of families experienced a delay of more than 12 months. Thirty-four (61%) participants noted a delay between referrals to a service and receipt of service management/therapy. Common themes impacting on families' experience in the diagnosis and health service delivery journey related to provision of information, and the style of communication, with both direct and ongoing communication styles common for greater family satisfaction. Overall, families desired the diagnosis experience to be informative and timely, with early follow up support and assistance with health sector navigation.
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Affiliation(s)
- Sîan A Williams
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
- Correspondence:
| | - Woroud Alzaher
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - Amy Hogan
- The Cerebral Palsy Society of New Zealand, Auckland 1023, New Zealand;
| | - Malcolm Battin
- Newborn Services, Starship Child Health, Auckland District Health Board, Auckland 1023, New Zealand;
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
- Department of Paediatric Orthopaedics, Starship Child Health, Auckland District Health Board, Auckland 1023, New Zealand
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24
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Kwong AKL, Eeles AL, Spittle AJ. Early neurodevelopmental screening: Parent perspectives from the neonatal intensive care unit. Acta Paediatr 2021; 110:359-360. [PMID: 33006152 DOI: 10.1111/apa.15563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amanda K. L. Kwong
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
| | - Abbey L. Eeles
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
- Department of Paediatrics Monash University Clayton Vic Australia
| | - Alicia J. Spittle
- Murdoch Children’s Research Institute Parkville Vic Australia
- Department of Physiotherapy The University of Melbourne Melbourne Vic Australia
- The Royal Women’s Hospital Parkville Vic Australia
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25
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Maitre NL, Burton VJ, Duncan AF, Iyer S, Ostrander B, Winter S, Ayala L, Burkhardt S, Gerner G, Getachew R, Jiang K, Lesher L, Perez CM, Moore-Clingenpeel M, Lam R, Lewandowski DJ, Byrne R. Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis. Pediatrics 2020; 145:e20192126. [PMID: 32269135 PMCID: PMC7193973 DOI: 10.1542/peds.2019-2126] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3- to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with P < .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability. CONCLUSIONS Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
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Affiliation(s)
- Nathalie L Maitre
- Center for Perinatal Research and
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Vera J Burton
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Andrea F Duncan
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sai Iyer
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Betsy Ostrander
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Sarah Winter
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Lauren Ayala
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | | | - Gwendolyn Gerner
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ruth Getachew
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
| | - Kelsey Jiang
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Laurie Lesher
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Carrie M Perez
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Rebecca Lam
- Cerebral Palsy Foundation, New York, New York
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26
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Guttmann K, Flibotte J, DeMauro SB, Seitz H. A Mixed Methods Analysis of Parental Perspectives on Diagnosis and Prognosis of Neonatal Intensive Care Unit Graduates With Cerebral Palsy. J Child Neurol 2020; 35:336-343. [PMID: 32063083 DOI: 10.1177/0883073820901412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate how parents of former neonatal intensive care unit patients with cerebral palsy perceive prognostic discussions following neuroimaging. Parent members of a cerebral palsy support network described memories of prognostic discussions after neuroimaging in the neonatal intensive care unit. We analyzed responses using Linguistic Inquiry and Word Count, manual content analysis, and thematic analysis. In 2015, a total of 463 parents met eligibility criteria and 266 provided free-text responses. Linguistic Inquiry and Word Count analysis showed that responses following neuroimaging contained negative emotion. The most common components identified through the content analysis included outcome, uncertainty, hope/hopelessness, and weakness in communication. Thematic analysis revealed 3 themes: (1) Information, (2) Communication, and (3) Impact. Parents of children with cerebral palsy report weakness in communication relating to prognosis, which persists in parents' memories. Prospective work to develop interventions to improve communication between parents and providers in the neonatal intensive care unit is necessary.
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Affiliation(s)
- Katherine Guttmann
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, NY, USA
| | - John Flibotte
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Sara B DeMauro
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Holli Seitz
- Department of Communication, Mississippi State University, MS, USA
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27
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DORNER REBECCAA, BOSS RENEED, BURTON VERAJOANNA, RAJA KATHERINE, LEMMON MONICAE. Parent preferences for neurodevelopmental screening in the neonatal intensive care unit. Dev Med Child Neurol 2020; 62:500-505. [PMID: 31909496 PMCID: PMC7056590 DOI: 10.1111/dmcn.14457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine whether, and how, neonatal intensive care unit (NICU) parents want to receive early neurodevelopmental screening information about their child's future risk of cerebral palsy and other disabilities. METHOD This was a qualitative interview study. Parents of hospitalized infants born preterm completed semi-structured interviews. Data were analysed using a directed content analysis approach. RESULTS Thematic saturation was achieved after 19 interviews. Four themes characterized parent perceptions of early neurodevelopmental screening: (1) acceptability: most parents were in favour of neurodevelopmental screening if parents could refuse; (2) disclosure of results: parents want emotional preparation for results, especially false positives; (3) emotional burden of uncertainty: parents of children in the NICU balance taking their infant's illness 'day by day' and preparing for an uncertain future. Parents expressed distress with screening that increased uncertainty about the future; and (4) disability: prior experience with disability informs parent concerns. INTERPRETATION Parents interpret the risks and benefits of NICU developmental screening through the lens of prior experiences with disability. Most expressed interest in screening and emphasized a desire for autonomy, pretest counselling, and emotional preparation. WHAT THIS PAPER ADDS Most parents with infants in the neonatal intensive care unit expressed interest in early screening for developmental disability. Prior experience with disability informed concerns about specific deficits. Parents emphasized a desire for autonomy, pretest counselling, and emotional preparation.
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Affiliation(s)
- REBECCA A DORNER
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - RENEE D BOSS
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD;,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - VERA JOANNA BURTON
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD;,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - MONICA E LEMMON
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD;,Department of Pediatrics, Division of Pediatric Neurology, Duke University School of Medicine, Durham, NC;,Duke-Margolis Center for Health Policy, Durham, NC, USA
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28
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Ihlen EAF, Støen R, Boswell L, de Regnier RA, Fjørtoft T, Gaebler-Spira D, Labori C, Loennecken MC, Msall ME, Möinichen UI, Peyton C, Schreiber MD, Silberg IE, Songstad NT, Vågen RT, Øberg GK, Adde L. Machine Learning of Infant Spontaneous Movements for the Early Prediction of Cerebral Palsy: A Multi-Site Cohort Study. J Clin Med 2019; 9:E5. [PMID: 31861380 PMCID: PMC7019773 DOI: 10.3390/jcm9010005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early identification of cerebral palsy (CP) during infancy will provide opportunities for early therapies and treatments. The aim of the present study was to present a novel machine-learning model, the Computer-based Infant Movement Assessment (CIMA) model, for clinically feasible early CP prediction based on infant video recordings. METHODS The CIMA model was designed to assess the proportion (%) of CP risk-related movements using a time-frequency decomposition of the movement trajectories of the infant's body parts. The CIMA model was developed and tested on video recordings from a cohort of 377 high-risk infants at 9-15 weeks corrected age to predict CP status and motor function (ambulatory vs. non-ambulatory) at mean 3.7 years age. The performance of the model was compared with results of the general movement assessment (GMA) and neonatal imaging. RESULTS The CIMA model had sensitivity (92.7%) and specificity (81.6%), which was comparable to observational GMA or neonatal cerebral imaging for the prediction of CP. Infants later found to have non-ambulatory CP had significantly more CP risk-related movements (median: 92.8%, p = 0.02) compared with those with ambulatory CP (median: 72.7%). CONCLUSION The CIMA model may be a clinically feasible alternative to observational GMA.
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Affiliation(s)
- Espen A. F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Ragnhild Støen
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Lynn Boswell
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (L.B.); (R.-A.d.R.)
| | - Raye-Ann de Regnier
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (L.B.); (R.-A.d.R.)
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Deborah Gaebler-Spira
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Cathrine Labori
- Department of Clinical Therapeutic Services, University Hospital of North Norway, 9038 Tromsø, Norway; (C.L.); (G.K.Ø.)
| | - Marianne C. Loennecken
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Michael E. Msall
- University of Chicago Medicine, Comer Children’s Hospital, Section of Developmental and Behavioral Pediatrics, Chicago, IL 60637, USA; (M.E.M.); (M.D.S.)
- University of Chicago, Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL 60637, USA
| | - Unn I. Möinichen
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Colleen Peyton
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
- Department of Pediatrics, Comer Children’s Hospital, Department of Physical Therapy and Human Movement Science, Chicago, IL 60637, USA
| | - Michael D. Schreiber
- University of Chicago Medicine, Comer Children’s Hospital, Section of Developmental and Behavioral Pediatrics, Chicago, IL 60637, USA; (M.E.M.); (M.D.S.)
| | - Inger E. Silberg
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Nils T. Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, 9038 Tromsø, Norway;
| | - Randi T. Vågen
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Gunn K. Øberg
- Department of Clinical Therapeutic Services, University Hospital of North Norway, 9038 Tromsø, Norway; (C.L.); (G.K.Ø.)
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT- The Arctic University of Norway, 9019 Tromsø, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
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29
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Byrne R, Duncan A, Pickar T, Burkhardt S, Boyd RN, Neel ML, Maitre NL. Comparing parent and provider priorities in discussions of early detection and intervention for infants with and at risk of cerebral palsy. Child Care Health Dev 2019; 45:799-807. [PMID: 31323144 DOI: 10.1111/cch.12707] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/11/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although literature suggests that parents need support when their child is diagnosed with cerebral palsy (CP), it is unclear to what extent providers implement these supports in practice and what parental perspectives surround provider early diagnosis and management of CP. Therefore, we aimed to characterize and compare experiences of providers and parents of children with CP with regards to early detection and intervention. METHOD Seventeen parents participated in day-long world-café style workshops focused on categories extracted from the International Classification of Function framework and recent systematic reviews of early detection for CP. Thirty regional providers (generalists, specialists, and therapists) caring for infants with CP completed surveys with scaled score and open-ended questions. Quantitative and qualitative data were independently assessed by two reviewers to identify prominent themes. RESULTS All parents (100%) stated early diagnosis or high risk for CP classification was beneficial compared with only 50% of providers who often gave early CP diagnoses before 12 months. Top parent priorities were honesty and positively phrased messages. Providers most often addressed cognition, primary care need, motor, and feeding issues (80%, 62%, 54%, 54% frequently/sometimes). Matching priorities for discussion were neuroimaging timing/risk/benefit, cognition, primary care, motor, and feeding/nutrition. Discordance occurred for participation, parent well-being, pain and vision, with parents wanting more education and resources. CONCLUSIONS Receiving early diagnoses or high-risk for CP classification is a parent priority. Alignment between parents and providers exists for International Classification of Function domains of body functions/structures and activity, but less for those of environment, personal, and participation.
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Affiliation(s)
| | - Andrea Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Stephanie Burkhardt
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation and Research Center, Queensland, Australia
| | - Mary Lauren Neel
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Nathalie L Maitre
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of High-Risk Infants in a Clinical Follow-Up Setting. J Clin Med 2019; 8:jcm8111790. [PMID: 31717717 PMCID: PMC6912231 DOI: 10.3390/jcm8111790] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP). METHODS Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009-2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results. RESULTS Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18-24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging. CONCLUSION In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.
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