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Ludovice MC, Saul KR, Kamper DG. Use of computational modeling to examine fingertip force production in children with hemiplegic cerebral palsy. J Biomech 2024; 172:112198. [PMID: 38964009 DOI: 10.1016/j.jbiomech.2024.112198] [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: 01/11/2024] [Revised: 05/08/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
Most children with hemiplegic cerebral palsy (HCP), one of the most prevalent subtypes of cerebral palsy, struggle with grasping and manipulating objects. This impairment may arise from a diminished capacity to properly direct forces created with the finger pad due to aberrant force application. Children with HCP were asked to create maximal force with the index finger pad in the palmar (normal) direction with both the paretic and non-paretic hands. The resulting forces and finger postures were then applied to a computational musculoskeletal model of the hand to estimate the corresponding muscle activation patterns. Subjects tended to create greater shear force relative to normal force with the paretic hand (p < 0.05). The resultant force was directed 33.6°±10.8° away from the instructed palmar direction in the paretic hand, but only 8.0°±7.3° in the non-paretic hand. Additionally, participants created greater palmar force with the non-paretic hand than with the paretic hand (p < 0.05). These differences in force production are likely due to differences in muscle activation pattern, as our computational models showed differences in which muscles are active and their relative activations when recreating the measured force vectors for the two hands (p < 0.01). The models predicted reduced activation in the extrinsic and greater reductions in activation in the intrinsic finger muscles, potentially due to reduced voluntary activation or muscle atrophy. As the large shear forces could lead to objects slipping from grasp, muscle activation patterns may provide an important target for therapeutic treatment in children with HCP.
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Affiliation(s)
- Miranda C Ludovice
- The Joint Department of Biomedical Engineering, the University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State University, Raleigh, NC, United States.
| | - Katherine R Saul
- The Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, United States
| | - Derek G Kamper
- The Joint Department of Biomedical Engineering, the University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State University, Raleigh, NC, United States
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Fernandez J, Shim V, Schneider M, Choisne J, Handsfield G, Yeung T, Zhang J, Hunter P, Besier T. A Narrative Review of Personalized Musculoskeletal Modeling Using the Physiome and Musculoskeletal Atlas Projects. J Appl Biomech 2023; 39:304-317. [PMID: 37607721 DOI: 10.1123/jab.2023-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
In this narrative review, we explore developments in the field of computational musculoskeletal model personalization using the Physiome and Musculoskeletal Atlas Projects. Model geometry personalization; statistical shape modeling; and its impact on segmentation, classification, and model creation are explored. Examples include the trapeziometacarpal and tibiofemoral joints, Achilles tendon, gastrocnemius muscle, and pediatric lower limb bones. Finally, a more general approach to model personalization is discussed based on the idea of multiscale personalization called scaffolds.
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Affiliation(s)
- Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
- Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland,New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Marco Schneider
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Geoff Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Ted Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Ju Zhang
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Peter Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
| | - Thor Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland,New Zealand
- Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland,New Zealand
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Ogourtsova T. Telerehabilitation for the Mental Health of Children with Physical Disabilities and Their Families: Let's Look out the Window of Opportunity! Phys Occup Ther Pediatr 2023; 43:176-181. [PMID: 36192840 DOI: 10.1080/01942638.2022.2130023] [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: 02/07/2023]
Affiliation(s)
- Tatiana Ogourtsova
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,The Research Center of the Jewish Rehabilitation Hospital; Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
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ERTURAN S, BURAK M, ELBASAN B. Eylem Gözlem Terapisi ile Unilateral Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin Geliştirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1094792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Eylem Gözlem Terapisi (EGT) hareketlerin izlenmesi sonrası aynı hareketlerin taklit edilmesi ile merkezi sinir sistemi restorasyonunu destekleyen nörorehabilitasyon temelli bir tedavi yaklaşımıdır. Serebral palsi, parkinson, inme, ortopedik yaralanmalar, alzheimer ve konuşma bozuklukları gibi pek çok hastalıkta, fonksiyonu gerçekleştiren nöral yapıları aktive etmek için nörofizyolojik mekanizmadan yararlanan yeni bir rehabilitasyon yaklaşımı olarak bilinir. Sağlıklı bireylerde ve nörolojik veya ortopedik etkilenimi olan bireylerde yapılan araştırmalar; EGT uygulamasının gözlemcinin motor sisteminde kolaylaştırmayı indüklediği ve eylem-algı eşleştirme mekanizmasını desteklediği bilinir. Bu derleme, Serebral Palsi (SP) tanılı çocuklarda üst ekstremiteye yönelik uygulanan EGT programlarının kullanımı ve etkinliği ile ilgili mevcut bilgileri gözden geçirmek amacıyla planlanmıştır. EGT kullanımının farklı koşullara kolayca adapte edilebilmesi, nöral plasitisiteyi destekleyerek motor öğrenmeyi fasilite etmesi ve ekonomik olması nedeniyle, SP’li çocukların üst ekstremite rehabilitasyonunda kullanımının uygun olduğu; ancak protokol, süre ve uygulama şekli açısından optimal uygulama prensiplerinin belirlenebilmesi için daha detaylı çalışmalara ihtiyaç olduğu düşünülmektedir.
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Affiliation(s)
- Sinem ERTURAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Mustafa BURAK
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
| | - Bülent ELBASAN
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, FİZYOTERAPİ VE REHABİLİTASYON BÖLÜMÜ
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Heydarian S, Abbasabadi MM, Khabazkhoob M, Hoseini-Yazdi H, Gharib M. Vision Abnormalities in Children and Young Adults With Cerebral Palsy; A Systematic Review. Semin Ophthalmol 2022; 37:471-479. [PMID: 34978933 DOI: 10.1080/08820538.2021.2021248] [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] [Indexed: 10/19/2022]
Abstract
AIM The current study was designed to provide detailed information on the prevalence of ocular abnormalities in patients with cerebral palsy (CP). METHODS Four international online scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar were systemically searched. First, the titles of the articles were evaluated, and if relevant, their abstracts and full texts were reviewed. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS A total of 147 articles were found in the initial search. After applying the exclusion criteria, 65 articles were chosen for further review, from which 17 articles, comprising a total of 1734 patients with CP ranging in age from birth to 22 years, passed the STROBE quality check and were included in this review. The prevalence of ocular abnormalities in the CP patients reported in the evaluated studies ranged between 34% to 100%, with refractive error, strabismus, and nystagmus exhibiting the greatest overall prevalence at 52%, 48%, and 11%, respectively in this population. CONCLUSION Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.
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Affiliation(s)
- Samira Heydarian
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marziye Moradi Abbasabadi
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Hoseini-Yazdi
- Contact Lens and Visual Optics Laboratory Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Masoud Gharib
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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McCall JV, Ludovice MC, Elliott C, Kamper DG. Hand function development of children with hemiplegic cerebral palsy: A scoping review. J Pediatr Rehabil Med 2022; 15:211-228. [PMID: 34864699 DOI: 10.3233/prm-200714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Hemiplegic cerebral palsy (hCP) typically impacts sensorimotor control of the hand, but comprehensive assessments of the hands of children with hCP are relatively rare. This scoping review summarizes the development of hand function for children with hCP. METHODS This scoping review focused on the development of hand function in children with hCP. Electronic databases (PubMed, PEDro, Web of Science, CINAHL, and SpringerLink) were searched to identify studies assessing hand function in children with hCP. The search was performed using keywords (e.g., "hemiplegia"). An iterative approach verified by two authors was used to select the studies. Articles which reported quantitative data for children with hCP on any items of a specified set of hand evaluations were included. Measures were sorted into three categories: quantitative neuromechanics, clinical assessments, and clinical functional evaluations. RESULTS Initial searches returned 1536 articles, 131 of which were included in the final review. Trends between assessment scores and age were examined for both hands. CONCLUSION While several studies have evaluated hand function in children with hCP, the majority relied on clinical scales, assessments, or qualitative descriptions. Further assessments of kinematics, kinetics, and muscle activation patterns are needed to identify the underlying impairment mechanisms that should be targeted for treatment.
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Affiliation(s)
- James V McCall
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Miranda C Ludovice
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Child and Adolescent Health Services, Perth Children's Hospital, Perth, Australia
| | - Derek G Kamper
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Azouz HG, AbdelMohsen AM, Abdel Ghany HM, Mohamed RM. Evaluation of autonomic nervous system in children with spastic cerebral palsy: clinical and electophysiological study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically.
Results
Age of the studied children ranged from 4 to 12 years. Quadriplegic type of spastic cerebral palsy constituted 82.5% of CP children while diplegic type constituted 17.5%. Based on Gross Motor Function Classification System (GMFCS), the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards sympathetic skin response, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test.
Conclusions
Autonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.
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Masefield SC, Prady SL, Pickett KE. An approach to identifying young children with developmental disabilities via primary care records. Wellcome Open Res 2021; 6:189. [PMID: 35141426 PMCID: PMC8822140 DOI: 10.12688/wellcomeopenres.17051.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Preschool aged children with developmental disabilities frequently receive a diagnosis of an indicator of disability, such as developmental delay, some time before receiving a definitive diagnosis at school age, such as autism spectrum disorder. The absence of a definitive diagnosis potentially underestimates the need for support by families with young disabled children, also delaying the access of families to condition-specific information and support. Our aim was to develop a strategy to identify children with probable and potential developmental disabilities before the age of five in primary care records for a UK birth cohort, considering how the identification of only probable or potential developmental disability might influence prevalence estimates. Methods: As part of a study of the effects of caring for young children with developmental disabilities on mothers’ health and healthcare use, we developed a two-part strategy to identify: 1) children with conditions associated with significant disability and which can be diagnosed during the preschool period; and 2) children with diagnoses which could indicate potential disability, such as motor development disorder. The strategy, using Read codes, searched the electronic records of children in the Born in Bradford cohort with linked maternal and child sociodemographic information. The results were compared with national and Bradford prevalence estimates. Results: We identified 83 children with disability conditions and 394 with potential disability (44 children had a disability condition and an indicator of potential disability). Combined they produced a developmental disability prevalence of 490 per 10,000 which is above the UK estimate for developmental disabilities in children under five (468 per 10,000) and within the 419-505 per 10,000 prevalence estimated for Bradford (for children aged 0-18). Conclusions: When disability prevalence is estimated only using conditions diagnosed as developmental disabilities, most young children with developmental disabilities likely to be diagnosed at later ages will be missed.
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Affiliation(s)
| | | | - Kate E. Pickett
- Health Sciences, University of York, York, Yorkshire, YO10 5DD, UK
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Masefield SC, Prady SL, Pickett KE. An approach to identifying young children with developmental disabilities via primary care records. Wellcome Open Res 2021; 6:189. [DOI: 10.12688/wellcomeopenres.17051.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Preschool aged children with developmental disabilities frequently receive a diagnosis of an indicator of disability, such as developmental delay, some time before receiving a definitive diagnosis at school age, such as autism spectrum disorder. The absence of a definitive diagnosis potentially underestimates the need for support by families with young disabled children. Our aim was to develop a two-part strategy to identify children with probable and potential developmental disabilities before the age of five in primary care records for a UK birth cohort, considering how the identification of only probable or potential developmental disability might also influence prevalence estimates. Methods: As part of a study of the effects of caring for young children with developmental disabilities on mothers’ health and healthcare use, we developed a two-part strategy to identify: 1) children with conditions associated with significant disability and which can be diagnosed during the preschool period; and 2) children with diagnoses which could indicate potential disability, such as motor development disorder and developmental delay. The strategy, using Read codes, searched the electronic records of children in the Born in Bradford cohort with linked maternal and child sociodemographic information. The results were compared with national and Bradford prevalence estimates, where available. Results: We identified 83 children with disability conditions and 394 with potential disability (44 children had both a disability condition and an indicator of potential disability). When combined, they produced a developmental disability prevalence of 490 per 10,000 which is above the UK estimate for developmental disabilities in children under five (468 per 10,000) and within the 419-505 per 10,000 prevalence estimated for Bradford (for children aged 0-18). Conclusions: When only conditions diagnosed as developmental disabilities are used for case ascertainment, most of the young children with developmental disabilities likely to be diagnosed at later ages will be missed.
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Water-Based Interventions for People With Neurological Disability, Autism, and Intellectual Disability: A Scoping Review. Adapt Phys Activ Q 2021; 38:474-493. [PMID: 33873153 DOI: 10.1123/apaq.2020-0036] [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: 03/23/2020] [Revised: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to produce a descriptive overview of the types of water-based interventions for people with neurological disability, autism, and intellectual disability and to determine how outcomes have been evaluated. Literature was searched through MEDLINE, EMBASE, Ovid Emcare, SPORTDiscus, Google Scholar, and Google. One hundred fifty-three papers met the inclusion criteria, 115 hydrotherapy, 62 swimming, 18 SCUBA (self-contained underwater breathing apparatus), and 18 other water-based interventions. Common conditions included cerebral palsy, spinal cord injury, Parkinson's disease, and intellectual disability. Fifty-four papers explored physical outcomes, 36 psychosocial outcomes, and 24 both physical and psychosocial outcomes, with 180 different outcome measures reported. Overall, there is a lack of high-quality evidence for all intervention types. This review provides a broad picture of water-based interventions and associated research. Future research, guided by this scoping review, will allow a greater understanding of the potential benefits for people with neurological disability, autism, and intellectual disability.
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Zistatsis J, Peters KM, Ballesteros D, Feldner H, Bjornson K, Steele KM. Evaluation of a passive pediatric leg exoskeleton during gait. Prosthet Orthot Int 2021; 45:153-160. [PMID: 33094685 PMCID: PMC8916307 DOI: 10.1177/0309364620956868] [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: 02/23/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Children with hemiparesis are commonly prescribed ankle foot orthoses to help improve gait; however, these orthoses often result in only small and variable changes in gait. Research with adult stroke survivors has suggested that orthoses that extend beyond the ankle using long, passive tendon-like structures (i.e. exotendons) can improve walking. OBJECTIVES The aim of this study was to quantify the impact of an exotendon-based exoskeleton on pediatric gait. STUDY DESIGN Repeated-measures study. METHODS Two typically-developing children and two children with hemiparesis completed a gait analysis, walking without and with the exoskeleton. The exotendon was tested at three stiffness levels. RESULTS All children were able to walk comfortably with the exoskeleton, with minimal changes in step width. Walking speed increased and lower limb joint symmetry improved for the children with hemiparesis with the exoskeleton. Each participant had changes in muscle activity while walking with the exoskeleton, although the impact on specific muscles and response to exotendon stiffness varied. CONCLUSION Exotendon-based exoskeletons may provide an alternative solution for optimizing gait in therapy and in the community for children with hemiparesis. Determining the optimal stiffness and configuration for each child is an important area of future research.
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Affiliation(s)
- Jessica Zistatsis
- Mechanical Engineering, University of Washington, Seattle, Washington, United States
| | - Keshia M. Peters
- Mechanical Engineering, University of Washington, Seattle, Washington, United States
| | - Daniel Ballesteros
- Bioengineering, University of Washington, Seattle, Washington, United States
| | - Heather Feldner
- Mechanical Engineering, University of Washington, Seattle, Washington, United States
- Rehabilitation Medicine, University of Washington, Seattle, Washington, United States
| | - Kristie Bjornson
- Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle
- Rehabilitation Medicine, University of Washington, Seattle, Washington, United States
| | - Katherine M. Steele
- Mechanical Engineering, University of Washington, Seattle, Washington, United States
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Goodwin BM, Sabelhaus EK, Pan YC, Bjornson KF, Pham KLD, Walker WO, Steele KM. Accelerometer Measurements Indicate That Arm Movements of Children With Cerebral Palsy Do Not Increase After Constraint-Induced Movement Therapy (CIMT). Am J Occup Ther 2020; 74:7405205100p1-7405205100p9. [PMID: 32804628 DOI: 10.5014/ajot.2020.040246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Constraint-induced movement therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). Although clinic-based assessments have demonstrated improvements in arm function after CIMT, whether these changes are translated and sustained outside of a clinic setting remains unclear. OBJECTIVE Accelerometers were used to quantify arm movement for children with CP 1 wk before, during, and 4 wk or more after CIMT; measurements were compared with those from typically developing (TD) peers. DESIGN Observational. SETTING Tertiary hospital and community. PARTICIPANTS Seven children with CP (5 boys, 2 girls; average [AVE] age ± standard deviation [SD] = 7.4 ± 1.2 yr) and 7 TD peers (2 boys, 5 girls; AVE age ± SD = 7.0 ± 2.3 yr). INTERVENTION 30-hr CIMT protocol. OUTCOMES AND MEASURES Use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometer data. Clinical measures were administered before and after CIMT, and parent surveys assessed parent and child perceptions of wearing accelerometers. RESULTS During CIMT, the frequency and magnitude of paretic arm use among children with CP increased in the clinic and in daily life. After CIMT, although clinical scores showed sustained improvement, the children's accelerometry data reverted to baseline values. Children and parents in both cohorts had positive perceptions of accelerometer use. CONCLUSIONS AND RELEVANCE The lack of sustained improvement in accelerometry metrics after CIMT suggests that therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help transfer gains outside the clinic. WHAT THIS ARTICLE ADDS Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.
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Affiliation(s)
- Brianna M Goodwin
- Brianna M. Goodwin, MS, is Research Engineer, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. At the time of the research, she was Graduate Student, Department of Mechanical Engineering, University of Washington, Seattle, and Clinical Research Assistant, Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA
| | - Emily K Sabelhaus
- Emily K. Sabelhaus, MS, OTR/L, is Occupational Therapist, Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA, and Pediatric Occupational Therapist, Whatcom Center for Early Learning, Bellingham, WA
| | - Ying-Chun Pan
- Ying-Chun Pan, BS, is Graduate Student, Department of Biomedical Engineering, University of Michigan, Ann Arbor. At the time of the research, he was Undergraduate Student, Department of Bioengineering, University of Washington, Seattle, and Clinical Research Assistant, Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA
| | - Kristie F Bjornson
- Kristie F. Bjornson, PT, PhD, is Associate Professor of Pediatrics, Department of Pediatrics, University of Washington, Seattle
| | - Kelly L D Pham
- Kelly L. D. Pham, MD, is Assistant Professor, Department of Physical Medicine and Rehabilitation Medicine, University of Washington, Seattle, and Assistant Professor, Seattle Children's Hospital, Seattle, WA
| | - William O Walker
- William O. Walker, Jr., MD, is Robert Aldrich Endowed Professor, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Katherine M Steele
- Katherine M. Steele, PhD, is Albert S. Kobayashi Endowed Professor, Department of Mechanical Engineering, University of Washington, Seattle;
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Kuschmann A, Lowit A. Pausing and Sentence Stress in Children with Dysarthria due to Cerebral Palsy. Folia Phoniatr Logop 2020; 73:298-307. [PMID: 32604092 DOI: 10.1159/000508097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Children with dysarthria due to cerebral palsy (CP) can experience problems manipulating intensity, fundamental frequency, and duration to signal sentence stress in an utterance. Pauses have been identified as a potential additional cue for stress-marking, which could compensate for this deficit. OBJECTIVE This study aimed to determine whether children use pauses to signal stress placement, and whether this differs between typically developing children and those with CP. METHODS Six children with CP and 8 typically developing children produced utterances with stresses on target words in 2 different positions. Pauses before and after the stressed target words were analyzed in terms of number, location, and duration. RESULTS Both groups inserted pauses into their utterances. However, neither group used pause location or duration in a systematic manner to signal the position of the words stressed. CONCLUSIONS The results suggest that pausing was not used strategically by either group to signal sentence stress. Further research is necessary to explore the value of pausing as a cue to stress-marking in general and as a potential compensatory strategy for speakers with dysarthria.
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Affiliation(s)
- Anja Kuschmann
- Speech and Language Therapy Department, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom,
| | - Anja Lowit
- Speech and Language Therapy Department, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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Quadrelli E, Anzani A, Ferri M, Bolognini N, Maravita A, Zambonin F, Turati C. Electrophysiological correlates of action observation treatment in children with cerebral palsy: A pilot study. Dev Neurobiol 2020; 79:934-948. [PMID: 31981294 DOI: 10.1002/dneu.22734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 11/08/2022]
Abstract
Action Observation Treatment (AOT) has been shown to be effective in the functional recovery of several clinical populations. However, little is known about the neural underpinnings of the clinical efficacy of AOT in children with Cerebral Palsy (CP). Using electroencephalography (EEG), we recorded µ rhythm desynchronization as an index of sensorimotor cortex modulation during a passive action observation task before and after AOT. The relationship between sensorimotor modulation and clinical outcomes was also assessed. Eight children with CP entered the present randomized controlled crossover pilot study in which the experimental AOT preceded or followed a control Videogame Observation Treatment (VOT). Results provide further evidence of the clinical efficacy of AOT for improving hand motor function in CP, as assessed with the Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function Scale (MUUL). The novel finding is that AOT increases µ rhythm desynchronization at scalp locations corresponding to the hand representation areas. This effect is associated to functional improvement assessed with the MUUL. These preliminary findings, although referred to as a small sample, suggest that AOT may affect upper limb motor recovery in children with CP and modulate the activation of sensorimotor areas, offering a potential neurophysiological correlate to support the clinical utility of AOT.
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Affiliation(s)
- Ermanno Quadrelli
- Department of Psychology, Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Anna Anzani
- Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
| | - Matteo Ferri
- Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
| | - Nadia Bolognini
- Department of Psychology, Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Angelo Maravita
- Department of Psychology, Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy
| | - Fabio Zambonin
- Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
| | - Chiara Turati
- Department of Psychology, Milan Center for Neuroscience, University of Milano-Bicocca, Milano, Italy.,Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
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15
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Johnson E, Nilsson S, Adolfsson M. How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge. Afr J Disabil 2019; 8:575. [PMID: 31824834 PMCID: PMC6890561 DOI: 10.4102/ajod.v8i0.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/19/2019] [Indexed: 01/18/2023] Open
Abstract
Background Pain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff's perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions. Objectives This study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers). Method Five focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection. Results Most treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered. Conclusion A discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children's hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.
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Affiliation(s)
- Ensa Johnson
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Stefan Nilsson
- Children, Health, Intervention, Learning and Development (CHILD), Jönköping University, Jönköping, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Adolfsson
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa.,School of Education and Communication, Jönköping University, Jönköping, Sweden.,Swedish Institute of Disability Research, Jönköping University, Jönköping, Sweden
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16
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Pereira A, Rosário P, Lopes S, Moreira T, Magalhães P, Núñez JC, Vallejo G, Sampaio A. Promoting School Engagement in Children with Cerebral Palsy: A Narrative Based Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3634. [PMID: 31569711 PMCID: PMC6801813 DOI: 10.3390/ijerph16193634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022]
Abstract
This study assessed the efficacy of an educational program focused on the promotion of school engagement in children with Cerebral Palsy. A 9 weeks, narrative-based intervention program, with a pre-post neuropsychological and self-report evaluation, was developed with a dual focus: a self-regulation theoretical model and executive function stimulation. Fifteen children with Cerebral Palsy participated in the study. Results showed a significant main effect of time (F(2.82) = 6.04, p = 0.0066, partial η2 = 0.30; F(2.82) = 9.91, p = 0.0006, partial η2 = 0.41; F(2.82) = 26.90, p < 0.0001, partial η2 = 0.66) in the three dimensions of school engagement. Findings indicate that the program to train self-regulated competences and executive function skills was efficacious in promoting school engagement in children with Cerebral Palsy. Educational implications were discussed.
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Affiliation(s)
- Armanda Pereira
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal.
| | - Pedro Rosário
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal
| | - Sílvia Lopes
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal
| | - Tânia Moreira
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal
| | - Paula Magalhães
- Department of Applied Psychology, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal
| | - José Carlos Núñez
- Faculty of Psychology, University of Oviedo, Oviedo, 33003 Asturias, Spain
- Facultad de Ciencias Sociales y Humanidades, Universidad Politécnica y Artística de Paraguay, Mayor Sebastián Bullo s/n, Asunción 1628, Paraguay
| | - Guillermo Vallejo
- Faculty of Psychology, University of Oviedo, Oviedo, 33003 Asturias, Spain
| | - Adriana Sampaio
- Neuropsychophysiology Lab, CIPsi, School of Psychology, University of Minho, 4700-032 Braga, Portugal
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Yana M, Tutuola F, Westwater-Wood S, Kavlak E. The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: A systematic review. NeuroRehabilitation 2019; 44:175-189. [PMID: 30856126 DOI: 10.3233/nre-182581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND To assess treatment effect of lower limb botulinum toxin type A (BTX-A) in combination with physiotherapy approaches on gross motor functions in children with cerebral palsy compared with only physiotherapy treatment. OBJECTIVE The purpose of this review was to analyze the efficacy botulinum toxin a lower limb injections in addition to physiotherapy approaches in children with cerebral palsy. METHODS A literature search was conducted in the following databases: Cochrane, PEDro, PubMed, MEDLINE, AMED and EMBASE. The searches were limited to the period from July 2009 to July 2015. The intervention had to contain BTX-A into the lower limb plus physiotherapy approaches and be compared with only physiotherapy. The methodological quality and clinical relevance were independently assessed by the authors. RESULTS The database search resulted in a total of 1521 studies, of which 4 (Level II of evidence) trials were included in this review. The population represented by were age between from 11 month to 15 years. Overall there were 153 children all diagnosed with CP (87 Male, 66 Female). CONCLUSIONS The use of BTX-A injections in addition to physiotherapy approaches seems to have positive effect on spasticity and ROM. However, the question of whether the treatment of BTX-A plus physiotherapy has a greater improvement on functional capacity, such as gross motor function or gait parameter than only physiotherapy treatments, was inconclusive. Further investigation by rigorous studies is required.
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Affiliation(s)
- Metehan Yana
- University of Karabuk, Faculty of Health Science Karabük, Turkey
| | - Fadodun Tutuola
- Queens Medical Centre, Nottingham University Hospital NHS, Nottingham, UK
| | - Sarah Westwater-Wood
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Erdoğan Kavlak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
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18
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Houx L, Dubois A, Brochard S, Pons C. Do clowns attenuate pain and anxiety undergoing botulinum toxin injections in children? Ann Phys Rehabil Med 2019; 63:393-399. [PMID: 30708069 DOI: 10.1016/j.rehab.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Botulinum toxin injection (BTI) is the primary treatment for spasticity in children. Anxiety and pain are important concerns to address to attenuate the discomfort of BTI. The aim of this study was to compare the effectiveness of medical clowns and usual distractions, both added to nitrous oxide (N2O) and analgesic cream, on pain and anxiety during BTI sessions in children. METHODS The primary outcome was pain evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Secondary criteria were pain rated on a Visual Analog Scale (VAS) by the child and parent, anxiety rated on a VAS before and during BTIs by the child and parent(s), rating of the success of the sessions on a 4-point Likert scale by the physician and parent(s), and rating of the benefits of the distraction by the parent(s). Non-parametric tests were used for between-group comparisons. RESULTS Baseline group characteristics of the clown and control groups did not differ. During 88 BTI sessions (40 with clown distraction and 48 with control distraction) in 59 children (35 boys; 52 with cerebral palsy, 12 with moderate to severe cognitive disorders), median maximal FLACC score was 2.5 (interquartile range [IQR]: 1-4) in the clown group and 3 (IQR: 1-4.3) in the control group. VAS self-reported pain score was 2.5 (IQR: 0-5) and 3 (IQR: 1-6.3) in the clown and control groups (P=0.56), and VAS proxy-reported pain score was 2.5 (IQR: 0.3-3.4) and 3 (IQR: 1-4.5) (P=0.25). After BTI sessions, the 2 groups did not differ in VAS self- and proxy-reported anxiety (P=0.83 and P=0.81). Physician and parent ratings of the success of sessions were similar between the groups (P=0.89 and P=0.11). Parent ratings of the perceived benefits of distraction were higher in the clown than control group (P=0.004). CONCLUSIONS Although clown distraction was particularly appreciated by parents, it did not significantly reduce pain or anxiety in children as compared with usual distraction. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03149263.
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Affiliation(s)
- Laetitia Houx
- Department of physical and medical rehabilitation, CHRU MORVAN, 29602 Brest, Bretagne, France; Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France.
| | - Amandine Dubois
- Department of psychology, university of occidental Brittany, 29200 Brest, Bretagne, France; LP3C, EA 1285, Rennes 2, 35000 Rennes, Bretagne, France
| | - Sylvain Brochard
- Department of physical and medical rehabilitation, CHRU MORVAN, 29602 Brest, Bretagne, France; Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France
| | - Christelle Pons
- Department of pediatric physical and medical rehabilitation, fondation ILDYS, 29200 Brest, Bretagne, France; Laboratory of medical information processing, Inserm U1101, 29200 Brest, Bretagne, France
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Schiariti V, Mahdi S, Bölte S. International Classification of Functioning, Disability and Health Core Sets for cerebral palsy, autism spectrum disorder, and attention-deficit-hyperactivity disorder. Dev Med Child Neurol 2018; 60:933-941. [PMID: 29845609 DOI: 10.1111/dmcn.13922] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 12/27/2022]
Abstract
AIM Capturing functional information is crucial in childhood disability. The International Classification of Functioning, Disability and Health (ICF) Core Sets promote assessments of functional abilities and disabilities in clinical practice regarding circumscribed diagnoses. However, the specificity of ICF Core Sets for childhood-onset disabilities has been doubted. This study aimed to identify content commonalities and differences among the ICF Core Sets for cerebral palsy (CP), and the newly developed Core Sets for autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD). METHOD The categories within each Core Set were aggregated at the ICF component and chapter levels. Content comparison was conducted using descriptive analyses. RESULTS The activities and participation component of the ICF was the most covered across all Core Sets. Main differences included representation of ICF components and coverage of ICF chapters within each component. CP included all ICF components, while ADHD and ASD predominantly focused on activities and participation. Environmental factors were highly represented in the ADHD Core Sets (40.5%) compared to the ASD (28%) and CP (27%) Core Sets. INTERPRETATION International Classification of Functioning, Disability and Health Core Sets for CP, ASD, and ADHD capture both common but also unique functional information, showing the importance of creating condition-specific, ICF-based tools to build functional profiles of individuals with childhood-onset disabilities. WHAT THIS PAPER ADDS The International Classification of Functioning, Disability and Health (ICF) Core Sets for cerebral palsy (CP), autism spectrum disorder (ASD), and attention-deficit-hyperactivity disorder (ADHD) include unique functional information. The ICF-based tools for CP, ASD, and ADHD differ in terms of representation and coverage of ICF components and ICF chapters. Representation of environmental factors uniquely influences functioning and disability across ICF Core Sets for CP, ASD and ADHD.
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Affiliation(s)
- Verónica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Soheil Mahdi
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Sven Bölte
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
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20
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Pennington L, Akor WA, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Cochrane Database Syst Rev 2018; 7:CD012507. [PMID: 30040119 PMCID: PMC6513435 DOI: 10.1002/14651858.cd012507.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills. OBJECTIVES To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies. SELECTION CRITERIA We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it. AUTHORS' CONCLUSIONS There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Wanwuri A Akor
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Kate Laws
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park Centre for Neuro‐Rehabilitation and Neuro‐PsychiatryRegional Communication Aid ServiceBenfield RoadNewcastle upon TyneUKNE6 4 QD
| | - Juliet Goldbart
- Manchester Metropolitan UniversityFaculty of Health, Psychology & Social CareBrooks Building, Birley Fields Campus53 Bonsall StreetManchesterUKM15 6GX
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Trujillo-Leon A, Bachta W, Vidal-Verdu F. Tactile Sensor-Based Steering as a Substitute of the Attendant Joystick in Powered Wheelchairs. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1381-1390. [PMID: 29985147 DOI: 10.1109/tnsre.2018.2838326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Attendant joysticks of powered wheelchairs are devices oriented to help caregivers. Diseases and disabilities such as dementia, spinal cord injuries or blindness make the user unable to drive the chair by his or her own. However, this device is not intuitive to use, especially for old people. Proper processing of the information provided by two tactile sensors in the handlebar achieves control signals that allow an easy and intuitive driving. This is done in this paper, where the performance of this approach is evaluated in comparison with that of the joystick by means of objective measurements as well as questionnaires to obtain the subjective perception of the participants in the experiments. The results show a better performance of the handlebar in terms of error in following a trajectory, collisions with the surrounding furniture, and user feeling related to ease of use, comfort, required training, usefulness, safety, and fatigue.
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Participation in Daily Life: Influence on Quality of Life in Ambulatory Children with Cerebral Palsy. PM R 2018; 10:1185-1191. [PMID: 29783065 DOI: 10.1016/j.pmrj.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a chronic condition that affects children and has an impact on social and physical activity, as well as participation in daily life. Participation and quality of life (QOL) are 2 important measures of successful rehabilitation that have not been well studied in children with CP. OBJECTIVE To report levels of participation and examine the relationship of participation to QOL in ambulatory children with CP. DESIGN Secondary analysis, cross-sectional cohort study. SETTING Regional pediatric specialty care center. PARTICIPANTS A cohort of 128 ambulatory children with CP, Gross Motor Function Classification System levels I-III, age 2-9 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pediatric Quality of Life Inventory; Assessment of Life Habits; and Children's Assessment of Participation and Enjoyment and Assessment of Preschool Children's Participation. RESULTS Participation was negatively associated with increasing Gross Motor Function Classification System but not age. Level of participation was associated with psychosocial QOL (2.97, P = .001) and total QOL (54.70, P = .03) but not physical QOL. There was a positive relationship between physical activity performance (0.63, P = .001), walking performance (0.002, P = .01), and communication level (7.23, P = .05) with physical QOL. Increasing age and decreased frequency of participation were negatively associated with all QOL domains. CONCLUSIONS The results suggest that participation in daily life is negatively influenced by physical impairment and that levels of participation are positively associated with psychosocial and total QOL among ambulatory children with CP. This suggests that participation influences QOL and further studies are needed to determine the aspects of participation directly impacting QOL in ambulatory children with CP. LEVEL OF EVIDENCE III.
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23
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Stadskleiv K, Batorowicz B, Massaro M, van Balkom H, von Tetzchner S. Visual-spatial cognition in children using aided communication. Augment Altern Commun 2018; 34:68-78. [DOI: 10.1080/07434618.2017.1422017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Kristine Stadskleiv
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Munique Massaro
- Department of Special Education, Rio Claro Municipality, Rio Claro, Brazil
| | - Hans van Balkom
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Milo Foundation, Schijndel, Netherlands
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Pennington L, Lombardo E, Steen N, Miller N. Acoustic changes in the speech of children with cerebral palsy following an intensive program of dysarthria therapy. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:182-195. [PMID: 28714530 DOI: 10.1111/1460-6984.12336] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The speech intelligibility of children with dysarthria and cerebral palsy has been observed to increase following therapy focusing on respiration and phonation. AIMS To determine if speech intelligibility change following intervention is associated with change in acoustic measures of voice. METHODS & PROCEDURES We recorded 16 young people with cerebral palsy and dysarthria (nine girls; mean age 14 years, SD = 2; nine spastic type, two dyskinetic, four mixed; one Worster-Drought) producing speech in two conditions (single words, connected speech) twice before and twice after therapy focusing on respiration, phonation and rate. In both single-word and connected speech we measured vocal intensity (root mean square-RMS), period-to-period variability (Shimmer APQ, Jitter RAP and PPQ) and harmonics-to-noise ratio (HNR). In connected speech we also measured mean fundamental frequency, utterance duration in seconds and speech and articulation rate (syllables/s with and without pauses respectively). All acoustic measures were made using Praat. Intelligibility was calculated in previous research. OUTCOMES & RESULTS In single words statistically significant but very small reductions were observed in period-to-period variability following therapy: Shimmer APQ -0.15 (95% CI = -0.21 to -0.09); Jitter RAP -0.08 (95% CI = -0.14 to -0.01); Jitter PPQ -0.08 (95% CI = -0.15 to -0.01). No changes in period-to-period perturbation across phrases in connected speech were detected. However, changes in connected speech were observed in phrase length, rate and intensity. Following therapy, mean utterance duration increased by 1.11 s (95% CI = 0.37-1.86) when measured with pauses and by 1.13 s (95% CI = 0.40-1.85) when measured without pauses. Articulation rate increased by 0.07 syllables/s (95% CI = 0.02-0.13); speech rate increased by 0.06 syllables/s (95% CI = < 0.01-0.12); and intensity increased by 0.03 Pascals (95% CI = 0.02-0.04). There was a gradual reduction in mean fundamental frequency across all time points (-11.85 Hz, 95% CI = -19.84 to -3.86). Only increases in the intensity of single words (0.37 Pascals, 95% CI = 0.10-0.65) and reductions in fundamental frequency (-0.11 Hz, 95% CI = -0.21 to -0.02) in connected speech were associated with gains in intelligibility. CONCLUSIONS & IMPLICATIONS Mean reductions in impairment in vocal function following therapy observed were small and most are unlikely to be clinically significant. Changes in vocal control did not explain improved intelligibility.
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Affiliation(s)
- Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eftychia Lombardo
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Miller
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Glinianaia SV, Best KE, Lingam R, Rankin J. Predicting the prevalence of cerebral palsy by severity level in children aged 3 to 15 years across England and Wales by 2020. Dev Med Child Neurol 2017; 59:864-870. [PMID: 28574167 DOI: 10.1111/dmcn.13475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 11/30/2022]
Abstract
AIM To estimate the number of children living with cerebral palsy (CP) in England and Wales in 2013 by severity, and to extrapolate this figure to 2020. METHOD Data from the North of England Collaborative Cerebral Palsy Survey for births during the period 1991 to 2000 were restricted to individuals aged at or above 3 years to estimate the prevalence of CP and to calculate 15-year survival by severity according to the number of severe impairments and lifestyle assessment score. The number of 3- to 15-year-olds with CP of different severity in England and Wales was estimated in 2013 and 2019 using actual and nationally projected births. RESULTS Cumulative survival estimates up to the age of 16 years in children with CP differ significantly by severity, ranging between 97 per cent and 100 per cent for children with non-severe CP, and between 64 per cent and 67 per cent for those with the most severe CP. By the end of 2013, the estimated number of children aged 3 to 15 years living with CP in England and Wales will be about 20 500 rising to approximately 22 100 by 2020, a 7.5 per cent increase. INTERPRETATION Owing to an increasing population, the number of children living with CP in England and Wales will increase by 2020. This will have significant implications for health and social care service planning.
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Affiliation(s)
| | - Kate E Best
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Kuschmann A, Miller N, Lowit A, Pennington L. Intonation patterns in older children with cerebral palsy before and after speech intervention. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:370-380. [PMID: 27705032 DOI: 10.1080/17549507.2016.1216601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/15/2016] [Accepted: 07/03/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE This paper examined the production of intonation patterns in children with developmental dysarthria associated with cerebral palsy (CP) prior to and after speech intervention focussing on respiration and phonation. The study further sought to establish whether intonation performance might be related to changes in speech intelligibility. METHOD Intonation patterns were examined using connected speech samples of 15 older children with moderate to severe developmental dysarthria due to CP (9 females; age range: 11-18). Recordings were made prior to and after speech intervention based on a systems approach. Analyses are focussed on the use of intonation patterns, pitch accentuation and phrasing. RESULT Group analyses showed a significant increase in the use of rising intonation patterns after intervention. There were also some indications that this increase might have been related to gains in speech intelligibility for some of the children. No changes were observed regarding pitch accentuation and phrasing following intervention. CONCLUSION The findings highlight that changes can occur in the use of intonation patterns in children with dysarthria and CP following speech systems intervention. It is hypothesised that the emergence of the rising pattern in some of the children's intonational inventories possibly reflected improved breath support and control of laryngeal muscles.
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Affiliation(s)
- Anja Kuschmann
- a School of Psychological Sciences & Health , University of Strathclyde , Glasgow , UK
| | - Nick Miller
- b Institute of Health & Society, Newcastle University , Newcastle upon Tyne , UK
| | - Anja Lowit
- a School of Psychological Sciences & Health , University of Strathclyde , Glasgow , UK
| | - Lindsay Pennington
- b Institute of Health & Society, Newcastle University , Newcastle upon Tyne , UK
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Pennington L, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Hippokratia 2017. [DOI: 10.1002/14651858.cd012507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lindsay Pennington
- Newcastle University; Institute of Health and Society; Sir James Spence Institute - Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne UK NE1 4LP
| | - Kate Laws
- City Hospitals Sunderland NHS Foundation Trust; Department of Speech and Language Therapy; Childrens Centre Durham Road Sunderland UK SR3 4AF
| | - Juliet Goldbart
- Manchester Metropolitan University; Faculty of Health, Psychology & Social Care; Brooks Building, Birley Fields Campus 53 Bonsall Street Manchester UK M15 6GX
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Keeratisiroj O, Thawinchai N, Siritaratiwat W, Buntragulpoontawee M, Pratoomsoot C. Prognostic predictors for ambulation in children with cerebral palsy: a systematic review and meta-analysis of observational studies. Disabil Rehabil 2016; 40:135-143. [DOI: 10.1080/09638288.2016.1250119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Orawan Keeratisiroj
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Nuanlaor Thawinchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wantana Siritaratiwat
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
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Dalvand H, Dehghan L, Yavari A, Riyahi A, Valizadeh A. Determination of the Needs of Mothering Handling Training for Family Caregiving of Children and Youth With Cerebral Palsy at Home Based on a Family- Centered Approach. JOURNAL OF REHABILITATION 2016. [DOI: 10.21859/jrehab-1703212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hsieh YL, Yang CC, Sun SH, Chan SY, Wang TH, Luo HJ. Effects of hippotherapy on body functions, activities and participation in children with cerebral palsy based on ICF-CY assessments. Disabil Rehabil 2016; 39:1703-1713. [PMID: 27440177 DOI: 10.1080/09638288.2016.1207108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist. METHODS Fourteen children with cerebral palsy (CP) (3-8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase. RESULTS Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (all p < 0.05) when compared with baseline. CONCLUSION This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP. Implications for Rehabilitation ICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP. In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation. The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I-III.
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Affiliation(s)
- Yueh-Ling Hsieh
- a Department of Physical Therapy , Graduate Institute of Rehabilitation Science, China Medical University , Taichung , Taiwan
| | - Chen-Chia Yang
- b Kao-an Rehabilitation and Pain Clinic , Taichung , Taiwan
| | - Shih-Heng Sun
- a Department of Physical Therapy , Graduate Institute of Rehabilitation Science, China Medical University , Taichung , Taiwan
| | - Shu-Ya Chan
- a Department of Physical Therapy , Graduate Institute of Rehabilitation Science, China Medical University , Taichung , Taiwan.,c Therapeutic Riding Centre of Taiwan , Taoyuan County , Taiwan
| | - Tze-Hsuan Wang
- c Therapeutic Riding Centre of Taiwan , Taoyuan County , Taiwan
| | - Hong-Ji Luo
- d Department of Physical Therapy and Assistive Technology and Research Center on International Classification of Functioning, Disability and Health (ICF) and Assistive Technology , National Yang-Ming University , Taipei , Taiwan.,e Resource Portal of Assistive Technology , Ministry of Health and Welfare , Taipei , Taiwan
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Löwing K, Arredondo YC, Tedroff M, Tedroff K. Introduction of the gross motor function classification system in Venezuela--a model for knowledge dissemination. BMC Pediatr 2015; 15:111. [PMID: 26341265 PMCID: PMC4560893 DOI: 10.1186/s12887-015-0433-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A current worldwide common goal is to optimize the health and well-being of children with cerebral palsy (CP). In order to reach that goal, for this heterogeneous group, a common language and classification systems are required to predict development and offer evidence based interventions. In most countries in Africa, South America, Asia and Eastern Europe the classification systems for CP are unfamiliar and rarely used. Education and implementation are required. The specific aims of this study were to examine a model in order to introduce the Gross Motor Function Classification System (GMFCS-E&R) in Venezuela, and to examine the validity and the reliability. METHODS Children with CP, registered at a National child rehabilitation centre in Venezuela, were invited to participate. The Spanish version of GMFCS-E&R was used. The Wilson mobility scale was translated and used to examine the concurrent validity. A structured questionnaire, comprising aspects of mobility and gross motor function, was constructed. In addition, each child was filmed. A paediatrician in Venezuela received supervised self-education in GMFCS-E&R and the Wilson mobility scale. A Swedish student was educated in GMFCS-E&R and the Wilson mobility scale prior to visiting Venezuela. In Venezuela, all children were classified and scored by the paediatrician and student independently. An experienced paediatric physiotherapist (PT) in Sweden made independent GMFCS-E&R classifications and Wilson mobility scale scorings, accomplished through merging data from the structured questionnaire with observations of the films. Descriptive statistics were used and reliability was presented with weighted Kappa (Kw). Spearman's correlation coefficient was calculated to explore the concurrent validity between GMFCS-E&R and Wilson mobility scale. RESULTS Eighty-eight children (56 boys), mean age 10 years (3-18), with CP participated. The inter-rater reliability of GMFCS-E&R between; the paediatrician and the PT was Kw = 0.85 (95% CI: 0.75-0.88), the PT and student was Kw = 0.91 (95% CI: 0.86-0.95) and the paediatrician and student was Kw = 0.85 (95 % CI: 0.79-0.90). The correlations between GMFCS-E&R and Wilson mobility scale were high rs =0.94-0.95 (p < 0.001). CONCLUSIONS In a setting with no previous knowledge of GMFCS-E&R, the model with education, supervised self-education and practice was efficient and resulted in very good reliability and validity.
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Affiliation(s)
- Kristina Löwing
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Q2:07, SE-171 76, Stockholm, Sweden.
| | - Ynes C Arredondo
- Child Rehabilitation Center Mundo de Sonrisas Alta Vista, Mundo De Sonrisas Building, Puerto Ordaz, 8050, Venezuela.
| | - Marika Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Q2:07, SE-171 76, Stockholm, Sweden.
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Q2:07, SE-171 76, Stockholm, Sweden.
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Dalvand H, Hosseini SA, Rassafiani M, Samadi SA, Khankeh HR, Kelly G. Co-occupations: The caregiving challenges of mothers of children with cerebral palsy. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This study was conducted in an Iranian context to explore the co-occupations of mothers of children with cerebral palsy as experienced by them. Method This qualitative study was conducted using content analysis methodology. Sixteen mothers of children with cerebral palsy participated in the study. Data was collected via in-depth, semi-structured interviews. Constant comparative analysis was deployed for data analysis. Results The results were classified into nine sub-categories and four main categories that were identified as (1) coping with self-care problems, (2) effort to gain treatment follow-up, (3) coping challenges of educational care, and (4) limited parental personal leisure time. Conclusion Understanding the challenges of caring for a child with cerebral palsy and the experiences of mothers when engaging in co-occupations with their child, provides a broader perspective of the potential impact on participation and engagement of mothers. However, more research is required to understand the various factors influencing participation and co-occupations and interaction effects between these factors.
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Affiliation(s)
- Hamid Dalvand
- Assistant Professor, School of Rehabilitation, Arak University of Medical Sciences, Arak, Iran
| | - Seyyed Ali Hosseini
- Associate Professor and Head of Department, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- Associate Professor and Head of Department, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | | | - Hamid Reza Khankeh
- Associate Professor, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
| | - Greg Kelly
- Reader in Occupational Therapy, University of Ulster, Northern Ireland, UK
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Imms C, Novak I, Kerr C, Shields N, Randall M, Harvey A, Graham HK, Reddihough D. Improving allied health professionals' research implementation behaviours for children with cerebral palsy: protocol for a before-after study. Implement Sci 2015; 10:16. [PMID: 25889110 PMCID: PMC4328993 DOI: 10.1186/s13012-014-0202-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed. METHODS/DESIGN This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve research implementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children's health outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children's health outcomes will be evaluated by longitudinal analyses. DISCUSSION Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy. TRIAL REGISTRATION Trial is not a controlled healthcare intervention and is not registered.
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Affiliation(s)
- Christine Imms
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Frenchs Forest, PO Box 6427, NSW, 2086, Sydney, Australia.
- School of Medicine, University of Notre Dame Australia, Broadway, PO Box 944, 2007, Sydney, Australia.
| | - Claire Kerr
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
| | - Nora Shields
- La Trobe University, Kingsbury Drive, Bundoora, 3086, Victoria, Australia.
- Northern Health, 1231 Plenty Road, Bundoora, 3083, Victoria, Australia.
| | - Melinda Randall
- Australian Catholic University, 17 Young Street, Fitzroy, Melbourne, 3065, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Adrienne Harvey
- Victorian Paediatric Rehabilitation Service, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - H Kerr Graham
- Hugh Williamson Gait Laboratory, Royal Children's Hospital, Parkville, Australia.
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
| | - Dinah Reddihough
- University of Melbourne, Parkville, Australia.
- Murdoch Children's Research Institute, Parkville, 3052, Australia.
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Schiariti V, Selb M, Cieza A, O'Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: a consensus meeting. Dev Med Child Neurol 2015; 57:149-58. [PMID: 25131642 DOI: 10.1111/dmcn.12551] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
AIM The objective of this article is to report on the Core Sets developed for children and youth aged 0 to 18 years, with cerebral palsy (CP) based on the pediatric International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO). METHOD A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. Preparatory studies included: a systematic literature review; an international expert survey; a qualitative study of children and youth with CP and their caregivers; and a clinical study. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. Twenty-six international experts chosen by WHO region with expertise in CP attended the consensus meeting. RESULTS Overall, five ICF Core Sets were developed: a Comprehensive Core Set (135 ICF categories); a Common Brief (25 ICF categories); and three age-specific Core Sets: under 6 years (31 ICF categories), from 6 to <14 years (35 ICF categories) and from 14 to 18 years (37 ICF categories). INTERPRETATION These ICF Core Sets for children and youth with CP are the first ICF-based tools developed for this population. The ICF Core Sets for children and youth with CP can be applied in clinical practice, research, teaching and administration. The application of the ICF Core Sets to this population will standardize the functional assessments of CP worldwide.
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Affiliation(s)
- Veronica Schiariti
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Schiariti V, Mâsse LC. Relevant areas of functioning in children with cerebral palsy based on the international classification of functioning, disability and health coding system: a clinical perspective. J Child Neurol 2015; 30:216-22. [PMID: 24810085 DOI: 10.1177/0883073814533005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the context of the development of the International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy, an evidence-based methodology was implemented to select the most relevant categories out of the entire classification. The aim of this study was to describe the contribution of the clinical perspective to select categories of functioning in children and youth with cerebral palsy. We conducted a chart review of clinical assessments of children and youth with cerebral palsy aged 0 to 18 years in a tertiary level center. In total, 129 International Classification of Functioning categories were covered in clinical encounters: representing 19% body structures, 33% body functions, 37% activity and participation, and 11% environmental factors. Our findings can guide clinical assessments and goal-setting of this population. This important perspective will inform the development of the International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy.
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Affiliation(s)
- Veronica Schiariti
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Swe NN, Sendhilnnathan S, van Den Berg M, Barr C. Over ground walking and body weight supported walking improve mobility equally in cerebral palsy: a randomised controlled trial. Clin Rehabil 2015; 29:1108-16. [DOI: 10.1177/0269215514566249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/06/2014] [Indexed: 11/17/2022]
Abstract
Objective: To assess partial body weight supported treadmill training versus over ground training for walking ability in children with mild to moderate cerebral palsy. Design: Randomised controlled trial. Setting: A Special Needs school in Singapore. Subjects: Thirty children with cerebral palsy, aged 6-18, with a Gross Motor Function Classification System score of II-III. Interventions: Two times 30 minute sessions of walking training per week for 8 weeks, progressed as tolerated, either over ground (control) or using partial body weight supported treadmill training (intervention). Main measures: The 10 metre walk test, and the 6 minute walk test. Secondary measures were sub-sections D and E on the Gross Motor Function Measure. Outcomes were assessed at baseline, and after 4 and 8 weeks of training. Results: There was no effect of group allocation on any outcome measure, while time was a significant factor for all outcomes. Walking speed improved significantly more in the intervention group by week 4 (0.109 (0.067)m/s vs 0.048 (0.071)m/s, P=0.024) however by week 8 the change from baseline was similar (intervention 0.0160 (0.069)m/s vs control 0.173 (0.109)m/s, P=0.697). All gains made by week 4 were significantly improved on by week 8 for the 10 metre walk test, 6 minute walk test, and the gross motor function measure. Conclusions: Partial body weight supported treadmill training is no more effective than over ground walking at improving aspects of walking and function in children with mild to moderate cerebral palsy. Gains seen in 4 weeks can be furthered by 8 weeks.
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Affiliation(s)
- Ni Ni Swe
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
- Cerebral Palsy Alliance Singapore, Singapore
| | | | - Maayken van Den Berg
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
| | - Christopher Barr
- Department of Rehabilitation Aged and Extended Care, Flinders University, Australia
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Schiariti V, Mâsse LC. Identifying relevant areas of functioning in children and youth with Cerebral Palsy using the ICF-CY coding system: from whose perspective? Eur J Paediatr Neurol 2014; 18:609-17. [PMID: 24813657 DOI: 10.1016/j.ejpn.2014.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/27/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
AIMS A standardized methodology endorsed by the World Health Organization was used to select the most relevant International Classification of Functioning, Disability and Health for children and youth (ICF-CY) categories to inform the development of the ICF Core Sets for CY with Cerebral Palsy (CP). The aim of this study was to appraise comparatively the results of the four studies included in the preparatory phase of the project exploring relevant areas of functioning in CY with CP. METHODS ICF-CY categories identified in the preparatory studies - systematic review, global expert survey, qualitative study, and clinical study - were ranked. We compared the ranking percentile scores of the categories across studies. RESULTS Each study emphasized different ICF-CY components and provided unique categories. Professionals from the health, education and social sectors described areas of functioning that were well distributed across the ICF-CY components (global expert survey), CY with CP and caregivers highlighted areas within the components activity and participation (a & p) and environmental factors (qualitative study), while the research community and clinical encounters mainly focused on body functions and a & p (systematic review and clinical study). INTERPRETATION This study highlights the need to consider all relevant perspectives when describing the functional profile of CY with CP.
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Affiliation(s)
- Veronica Schiariti
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Dakovic I, da Graça Andrada M, Folha T, Neubauer D, Hollody K, Honold M, Horber V, Duranovic V, Bosnjak VM. Clinical features of cerebral palsy in children with symptomatic congenital cytomegalovirus infection. Eur J Paediatr Neurol 2014; 18:618-23. [PMID: 24931914 DOI: 10.1016/j.ejpn.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/09/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Human cytomegalovirus is the most common cause of vertically transmitted viral infection, affecting around 1% of liveborns. Infection is symptomatic in nearly 10% of infected children who are at higher risk of development of severe neurological disorders, including cerebral palsy. AIMS To study the clinical profile of children with cerebral palsy caused by symptomatic congenital cytomegalovirus infection in a multicenter study involving six countries from the Surveillance of Cerebral Palsy in Europe (SCPE) Network. METHODS Data on 35 children (13 males, 22 females; mean age at last assessment 12y 6mo, age range 14y 6mo, min 4y, max 18y 6mo) on pre/peri/neonatal history and last clinical assessment were collected. Classification of cerebral palsy and associated impairments was performed according to SCPE criteria. RESULTS The majority of children had bilateral spastic cerebral palsy, 85.7%, with a confidence interval (CI) [69.7-95.2], and 71.4% [CI 53.7-85.4] were unable to walk (GMFCS levels IV-V) while fine motor function was severely affected in 62.8% [CI 44.9-78.5] (BFMF levels IV and V). Most of the children with severe CP had severe associated impairments. 11.4% of children had severe visual and 42.8% severe hearing impairment, 77.1% [CI 59.9-89.6] suffered from epilepsy, also 77.1% had severe intellectual impairment, and speech was undeveloped in 71.4%. Female:male ratio was 1.69:1 and 80% of children were term born. CONCLUSIONS Cerebral palsy following symptomatic congenital cytomegalovirus infection seems to be in most cases a severe condition and associated impairments are overrepresented.
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Affiliation(s)
- Ivana Dakovic
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia
| | - Maria da Graça Andrada
- Federação das Associações Portuguesas de Paralisia Cerebral FAPPC/National Epidemiological Program for Cerebral Palsy, Lisbon, Portugal
| | - Teresa Folha
- Centro de Reabilitação de Paralisia Cerebral Calouste Gulbenkian Santa, Casa da Misericordia de Lisboa/National Epidemiological Program for Cerebral Palsy, Lisbon, Portugal
| | - David Neubauer
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Katalin Hollody
- University of Pecs, Department of Paediatrics, Pecs, Hungary
| | - Michaela Honold
- Medical University Innsbruck, Division of Pediatric Neurology, Department of Pediatrics I, Innsbruck, Austria
| | - Veronka Horber
- University Children's Hospital Tübingen, Department of Child Neurology, Tübingen, Germany
| | - Vlasta Duranovic
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia
| | - Vlatka Mejaski Bosnjak
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Department of Neuropediatrics, Klaiceva 16, 10000 Zagreb, Croatia.
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Gilliaux M, Renders A, Dispa D, Holvoet D, Sapin J, Dehez B, Detrembleur C, Lejeune TM, Stoquart G. Upper limb robot-assisted therapy in cerebral palsy: a single-blind randomized controlled trial. Neurorehabil Neural Repair 2014; 29:183-92. [PMID: 25015650 DOI: 10.1177/1545968314541172] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP). OBJECTIVE To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial. PATIENTS AND METHODS Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits). RESULTS During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement (P < .01) and manual dexterity assessed by the Box and Block test (P = .04) improved significantly more in the robotic group than in the control group. CONCLUSIONS This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy.
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Affiliation(s)
- Maxime Gilliaux
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Anne Renders
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Delphine Dispa
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Holvoet
- Institut d'Enseignement Supérieur Parnasse-Deux Alice, Brussels, Belgium
| | - Julien Sapin
- Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium Université catholique de Louvain, Institute of Mechanics, Materials and Civil Engineering, Louvain-la-Neuve, Belgium
| | - Bruno Dehez
- Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium Université catholique de Louvain, Institute of Mechanics, Materials and Civil Engineering, Louvain-la-Neuve, Belgium
| | - Christine Detrembleur
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Thierry M Lejeune
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gaëtan Stoquart
- Université catholique de Louvain, Institute of Neuroscience, Brussels, Belgium Université catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Pennington L, Virella D, Mjøen T, da Graça Andrada M, Murray J, Colver A, Himmelmann K, Rackauskaite G, Greitane A, Prasauskiene A, Andersen G, de la Cruz J. Development of The Viking Speech Scale to classify the speech of children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3202-3210. [PMID: 23891732 DOI: 10.1016/j.ridd.2013.06.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 06/02/2023]
Abstract
Surveillance registers monitor the prevalence of cerebral palsy and the severity of resulting impairments across time and place. The motor disorders of cerebral palsy can affect children's speech production and limit their intelligibility. We describe the development of a scale to classify children's speech performance for use in cerebral palsy surveillance registers, and its reliability across raters and across time. Speech and language therapists, other healthcare professionals and parents classified the speech of 139 children with cerebral palsy (85 boys, 54 girls; mean age 6.03 years, SD 1.09) from observation and previous knowledge of the children. Another group of health professionals rated children's speech from information in their medical notes. With the exception of parents, raters reclassified children's speech at least four weeks after their initial classification. Raters were asked to rate how easy the scale was to use and how well the scale described the child's speech production using Likert scales. Inter-rater reliability was moderate to substantial (k>.58 for all comparisons). Test-retest reliability was substantial to almost perfect for all groups (k>.68). Over 74% of raters found the scale easy or very easy to use; 66% of parents and over 70% of health care professionals judged the scale to describe children's speech well or very well. We conclude that the Viking Speech Scale is a reliable tool to describe the speech performance of children with cerebral palsy, which can be applied through direct observation of children or through case note review.
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Affiliation(s)
- Lindsay Pennington
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
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Bøttcher L, Dammeyer J. Disability as a risk factor? Development of psychopathology in children with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3607-3617. [PMID: 23962606 DOI: 10.1016/j.ridd.2013.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 06/02/2023]
Abstract
Empirical research has established that children with disabilities are more likely to develop psychopathology than children without disabilities. But too little is known about the association between disability and psychopathology. The aim of this article is to discuss developmental psychopathological models that conceptualise the connection between childhood disability and psychopathology. Empirical studies of psychopathology among children with a congenital hearing impairment and children with cerebral palsy will be reviewed, representing in-depth examples of association between disability and psychopathology. Both a congenital hearing impairment and cerebral palsy were found to be dominating risk factors for all types of psychopathology, but no relationship was identified between degree of disability and risk of psychopathology. The higher risk cannot be explained by biological impairments alone. To explain the contradictory findings, developmental models of disability and psychopathology are applied. Within a multi-factorial developmental psychopathological perspective and a dialectical model of disability (Vygotsky, 1993), it is suggested that disability can be understood as an incongruence between the individual development of the child and demands and expectations in the specific relations and institutions in which the child participates. This incongruence creates and strengthens negative factors for the child with disability and results in a higher risk of psychopathology.
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Affiliation(s)
- Louise Bøttcher
- Aarhus University, Department of Education, Tuborgvej 164, 2400 Copenhagen NV, Denmark.
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Mitha A, Foix-L'Hélias L, Arnaud C, Marret S, Vieux R, Aujard Y, Thiriez G, Larroque B, Cambonie G, Burguet A, Boileau P, Rozé JC, Kaminski M, Truffert P, Ancel PY. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics 2013; 132:e372-80. [PMID: 23878051 DOI: 10.1542/peds.2012-3979] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children. METHODS We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models. RESULTS A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84-3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14-2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02-5.33]). There was no association between neonatal infection and cognitive impairment. CONCLUSIONS Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.
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Affiliation(s)
- Ayoub Mitha
- Neonatal Unit Hôpital Jeanne de Flandre, Lille, France.
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Sacaze E, Garlantezec R, Rémy-néris O, Peudenier S, Rauscent H, le Tallec H, Bernier-Francois V, Pichancourt D, Brochard S. A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: Preliminary results. Ann Phys Rehabil Med 2013; 56:253-67. [DOI: 10.1016/j.rehab.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 11/21/2012] [Accepted: 11/24/2012] [Indexed: 11/30/2022]
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Maenner MJ, Benedict RE, Arneson CL, Yeargin-Allsopp M, Wingate MS, Kirby RS, Van Naarden Braun K, Durkin MS. Children with cerebral palsy: racial disparities in functional limitations. Epidemiology 2012; 23:35-43. [PMID: 22081059 DOI: 10.1097/ede.0b013e31823a4205] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies of the frequency of cerebral palsy in the United States have found excess prevalence in black children relative to other groups. Whether the severity of cerebral palsy differs between black and white children has not previously been investigated. METHODS A population-based surveillance system in 4 regions of the United States identified 476 children with cerebral palsy among 142,338 8-year-old children in 2006. Motor function was rated by the Gross Motor Function Classification System and grouped into 3 categories of severity. We used multiple imputation to account for missing information on motor function and calculated the race-specific prevalence of each cerebral palsy severity level. RESULTS The prevalence of cerebral palsy was 3.7 per 1000 black children and 3.2 per 1000 white children (prevalence odds ratio [OR] = 1.2 [95% confidence interval = 1.0-1.4]). When stratified by severity of functional limitation, the racial disparity was present only for severe cerebral palsy (black vs. white prevalence OR=1.7 [1.1-2.4]). The excess prevalence of severe cerebral palsy in black children was evident in term and very preterm birth strata. CONCLUSION Black children in the United States appear to have a higher prevalence of cerebral palsy overall than white children, although the excess prevalence of cerebral palsy in black children is seen only among those with the most severe limitations. Further research is needed to explore reasons for this disparity in functional limitations; potential mechanisms include racial differences in risk factors, access to interventions, and under-identification of mild cerebral palsy in black children.
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Affiliation(s)
- Matthew J Maenner
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA.
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Impact sur les parents de la paralysie cérébrale chez l’enfant : revue de la littérature. Arch Pediatr 2011; 18:204-14. [DOI: 10.1016/j.arcped.2010.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/26/2010] [Accepted: 11/24/2010] [Indexed: 11/20/2022]
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Palisano RJ, Chiarello LA, Orlin M, Oeffinger D, Polansky M, Maggs J, Bagley A, Gorton G. Determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy. Dev Med Child Neurol 2011; 53:142-9. [PMID: 20964676 DOI: 10.1111/j.1469-8749.2010.03819.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To test a model of child, family, and service determinants of intensity of participation in leisure and recreational activities by children with cerebral palsy (CP). METHOD Participants were 288 children with CP, age range 6 to 12 years (mean 9y 8mo, SD 2y), and their parents from seven children's hospitals. The sample comprised 166 (57.6%) males and 122 (42.4%) females, and between 40 (13.9%) and 74 (25.7%) children in each of the five levels of the Gross Motor Function Classification System. Children completed the Children's Assessment of Participation and Enjoyment by interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, and two questionnaires. Structural equation modeling was used to test the model. RESULTS Fit statistics indicated a good model fit. The model explains 32% of the variance in intensity of participation. Path coefficients (p ≤ 0.05) indicate that higher gross motor function, higher enjoyment, more effective adaptive behavior, younger age, and higher family activity orientation are associated with higher intensity of participation. The path between services and participation was not significant. INTERPRETATION Intensity of participation of children with CP is influenced by multiple child and family determinants. Children's gross motor function and behavior in life situations are important for participation; knowledge of activities the child and family enjoy has implications for opportunities for participation. Professionals are encouraged to address priorities for leisure and recreation identified by children with CP and their families.
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Affiliation(s)
- Robert J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA 19102-1192, USA.
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Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998. Eur J Epidemiol 2010; 25:635-42. [PMID: 20532622 DOI: 10.1007/s10654-010-9474-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
Time trends for cerebral palsy (CP) prevalence in children born > or =2,500 g vary across studies and scarce data exist on trends by subtype of CP. The objective of this study was to describe changes in prevalence of CP in infants born > or =2,500 g between 1980 and 1998 in Europe. Data were collated from the SCPE (Surveillance of Cerebral Palsy in Europe collaboration) common database. Poisson regression was used to test for change in prevalence over time. Birth year and register effects were explored and trends in prevalence were estimated by CP subtype and severity. Four thousand and two children with CP and birthweight > or =2,500 g were recorded in 15 population based-registers. The overall prevalence of CP was 1.16 per 1,000 live births (99% CI, 0.88-1.48) in 1980 and 0.99 (CI, 0.80-1.20) in 1998. The trend was not significant (P = .14), except in two registers. However, there were significant changes in the prevalence of spastic CP subtypes, with a decrease in the bilateral spastic form (P < .001), and an increase in the unilateral spastic form (P = .004). There was a concurrent reduction in neonatal mortality of children with birthweight > or =2,500 g: from 1.7 (CI, 1.4-2.1) to 0.9 (CI, 0.7-1.1) per 1,000 live births. In conclusion, for children born with birthweight > or =2,500 g, the prevalence of CP in Europe was stable in spite of changes by subtype and a significant decrease in neonatal mortality.
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Pakula AT, Van Naarden Braun K, Yeargin-Allsopp M. Cerebral Palsy: Classification and Epidemiology. Phys Med Rehabil Clin N Am 2009; 20:425-52. [DOI: 10.1016/j.pmr.2009.06.001] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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