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Liuzzi T, Bompard S, Raponi M, D’Arienzo F, Staccioli S, Napoli E, Diotallevi MF, Piga S, Giuliani R, Castelli E. Euterpe music therapy method for children with cerebral palsy. Front Neurol 2024; 15:1388712. [PMID: 38660092 PMCID: PMC11040093 DOI: 10.3389/fneur.2024.1388712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The main purpose of our study was to evaluate whether involvement in a personalized music therapy program (Euterpe method), could improve the condition of children with cerebral palsy and their parents, compared to a control group. It investigated whether it could positively affect children's sleep quality, temperament and quality of life, quality of family life, and parental stress. Methods A prospective single-center experimental study was conducted at "Bambino Gesù" Children's Hospital (Rome, Italy). All subjects involved attended an intensive rehabilitation program in the Neurorehabilitation Unit. In a group of patients (n = 25), a music therapy treatment was applied to evaluate the effect before and after the intervention. This group was also compared with a control group (n = 10) undergoing a standard protocol without music therapy. Results In the experimental group, the analysis shows statistically significant effects in the Disorders of initiating and maintaining sleep (p = 0.050) and the Sleep wake transition disorders (p = 0.026) factors, and the total score (p = 0.031) of Sleep Disturbances Scale for Children; the Positive emotionality scale (p = 0.013) of Italian Questionnaires of Temperament (QUIT); the Emotional Functioning (p = 0.029), Social Functioning (p = 0.012), Worry (p = 0.032), Daily Activities (p = 0.032), Total Score (p = 0.039) and Parent HRQL Summary Score (p = 0.035) dimensions of Pediatric Quality of Life for family. While in the control group, only the Attention scale of QUIT (p = 0.003) reaches statistical significance. Discussion Our study suggests that music therapy with the Euterpe Method has beneficial effects on fundamental aspects of the child's and his parents' lives, such as sleep, emotion control, and quality of family life.
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Affiliation(s)
- Tommaso Liuzzi
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Santa Cecilia Conservatory of Music, Rome, Italy
| | - Sarah Bompard
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Fiammetta D’Arienzo
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Euterpe APS Cultural Association, Rome, Italy
| | - Susanna Staccioli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Eleonora Napoli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Enrico Castelli
- Unit of Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Schneider JS. Response to "Comment on 'Neurotoxicity and Outcomes from Developmental Lead Exposure: Persistent or Permanent?'". ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:48002. [PMID: 38607983 PMCID: PMC11014070 DOI: 10.1289/ehp14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Jay S. Schneider
- Department of Pathology and Genomic Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Gonzalez A, Jack SM, Sim A, Ratcliffe J, Dumbaugh M, Bennett T, MacMillan HL. CHAMPP4KIDS: Mixed methods study protocol to evaluate acceptability and feasibility of Parenting for Lifelong Health materials in a Canadian context. PLoS One 2024; 19:e0298156. [PMID: 38452022 PMCID: PMC10919627 DOI: 10.1371/journal.pone.0298156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Parents and caregivers play a key role in children's healthy development and well-being. Traditional parenting interventions promote positive parenting practices and are key to preventing child maltreatment. However, numerous barriers can limit access to programs, barriers which were further exacerbated by the COVID-19 pandemic. The Parenting for Lifelong Health group developed mass media and public health communication materials to promote positive caregiving behaviours on a population level. The Champions of Positive Parenting 4 Kids (CHAMPP4KIDS) study will examine the acceptability and feasibility of these materials for service providers and caregivers of children aged 2-6 years in Ontario, Canada. METHODS This study will use a convergent mixed-methods design. Consenting service providers (n = 200) and caregivers (n = 100) will complete a quantitative survey to rate, rank and give feedback on Parenting for Lifelong Health tip sheets and social media ads. Caregivers will also complete self-report scales measuring depression and anxiety. We will hold focus group discussions with a sub-sample of surveyed providers (n = 40) and caregivers (n = 25). An adapted Trials of Improved Practices methodology will explore caregiver perspectives after implementing the tip sheets. Primary quantitative outcomes will be descriptive statistics of rankings, Likert Scale scores and descriptive analysis of caregiver depression and anxiety. Qualitative data will be analyzed using Rapid Qualitative Inquiry and triangulated through a convergent coding matrix. DISCUSSION The Parenting for Lifelong Health COVID-19 parenting materials offer succinct, engaging parenting information in a mass media format that addresses some challenges associated with accessing in-person programming. The CHAMPP4KIDS study will provide mixed methods insights on the materials' acceptability and feasibility from different groups in a Canadian context, with a focus on marginalized families. The use of Trials of Improved Practices methodology could prove a useful tool for participant-led adaptation of existing parenting, early childhood development and other health intervention materials.
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Affiliation(s)
- Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenna Ratcliffe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mari Dumbaugh
- School of Public Health, University of Illinois-Chicago, Chicago, Illinois, United States of America
| | - Teresa Bennett
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Harriet L. MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Dumbaugh M, Belem M, Kousse S, Ouoba P, Sankoudouma A, Tchibozo AM, Fearon P, Hollowell J, Hill Z. 'Children awaken by playing ': a qualitative exploration of caregivers' norms, beliefs and practices related to young children's learning and early childhood development in rural Burkina Faso. BMJ Open 2023; 13:e075675. [PMID: 37899153 PMCID: PMC10619012 DOI: 10.1136/bmjopen-2023-075675] [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: 05/15/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Evidence suggests that responsive caregiving and early learning activities positively impact developmental outcomes, with positive effects throughout the life course. Early childhood development interventions should align with local values, beliefs and resources but there has been little research of caregiver beliefs and perspectives on development and learning, especially in sub-Saharan Africa. This qualitative study explored norms, beliefs, practices and aspirations around child development of caregivers of young children in rural Burkina Faso. METHODS We conducted 32 in-depth interviews with mothers and fathers of young children and 24 focus group discussions with mothers, fathers and grandmothers, which included trying behaviours and reporting on experiences. The research informed the development of Scaling Up Nurturing Care, a Radio Intervention to Stimulate Early Childhood Development (SUNRISE), an early child development radio intervention. RESULTS Caregivers described a process of 'awakening', through which children become aware of themselves and the world around them.Perceptions of the timing of awakening varied, but the ability to learn was thought to increase as children became older and more awake. Consequently, talking and playing with babies and younger children were perceived to have little developmental impact. Caregivers said children's interactions with them, alongside God-given intelligence, was believed to impact later behaviour and development. Caregivers felt their role in helping their children achieve later in life was to pay for education, save money, provide advice and be good role models. Interaction and learning activities were not specifically mentioned. Caregivers who trialled interaction and learning activities reported positive experiences for themselves and their child, but interactions were often caregiver led and directive and play was often physical. Key barriers to carrying out the behaviours were poverty and a lack of time. CONCLUSIONS Exploring early childhood beliefs and practices can reveal important sociocultural beliefs which, if incorporated into programme planning and implementation, could help achieve more impactful, acceptable and equitable programmes. TRIAL REGISTRATION NUMBER NCT05335395.
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Affiliation(s)
- Mari Dumbaugh
- Institute for Global Health, University College London, London, UK
- Insight Impact Consulting, Chicago, Illinois, USA
| | - Mireille Belem
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Sylvain Kousse
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Patricia Ouoba
- Research, Develpment Media International, Ouagadougou, Burkina Faso
| | - Adama Sankoudouma
- Innovations for Poverty Action Francophone West Africa, Ouagadougou, Burkina Faso
| | | | - Pasco Fearon
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Family Research, Department of Psychology, University College London, London, UK
| | | | - Z Hill
- Institute for Global Health, University College London Research Department of Epidemiology and Public Health, London, UK
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Apaydın U, Yıldız R, Yıldız A, Acar ŞS, Gücüyener K, Elbasan B. Short-term effects of SAFE early intervention approach in infants born preterm: A randomized controlled single-blinded study. Brain Behav 2023; 13:e3199. [PMID: 37534617 PMCID: PMC10570479 DOI: 10.1002/brb3.3199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE Recent literature suggests that goal-oriented and family-based interventions in enriched environment have a beneficial effect on neuromotor and cognitive development. We aimed to examine the short-term effects of SAFE (Sensory strategies, Activity-based motor training, Family collaboration, and Environmental Enrichment) early intervention approach on motor, cognitive, speech and language, and sensory development in preterm infants. METHODS The study's sample population consisted of 24 preterm infants with corrected ages between 9 and 10 months. Infants in the control group participated in the family training program in accordance with the neurodevelopmental therapy principles (NDT). Infants in the treatment group were included in the family training program according to the principles of the SAFE Early Intervention Approach. Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS), Test of Sensory Functions in Infants (TSFI), Canadian Occupational Performance Measure (COPM), and Bayley Scales of Infant and Toddler Development III (Bayley III) were used to evaluate infants in both groups before and after 10 weeks of treatment (AHEMD-IS). The Depression, Anxiety, Stress Scale Short Form was used to assess the parents' mental health (DASS-SF). RESULTS The interaction effects (time × group) revealed significant differences for Bayley-III cognitive and language scores, TSFI total score, and AHEMD-IS total score in favor of the SAFE group (p < .05). However, there were no differences in Bayley-III motor composite score, COPM Performance score, and COPM Satisfaction score between the interaction effects (time × group) of the groups (p > .05). CONCLUSIONS SAFE early intervention approach improved cognitive, speech and language, sensory outcomes and provide enriched home environment in all domains when compared to NDT-based home program. SAFE is a promising novel early intervention approach for preterm infants.
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Affiliation(s)
- Umut Apaydın
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationKaradeniz Technical UniversityTrabzonTurkey
| | - Ramazan Yıldız
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationGazi UniversityAnkaraTurkey
| | - Ayşe Yıldız
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationGazi UniversityAnkaraTurkey
| | - Şebnem Soysal Acar
- Faculty of Medicine, Department of Pediatrics, Section of Pediatric NeurologyGazi UniversityAnkaraTurkey
| | - Kıvılcım Gücüyener
- Faculty of Medicine, Department of Pediatrics, Section of Pediatric NeurologyGazi UniversityAnkaraTurkey
| | - Bülent Elbasan
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationGazi UniversityAnkaraTurkey
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Deng W, Sargent B, Havens K, Vanderbilt D, Rosales M, Pulido JC, Matarić MJ, Smith BA. Correlation between performance and quantity/variability of leg exploration in a contingency learning task during infancy. Infant Behav Dev 2023; 70:101788. [PMID: 36399847 DOI: 10.1016/j.infbeh.2022.101788] [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: 07/20/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
Quantity and quality of motor exploration are proposed to be fundamental for infant motor development. However, it is still not clear what types of motor exploration contribute to learning. To determine whether changes in quantity of leg movement and/or variability of leg acceleration are related to performance in a contingency learning task, twenty 6-8-month-old infants with typical development participated in a contingency learning task. During this task, a robot provided reinforcement when the infant's right leg peak acceleration was above an individualized threshold. The correlation coefficient between the infant's performance and the change in quantity of right leg movement, linear variability, and nonlinear variability of right leg movement acceleration from baseline were calculated. Simple linear regression and multiple linear regression were calculated to explain the contribution of each variable to the performance individually and collectively. We found significant correlation between the performance and the change in quantity of right leg movement (r = 0.86, p < 0.001), linear variability (r = 0.71, p < 0.001), and nonlinear variability (r = 0.62, p = 0.004) of right leg movement acceleration, respectively. However, multiple linear regression showed that only quantity and linear variability of leg movements were significant predicting factors for the performance ratio (p < 0.001, adjusted R2 = 0.94). These results indicated that the quantity of exploration and variable exploratory strategies could be critical for the motor learning process during infancy.
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Affiliation(s)
- Weiyang Deng
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, USA,.
| | - Barbara Sargent
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, USA,.
| | - Kathryn Havens
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, USA,.
| | - Douglas Vanderbilt
- Division of Behavioral Pediatrics, Department of Pediatrics, Keck School of Medicine, University of Southern California, USA,.
| | - Marcelo Rosales
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, USA,.
| | - Jose Carlo Pulido
- Department of Innovation and Product Design, University Carlos III of Madrid, Spain,.
| | - Maja J Matarić
- Department of Computer Science, Viterbi School of Engineering, University of Southern California, USA,.
| | - Beth A Smith
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, USA,; Division of Behavioral Pediatrics, Department of Pediatrics, Keck School of Medicine, University of Southern California, USA,; Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, USA.
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Ensuring Optimal Early Childhood Development Globally: Optimism about the Increasing Role of Pediatricians. J Dev Behav Pediatr 2023; 44:e70. [PMID: 36563348 DOI: 10.1097/dbp.0000000000001145] [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: 12/24/2022]
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Heidarabadi S, Barzegar M, Hazrati H, Shahrokhi H, Nemati S, Khiabani NH, Maleki Z. A report on the blended short-term supplementary course on "Developmental Care for infants and toddlers" taught with a multidisciplinary approach for pediatricians -qualitative and quantitative study. BMC MEDICAL EDUCATION 2022; 22:877. [PMID: 36528574 PMCID: PMC9759875 DOI: 10.1186/s12909-022-03943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The implementation of follow-up programs for high-risk infants and toddlers aimed to promptly diagnose developmental delays and disorders and initiate early intervention to help improve their developmental status, reduce their care costs in the future, as well as improve their productivity as members of society. There is a lack of qualified specialists in the infant and toddler development field in Iran. To compensate for the lack of training in this area, for the first time, Tabriz University of Medical Sciences has designed a short-term supplementary course of "Developmental Care for Infants and Toddlers". Due to the multidisciplinary nature of the field of child development, this course has been designed as such. The current study aimed to evaluate this course and explain the graduates' relevant experiences using a multidisciplinary approach. METHODS The current study is a quantitative/qualitative study conducted in two phases. In the first step, the learners were asked to assess the teaching quality of the short-term supplementary course of "Developmental Care for Infants and Toddlers" in 5 areas of "educational design," "course administrators' support", " learners' motivation ", "acquisition of general learning and specialized skills" using the Australian Course Experience Questionnaire (CEQ). All graduates completed the questionnaires. The data from the questionnaires were analyzed using descriptive statistics of medians, and interquartile ranges in SPSS software. The second step was a qualitative study to explain the graduates' experiences of this course with a multidisciplinary approach. The samples were selected using a purposive sampling technique. The samples were those who had completed the course mentioned above, had rich experiences in this field, and were willing to share them. The data were collected through semi-structured interviews and analyzed using conventional content analysis. RESULTS In general, the graduates' satisfaction with the course in terms of the five areas studied was evaluated as follows: Educational design, motivating participants to do their best had the greatest median. 5(4-5), Learning objectives; in all items, the median was 4. Course content and resources; all items median were 4 .Relevant learner assessment methods; in all items, the median was 4.The median learners' satisfaction in the areas of "course administrators' support" in all items was 4 and "learners' motivation ", was 5. Learner's motivation" in all items it was 4, indicating the highest level of satisfaction with the "acquisition of specialized skills". In the area of education design, the highest satisfaction was found with the appropriateness of teaching strategies. The codes extracted from the analysis of interviews with the graduates, are divided into four categories: "Ethical and professional commitment of course teachers", "Being a role model in the observance of patients and their caregivers' rights", "Course planning with a multidisciplinary approach and teamwork" as well as "The use of virtual platforms to strengthen and maintain team communication between learners". CONCLUSION This course was the first experience of applying a multidisciplinary approach in an interprofessional course. Ideally, it is indispensable for the Iranian medical education system to move away from specialization and connect all related specialties and disciplines to achieve its educational and therapeutic goals. Therefore, the design of this course can be applied as an educational model for other disciplines and clinical courses.
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Affiliation(s)
- Seifollah Heidarabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hakimeh Hazrati
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hassan Shahrokhi
- Research Center of Psychiatry and Behavioral Sciences, Hassan Shahrokhi, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahrooz Nemati
- Educational Department, Shahrooz Nemati, University of Tabriz, Tabriz, Iran
| | | | - Zahra Maleki
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- , Tabriz, Iran
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Uchitel J, Alden E, Bhutta ZA, Cavallera V, Lucas J, Oberklaid F, Patterson J, Raghavan C, Richter L, Rikard B, Russell RR, Mikati MA. Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association. J Dev Behav Pediatr 2022; 43:e546-e558. [PMID: 35980036 DOI: 10.1097/dbp.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.
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Affiliation(s)
- Julie Uchitel
- Department of Paediatrics, University of Cambridge, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Errol Alden
- International Pediatric Association, Uniformed Services of Health Sciences, Bethesda, MD
| | - Zulfiqar A Bhutta
- International Pediatric Association; Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Jane Lucas
- Consultant in International Health and Child Development to UNICEF and the World Health Organization, New York, NY
| | - Frank Oberklaid
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Australia
| | - Janna Patterson
- Global Child Health and Life Support, American Academy of Pediatrics, Chicago, IL
| | - Chemba Raghavan
- Early Childhood Development Specialist/Acting Chief, UNICEF, New York, NY
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Blaire Rikard
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Robert Ross Russell
- European Board of Paediatrics, European Academy of Paediatrics; Paediatric Respiratory Paediatrics, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mohamad A Mikati
- Early Childhood Development Standing Advisory Group, International Pediatrics Association; Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine Duke University Medical Center, Durham, NC
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Feasibility of Overground Gait Training Using a Joint-Torque-Assisting Wearable Exoskeletal Robot in Children with Static Brain Injury. SENSORS 2022; 22:s22103870. [PMID: 35632279 PMCID: PMC9144762 DOI: 10.3390/s22103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Pediatric gait disorders are often chronic and accompanied by various complications, which challenge rehabilitation efforts. Here, we retrospectively analyzed the feasibility of overground robot-assisted gait training (RAGT) using a joint-torque-assisting wearable exoskeletal robot. In this study, 17 children with spastic cerebral palsy, cerebellar ataxia, and chronic traumatic brain injury received RAGT sessions. The Gross Motor Function Measure (GMFM), 6-min walk test (6 MWT), and 10-m walk test (10 MWT) were performed before and after intervention. The oxygen rate difference between resting and training was performed to evaluate the intensity of training in randomly selected sessions, while the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 assessment was performed to evaluate its acceptability. A total of four of five items in the GMFM, gait speed on the 10 MWT, and total distance on the 6 MWT showed statistically significant improvement (p < 0.05). The oxygen rate was significantly higher during the training versus resting state. Altogether, six out of eight domains showed satisfaction scores more than four out of five points. In conclusion, overground training using a joint-torque-assisting wearable exoskeletal robot showed improvement in gross motor and gait functions after the intervention, induced intensive gait training, and achieved high satisfaction scores in children with static brain injury.
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Aizawa T. Dynamic variation in receptive vocabulary acquisitions: Further evidence from the Young Lives study. COGNITIVE DEVELOPMENT 2021. [DOI: 10.1016/j.cogdev.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nishiyori R, Xiao R, Vanderbilt D, Smith BA. Electroencephalography measures of relative power and coherence as reaching skill emerges in infants born preterm. Sci Rep 2021; 11:3609. [PMID: 33574372 PMCID: PMC7878512 DOI: 10.1038/s41598-021-82329-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022] Open
Abstract
Electroencephalography (EEG) measures of relative power and coherence are associated with motor experience in infants with typical development, but these relationships have not been assessed in infants born preterm. The goal of our study was to investigate the changing patterns of relative power and coherence in the alpha band during resting state EEG in infants born preterm as they developed the skill of reaching. We collected monthly longitudinal data from fourteen infants born preterm between the adjusted ages of 56 and 295 days for a total of 37 sessions of EEG data. Alpha band power at motor cortices and cross-regional connectivity do not present consistent changing trends at the group level in infants born preterm. Individual level analysis reveals that infants born preterm are a heterogeneous group with subtypes of neural function development, some presenting similar changing trends as observed in the typically developing group while others present atypical patterns. This may be linked to the variability in developmental outcomes in infants born preterm. This study was a critical first step to support EEG as a potential tool for identifying and quantifying the developmental trajectories of neuromotor control in infants born preterm.
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Affiliation(s)
- Ryota Nishiyori
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, USA.
| | - Ran Xiao
- School of Nursing, Duke University, Durham, USA
| | - Douglas Vanderbilt
- Department of Pediatrics, Division of General Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Beth A Smith
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Los Angeles, USA
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Nejati V, Salehinejad MA, Nitsche MA, Najian A, Javadi AH. Transcranial Direct Current Stimulation Improves Executive Dysfunctions in ADHD: Implications for Inhibitory Control, Interference Control, Working Memory, and Cognitive Flexibility. J Atten Disord 2020; 24:1928-1943. [PMID: 28938852 DOI: 10.1177/1087054717730611] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: This study examined effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) on major executive functions (EFs), including response inhibition, executive control, working memory (WM), and cognitive flexibility/task switching in ADHD. Method: ADHD children received (a) left anodal/right cathodal DLPFC tDCS and (b) sham stimulation in Experiment 1 and (a) left anodal DLPFC/right cathodal OFC tDCS, (b) left cathodal DLPFC/right anodal OFC tDCS, and (c) sham stimulation in Experiment 2. The current intensity was 1 mA for 15 min with a 72-hr interval between sessions. Participants underwent Go/No-Go task, N-back test, Wisconsin Card Sorting Test (WCST), and Stroop task after each tDCS condition. Results: Anodal left DLPFC tDCS most clearly affected executive control functions (e.g., WM, interference inhibition), while cathodal left DLPFC tDCS improved inhibitory control. Cognitive flexibility/task switching benefited from combined DLPFC-OFC, but not DLPFC stimulation alone. Conclusion: Task-specific stimulation protocols can improve EFs in ADHD.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Ali Salehinejad
- Institute for Cognitive & Brain Sciences, Shahid Beheshti University, Tehran, Iran.,Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Asal Najian
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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Shafie A, Rahimi AM, Ahmadi I, Nabavizadeh F, Ranjbaran M, Ashabi G. High-protein and low-calorie diets improved the anti-aging Klotho protein in the rats' brain: the toxic role of high-fat diet. Nutr Metab (Lond) 2020; 17:86. [PMID: 33072166 PMCID: PMC7559193 DOI: 10.1186/s12986-020-00508-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the current study, our specific aim was to characterize the Klotho protein and expression levels in the hippocampus and prefrontal cortex of old rats treated with different diets (high-fat, high-protein, low-calorie, high-protein and low-calorie). METHODS Rats were treated with high-fat, high-protein, low-calorie, low-calorie high-protein diets for 10 weeks and then behavioral and molecular assessments were evaluated. RESULTS Statistical analysis showed the percentage of open arm time was increased in the high-protein, low-calorie and low-calorie high-protein groups compared with old control (old-C) rats. The percentage of open arm entries was increased in the low-calorie and low-calorie high-protein group compared with old-C rats. The body weight and serum triglyceride were decreased in the low-calorie and low-calorie high-protein groups in comparison to control old rats. Low-calorie and low-calorie high-protein treatments statistically enhanced caspase-3 level compared with old-C rats in the hippocampus and prefrontal cortex. Treatment of old rats with high-protein, low-calorie and low-calorie high-protein could increase Klotho-α level compared with control old rats. The levels of Klotho-α, c-fos and brain-derived neurotrophic factors were decreased in the low-calorie high-protein group in Klotho inhibitor's presence compared with the low-calorie high-protein group. CONCLUSION According to our findings, Klotho-α level was reduced in old rats. Low-calorie, high-protein and particularly low-calorie high-protein diets increased this protein level and consequently increased neuronal plasticity and improved memory function. GRAPHIC ABSTRACT
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Affiliation(s)
- Anahid Shafie
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, P.O.box: 1417613151, Tehran, Iran
| | - Ahmad Mustafa Rahimi
- Department of Physiology, School of Medicine, Alberoni University, Kohestan, Afghanistan
| | - Iraj Ahmadi
- Department of Physiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatemeh Nabavizadeh
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, P.O.box: 1417613151, Tehran, Iran
| | - Mina Ranjbaran
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, P.O.box: 1417613151, Tehran, Iran
| | - Ghorbangol Ashabi
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, P.O.box: 1417613151, Tehran, Iran
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15
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Fitter NT, Funke R, Pulido JC, Mataric MJ, Smith BA. Toward Predicting Infant Developmental Outcomes From Day-Long Inertial Motion Recordings. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2305-2314. [PMID: 32804651 DOI: 10.1109/tnsre.2020.3016916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As improvements in medicine lower infant mortality rates, more infants with neuromotor challenges survive past birth. The motor, social, and cognitive development of these infants are closely interrelated, and challenges in any of these areas can lead to developmental differences. Thus, analyzing one of these domains - the motion of young infants - can yield insights on developmental progress to help identify individuals who would benefit most from early interventions. In the presented data collection, we gathered day-long inertial motion recordings from N = 12 typically developing (TD) infants and N = 24 infants who were classified as at risk for developmental delays (AR) due to complications at or before birth. As a first research step, we used simple machine learning methods (decision trees, k-nearest neighbors, and support vector machines) to classify infants as TD or AR based on their movement recordings and demographic data. Our next aim was to predict future outcomes for the AR infants using the same simple classifiers trained from the same movement recordings and demographic data. We achieved a 94.4% overall accuracy in classifying infants as TD or AR, and an 89.5% overall accuracy predicting future outcomes for the AR infants. The addition of inertial data was much more important to producing accurate future predictions than identification of current status. This work is an important step toward helping stakeholders to monitor the developmental progress of AR infants and identify infants who may be at the greatest risk for ongoing developmental challenges.
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16
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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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Wu PP, He M, Yang J, Wang D, Shi L, Lin SL. [Current status of neglect among children aged 3-6 years in rural areas of Urumqi, China and risk factors for child neglect]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:1099-1104. [PMID: 31753092 PMCID: PMC7389302 DOI: 10.7499/j.issn.1008-8830.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the current status of neglect in children aged 3-6 years in the rural areas of Urumqi, China and risk factors for neglect. METHODS Stratified random cluster sampling was performed to select 1 326 children, aged 3-6 years, from 6 kindergartens in the rural areas of Urumqi. A self-designed questionnaire and "Chinese Neglect Evaluation Questionnaire for Rural Children Aged 3-6 Years" were used for investigation. RESULTS Of the 1 326 children, the neglect rate was 51.89% (688 cases), and the degree of neglect was 49±6. There were significant differences in the neglect rate and the degree of neglect between the children in different age groups (P<0.01). The single-parent families and the remarried families had significantly higher child neglect rate and degree of neglect than the families of three generations under one roof and the core families (P<0.01). The children in left-behind status had a significantly higher degree of neglect (P<0.01). The multivariate logistic regression analysis showed that younger children, mothers with low education level, employment status of the mother as a migrant worker, single-parent and remarried families, low-income families, and left-behind status were risk factors for child neglect (P<0.05). CONCLUSIONS The neglect of children aged 3-6 years in the rural areas of Urumqi is serious, and more attention should be paid to younger children, children whose mothers with low education level, left-behind children, and children from single-parent families, remarried families and low-income families.
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Affiliation(s)
- Ping-Ping Wu
- School of Nursing, Xinjiang Medical University, Urumqi 830011, China.
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18
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Deng W, Fan C, Fang Y, Zhao Y, Wei Y, Li M, Teng J. Role of XIAP gene overexpressed bone marrow mesenchymal stem cells in the treatment of cerebral injury in rats with cerebral palsy. Cancer Cell Int 2019; 19:273. [PMID: 31660045 PMCID: PMC6806515 DOI: 10.1186/s12935-019-0988-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
Background This study is performed to investigate the effects of adenovirus-mediated X-linked inhibitor of apoptosis protein (XIAP) overexpressed bone marrow mesenchymal stem cells (BMSCs) on brain injury in rats with cerebral palsy (CP). Methods Rat’s BMSCs were cultured and identified. The XIAP gene of BMSCs was modified by adenovirus expression vector Ad-XIAP-GFP. The rat model of CP with ischemia and anoxia was established by ligating the left common carotid artery and anoxia for 2 h, and BMSCs were intracerebroventricularly injected to the modeled rats. The mRNA and protein expression of XIAP in brain tissue of rats in each group was detected by RT-qPCR and western blot analysis. The neurobehavioral situation, content of acetylcholine (Ach), activity of acetylcholinesterase (AchE), brain pathological injury, apoptosis of brain nerve cells and the activation of astrocytes in CP rats were determined via a series of assays. Results Rats with CP exhibited obvious abnormalities, increased Ach content, decreased AchE activity, obvious pathological damage, increased brain nerve cell apoptosis, as well as elevated activation of astrocyte. XIAP overexpressed BMSCs improved the neurobehavioral situation, decreased Ach content and increased AchE activity, attenuated brain pathological injury, inhibited apoptosis of brain nerve cells and the activation of astrocytes in CP rats. Conclusion Our study demonstrates that XIAP overexpressed BMSCs can inhibit the apoptosis of brain nerve cells and the activation of astrocytes, increase AchE activity, and inhibit Ach content, so as to lower the CP caused by cerebral ischemia and hypoxia in rats.
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Affiliation(s)
- Wenjing Deng
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Chenghe Fan
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Yanbo Fang
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Yanan Zhao
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Yamin Wei
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Meng Li
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
| | - Junfang Teng
- The Neurology Intensive Care Unit, The First Affiliated of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052 Henan People's Republic of China
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A cross-sectional survey of clinical factors that influence the use of traditional Korean medicine among children with cerebral palsy. Integr Med Res 2018; 7:333-340. [PMID: 30591887 PMCID: PMC6303530 DOI: 10.1016/j.imr.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/26/2022] Open
Abstract
Background Traditional Korean medicine (TKM) is widely used to treat children with cerebral palsy (CP) in Korea; however, studies investigating factors that influence the use of TKM are scarce. Thus, we investigated the clinical factors that might influence the use of TKM. Methods A population-based, cross-sectional, multicenter survey was performed from August 2014 to May 2016. The history of TKM use, type and severity of CP, current treatment characteristics, presence of accompanying disabilities or other health problems not directly related to CP, and monthly cost for the treatment of CP were surveyed. Results In total, 182 children were recruited, and 78 children (42.9%) had used TKM. Among these 78 children, 50 (64.1% of the TKM-use group) had used both acupuncture and herbal medication, 15 (19.2%) had used acupuncture only, and 13 (16.7%) had used herbal medication only. Children with non-typical CP, accompanying disabilities and general health problems tended to use TKM. The monthly cost of treatment for CP was significantly higher in the TKM-use group than that in the no-TKM-use group, suggesting that economically disadvantaged children may have difficulty in accessing TKM. Dietary supplements, conventional pharmacological treatments, and rehabilitation therapies did not affect TKM use. Conclusion Children with non-typical symptoms or those with poor overall health status are likely to use TKM. Additionally, TKM use leads to increased treatment costs. Studies investigating the motivation for starting or ceasing TKM therapy, socioeconomic factors and the attitude of parents towards complementary and alternative medicine should be performed.
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Scavarda D, Cavalcante T, Trébuchon A, Lépine A, Villeneuve N, Girard N, McGonigal A, Milh M, Bartolomei F. Tailored suprainsular partial hemispherotomy: a new functional disconnection technique for stroke-induced refractory epilepsy. J Neurosurg Pediatr 2018; 22:601-609. [PMID: 30141751 DOI: 10.3171/2018.5.peds17709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/22/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVEHemispherotomy is currently the most frequently performed surgical option for refractory epilepsy associated with large perinatal or childhood ischemic events. Such an approach may lead to good seizure control, but it has inherent functional consequences linked to the disconnection of functional cortices. The authors report on 6 consecutive patients who presented with severe epilepsy associated with hemiplegia due to stroke and who benefitted from a new, stereoelectroencephalography-guided partial disconnection technique.METHODSThe authors developed a new disconnection technique termed "tailored suprainsular partial hemispherotomy" (TSIPH). Disconnection always included premotor and motor cortex with variable anterior and posterior extent.RESULTSAt a mean follow-up of 28 months, there were no deaths and no patient had hydrocephalus. Motor degradation was observed in all patients in the 2 weeks after surgery, but all patients completely recovered. The 6 patients were seizure free (Engel class IA) at the last follow-up. No neuropsychological aggravation was observed.CONCLUSIONSTSIPH appears to be a conservative alternative to classic hemispherotomy, leading to favorable outcome in this series.
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Affiliation(s)
| | | | - Agnès Trébuchon
- 2Institut de Neurosciences des Systèmes, Aix Marseille Université; and
- 3Neurophysiologie Clinique
| | - Anne Lépine
- 4Neurologie Pédiatrique, and
- 5Hôpital Henri Gastaut, Marseille, France
| | | | | | - Aileen McGonigal
- 2Institut de Neurosciences des Systèmes, Aix Marseille Université; and
- 3Neurophysiologie Clinique
| | | | - Fabrice Bartolomei
- 2Institut de Neurosciences des Systèmes, Aix Marseille Université; and
- 3Neurophysiologie Clinique
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21
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Chamudot R, Parush S, Rigbi A, Gross-Tsur V. Brain Lesions as a Predictor of Therapeutic Outcomes of Hand Function in Infants With Unilateral Cerebral Palsy. J Child Neurol 2018; 33:918-924. [PMID: 30307370 DOI: 10.1177/0883073818801632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The present study aimed to investigate whether the response variability of infants to modified constraint-induced movement therapy and bimanual therapy are associated with different types of brain lesions. METHOD Infants with unilateral cerebral palsy (N = 22) ages 8-15 months (mean = 10.95, standard deviation = 2.15 months) were grouped according to having either a periventricular brain lesion or a middle cerebral artery infarct lesion. Improvement in hand function was analyzed based on the mini-Assistive Hand Assessment results. RESULTS Infants with periventricular brain lesion displayed greater positive response to upper limb treatment compared to those with middle cerebral artery infarct ( P = .02). A significant difference in improvement according to type of treatment was found in the middle cerebral artery infarct group but not in the periventricular brain lesion. CONCLUSION The present study showed an association between the type of brain lesion and the efficacy of upper limb treatment in infants. Infants with periventricular brain lesions displayed greater positive responses than those with middle cerebral artery infarct.
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Affiliation(s)
- Rena Chamudot
- 1 School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Shula Parush
- 1 School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Amihai Rigbi
- 2 Research Authority and Faculty of Education, Beit Berl Academic College, Kfar-Sava, Israel
| | - Varda Gross-Tsur
- 3 Neuropediatric Unit, Shaare Zedek Medical Center.,4 The Hebrew University School of Medicine, Jerusalem, Israel
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Hooyman A, Kayekjian D, Xiao R, Jiang C, Vanderbilt DL, Smith BA. Relationships between variance in electroencephalography relative power and developmental status in infants with typical development and at risk for developmental disability: An observational study. Gates Open Res 2018; 2:47. [PMID: 30569037 PMCID: PMC6266744 DOI: 10.12688/gatesopenres.12868.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Electroencephalography (EEG) is a non-invasive tool that has the potential to identify and quantify atypical brain development. We introduce a new measure here, variance of relative power of resting-state EEG. We sought to assess whether variance of relative power of resting-state EEG could predict i) classification of infants as typical development (TD) or at risk (AR) for developmental disability, and ii) Bayley developmental scores at the same visit or future visits. Methods: A total of 22 infants with TD participated, aged between 38 and 203 days. In addition, 11 infants broadly at risk participated (6 high-risk pre-term, 4 low-risk pre-term, 1 high-risk full-term), aged between 40 and 225 days of age (adjusted for prematurity). We used EEG to measure resting-state brain function across months. We calculated variance of relative power as the standard deviation of the relative power across each of the 32 EEG electrodes. The Bayley Scales of Infant Development (3
rd edition) was used to measure developmental level. Infants were measured 1-6 times each, with 1 month between measurements. Results: Our main findings were: i) variance of relative power of resting state EEG can predict classification of infants as TD or AR, and ii) variance of relative power of resting state EEG can predict Bayley developmental scores at the same visit (Bayley raw fine motor, Bayley raw cognitive, Bayley total raw score, Bayley motor composite score) and at a future visit (Bayley raw fine motor). Conclusions: This was a preliminary, exploratory, small study. Our results support variance of relative power of resting state EEG as an area of interest for future study as a biomarker of neurodevelopmental status and as a potential outcome measure for early intervention.
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Affiliation(s)
- Andrew Hooyman
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90089, USA
| | - David Kayekjian
- Infant Neuromotor Control Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ran Xiao
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Crystal Jiang
- Infant Neuromotor Control Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90089, USA
| | - Douglas L Vanderbilt
- Department of Pediatrics, Division of General Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Beth A Smith
- Infant Neuromotor Control Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90089, USA
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Chamudot R, Parush S, Rigbi A, Horovitz R, Gross-Tsur V. Effectiveness of Modified Constraint-Induced Movement Therapy Compared With Bimanual Therapy Home Programs for Infants With Hemiplegia: A Randomized Controlled Trial. Am J Occup Ther 2018; 72:7206205010p1-7206205010p9. [DOI: 10.5014/ajot.2018.025981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity.
METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire.
RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance.
CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.
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Affiliation(s)
- Rena Chamudot
- Rena Chamudot, PhD, OT, is Lecturer, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Occupational Therapy Director, Dvorah Agmon Pre-School Development Center, Jerusalem, Israel. At the time of the study, she was Doctoral Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel;
| | - Shula Parush
- Shula Parush, PhD, OT, is Professor Emeritus, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amihai Rigbi
- Amihai Rigbi, PhD, is Senior Lecturer, Faculty of Education, and Research Authority, Beit Berl Academic College, Kfar-Sava, Israel
| | - Roni Horovitz
- Roni Horovitz, MSc, OTR/L, is OTD Candidate, Boston University, Boston, MA. At the time of the study, she was Graduate Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Varda Gross-Tsur
- Varda Gross-Tsur, PhD, MD, is Professor of Pediatrics, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel, and the Hebrew University of Jerusalem, Jerusalem, Israel
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Hooyman A, Kayekjian D, Xiao R, Jiang C, Vanderbilt DL, Smith BA. Relationships between variance in electroencephalography relative power and developmental status in infants with typical development and at risk for developmental disability: An observational study. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12868.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Electroencephalography (EEG) is a non-invasive tool that has the potential to identify and quantify atypical brain development. We introduce a new measure here, variance of relative power of resting-state EEG. We sought to assess whether variance of relative power of resting-state EEG could predict i) classification of infants as typical development (TD) or at risk (AR) for developmental disability, and ii) Bayley developmental scores at the same visit or future visits. Methods: A total of 22 infants with TD participated, aged between 38 and 203 days. In addition, 11 infants broadly at risk participated (6 high-risk pre-term, 4 low-risk pre-term, 1 high-risk full-term), aged between 40 and 225 days of age (adjusted for prematurity). We used EEG to measure resting-state brain function across months. We calculated variance of relative power as the standard deviation of the relative power across each of the 32 EEG electrodes. The Bayley Scales of Infant Development (3rd edition) was used to measure developmental level. Infants were measured 1-6 times each, with 1 month between measurements. Results: Our main findings were: i) variance of relative power of resting state EEG can predict classification of infants as TD or AR, and ii) variance of relative power of resting state EEG can predict Bayley developmental scores at the same visit (Bayley raw fine motor, Bayley raw cognitive, Bayley total raw score, Bayley motor composite score) and at a future visit (Bayley raw fine motor). Conclusions: This was a preliminary, exploratory, small study. Our results support variance of relative power of resting state EEG as an area of interest for future study as a biomarker of neurodevelopmental status and as a potential outcome measure for early intervention.
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Maternal methamphetamine exposure causes cognitive impairment and alteration of neurodevelopment-related genes in adult offspring mice. Neuropharmacology 2018; 140:25-34. [PMID: 30048643 DOI: 10.1016/j.neuropharm.2018.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/05/2018] [Accepted: 07/22/2018] [Indexed: 12/26/2022]
Abstract
Prenatal drug exposure altered cognitive function in individuals, and may also impact their offspring's susceptibility to cognitive impairment. The high incidence of methamphetamine (METH) abuse among adolescents and women of childbearing age elevates the importance to determine the influence of maternal METH exposure on cognitive functions in the descendants. We hypothesized that maternal METH exposure affects cognitive behavior in offspring mice by disrupting gene expression associated with neural development. Here, female C57BL/6 mice were exposed to intermittent escalating doses of METH or saline from adolescence to adulthood, and then continued through pregnancy. Interestingly, male but not female offspring exhibited impaired short-term recognition memory and long-term spatial memory retention in novel object recognition and Morris water maze test respectively. Additionally, maternal METH exposure altered neurodevelopmental genes in both male and female offspring, and 12 differentially expressed genes between male and female were observed in the HPC and NAc regions. These differentially expressed genes are involved in neurogenesis, axon guidance, neuron migration and synapse of neural development circuits. Our observations suggest that maternal METH exposure induced differential expression patterns of neurodevelopment-related genes in the HPC and NAc of male and female mice, which may underlie the different cognitive behavior phenotypes in both genders.
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Wu J, Li J, Li Y, Loo KK, Yang H, Wang Q, Duan R, Xiao X, Song X, Yang S, Sun L. Neurodevelopmental outcomes in young children born to HIV-positive mothers in rural Yunnan, China. Pediatr Int 2018; 60:618-625. [PMID: 29663621 DOI: 10.1111/ped.13584] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/07/2017] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Children born to HIV-infected mothers are at risk for neurodevelopmental delay. Little is known about the neurodevelopmental outcomes of infants and toddlers born to HIV-positive mothers but who were not themselves infected by HIV, especially in poor rural areas. This study was conducted to compare developmental outcomes between young children who were HIV exposed but uninfected (HEU), and their HIV unexposed and uninfected (HUU) peers in rural Yunnan, China. METHODS A total of 250 HEU children aged 6-36 months and 250 HUU children matched for age, gender and residency were recruited from rural Yunnan, China. Neurodevelopmental outcomes were measured using Bayley Scales of Infant and Toddler Development-Third Edition (Bayley III). Multivariate analysis was performed to adjust for potential confounding effects of caregiver demographic data, maternal health status, birth outcome and children's health status. RESULTS HIV exposed but uninfected children had significantly lower composite scores in Bayley III assessment than HUU children (in the cognitive domain: 90.34 vs 92.75, P<0.05; in the adaptive behavior domain: 77.04 vs 80.80, P< 0.05). On stepwise logistic regression analysis, HIV exposure (OR, 1.45; 95%CI: 1.04-1.98) and child malnutrition (OR, 1.67; 95%CI: 1.09-2.23) were risk factors for below-average cognition development. Mother's low education and child anemia were significant risk factors for below-average motor and adaptive behavior development. CONCLUSION Perinatal HIV infection may have a negative impact on neurodevelopment in young children. Other factors such as mother's education and child nutrition status may play important roles in child neurodevelopment, especially in resource-poor areas. Further studies are needed to examine the long-term effect of perinatal HIV infection on later childhood neurodevelopment.
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Affiliation(s)
- Jie Wu
- Department of Pediatrics, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Li
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Yan Li
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Kek Khee Loo
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Haixia Yang
- Department of Health Care, Kunming Maternal and Child Health Hospital, Kunming, China
| | - Qiong Wang
- Department of Health Care, Kunming Maternal and Child Health Hospital, Kunming, China
| | - Rufei Duan
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Xia Xiao
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Xiaoxiao Song
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Siwei Yang
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
| | - Lin Sun
- Department of Women and Child Health, School of Public Health, Kunming Medical University, Kunming, China
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Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy. Gait Posture 2018; 60:55-60. [PMID: 29156378 DOI: 10.1016/j.gaitpost.2017.11.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 04/12/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
Due to the intensity and repetition of movement, roboticassisted gait training therapy could have a beneficial effect on the recovery and improvement of postural and locomotor functions of the patient. This study sought to highlight the effects of robotic-assisted gait rehabilitation in gait of children with Cerebral Palsy (CP). We analyzed the different strategies before and after this rehabilitation which was used in order to generate forward motion while maintaining balance. Data were collected by a motion analysis system (Vicon® - Oxford Metrics, Oxford, UK). The children were divided into two groups in such a way as to obtain a randomized controlled population: i) a group of fourteen children (Treated Group) underwent 20 sessions of roboticassisted gait training therapy using the driven gait orthosis Lokomat®Pediatric (Hocoma AG, Volketswil, Switzerland) compared to ii) a group of sixteen children without sessions of Lokomat®Pediatric (Control Group). Significant differences are observed for the TG between the preand post-test values of the locomotor parameters and of the kinetic data of the propulsive forces of the Center of Mass (COM) and of the Center of Pressure (COP) dynamic trajectory. This first study, although performed on a limited number of patients, shows the usefulness of this robotic gait rehabilitation mainly in the balance control in gait. Indeed after this rehabilitation, these children improve their gait that is especially characterized by a more appropriate time lag between the time instant of COM-COP trajectory divergence and the time instant when the forward propulsive forces became apparent.
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Affiliation(s)
- L Wallard
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.
| | - G Dietrich
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - Y Kerlirzin
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - J Bredin
- Centre de Santé-Institut Rossetti-PEP06, Unité Clinique d'Analyse du Mouvement, 400, Boulevard de la Madeleine, 06000 Nice, France; Université Côte d'Azur, LAMHESS, France
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Lucas JE, Richter LM, Daelmans B. Care for Child Development: an intervention in support of responsive caregiving and early child development. Child Care Health Dev 2018; 44:41-49. [PMID: 29235167 DOI: 10.1111/cch.12544] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children. METHODS In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities. RESULTS The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services. CONCLUSIONS Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children.
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Affiliation(s)
| | - L M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - B Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Dirani J, Raad H, Akoury-Dirani L. SAFE START: AN EARLY CHILDHOOD MENTAL HEALTH PROGRAM IN A TERTIARY HEALTHCARE SETTING-A CRITICAL REVIEW. Infant Ment Health J 2017; 39:85-91. [PMID: 29266511 DOI: 10.1002/imhj.21684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Early childhood mental health programs are vital for the current and future mental health and brain development of infants, toddlers, and preschoolers. Founded in 2014, Safe Start is the only early childhood mental health program in Beirut, Lebanon. It aims at being the prototype of such services at the national level. A retrospective analysis of the outcomes of the first year of operations has resulted in important findings about the age of the participants, their diagnoses, previous therapies that the participants have undergone, types of referrals recommended, and the number of participants who were lost to follow-up. This first analysis pointed at the need for more in-depth research to encompass the gaps and benefits of such services. It shows the pivotal importance of designing awareness strategies about the importance of early childhood mental health services and care; to move from a diagnostic seeking behavior to commitment to psychotherapy and follow-up interventions.
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Devakumar D, Bamford A, Ferreira MU, Broad J, Rosch RE, Groce N, Breuer J, Cardoso MA, Copp AJ, Alexandre P, Rodrigues LC, Abubakar I. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. THE LANCET. INFECTIOUS DISEASES 2017; 18:e1-e13. [PMID: 28844634 DOI: 10.1016/s1473-3099(17)30398-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/02/2017] [Accepted: 06/15/2017] [Indexed: 01/08/2023]
Abstract
Microcephaly is an important sign of neurological malformation and a predictor of future disability. The 2015-16 outbreak of Zika virus and congenital Zika infection brought the world's attention to links between Zika infection and microcephaly. However, Zika virus is only one of the infectious causes of microcephaly and, although the contexts in which they occur vary greatly, all are of concern. In this Review, we summarise important aspects of major congenital infections that can cause microcephaly, and describe the epidemiology, transmission, clinical features, pathogenesis, management, and long-term consequences of these infections. We include infections that cause substantial impairment: cytomegalovirus, herpes simplex virus, rubella virus, Toxoplasma gondii, and Zika virus. We highlight potential issues with classification of microcephaly and show how some infants affected by congenital infection might be missed or incorrectly diagnosed. Although Zika virus has brought the attention of the world to the problem of microcephaly, prevention of all infectious causes of microcephaly and appropriately managing its consequences remain important global public health priorities.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Alasdair Bamford
- Infectious Diseases Department, Great Ormond Street Hospital, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Marcelo U Ferreira
- Department of Parasitology, Institute for Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jonathan Broad
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Richard E Rosch
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Nora Groce
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Marly A Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Andrew J Copp
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paula Alexandre
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Robotic-assisted gait training improves walking abilities in diplegic children with cerebral palsy. Eur J Paediatr Neurol 2017; 21:557-564. [PMID: 28188024 DOI: 10.1016/j.ejpn.2017.01.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/11/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
The robotic-assisted gait training therapy (RAGT), based on intensity and repetition of movement, presents beneficial effects on recovery and improvement of postural and locomotor functions of the patient. This study sought to highlight the effect of this RAGT on the dynamic equilibrium control during walking in children with Cerebral Palsy (CP) by analyzing the different postural strategies of the fullbody (upper/lower body) before and after this RAGT in order to generate forward motion while maintaining balance. Data were collected by a motion analysis system (Vicon® - Oxford Metrics). Thirty children with bilateral spastic CP were evaluated using a full-body marker set which allows assessing both the lower and upper limb kinematics. The children were divided into two groups in such a way as to obtain a randomized controlled population: i) a group of fourteen children (Treated Group) underwent 20 sessions of RAGT using the driven gait orthosis Lokomat®Pediatric (Hocoma) compared to ii) a group of sixteen children without sessions of Lokomat®Pediatric (Control Group) receiving only daily physiotherapy. Significant improvements are observed between the TG pre- and post-test values of i) the kinematic data of the full-body in the sagittal and frontal planes and ii) the Gross Motor Function Measure test (D and E). This study shows the usefulness of this RAGT mainly in the balance control in gait. Indeed, the Treated Group use new dynamic strategies of gait that are especially characterized by a more appropriate control of the upper body associated with an improvement of the lower limbs kinematics.
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Affiliation(s)
- L Wallard
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.
| | - G Dietrich
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - Y Kerlirzin
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - J Bredin
- Centre de Santé - Institut Rossetti-PEP06, Unité Clinique d'Analyse du Mouvement, 400, Boulevard de la Madeleine, 06000 Nice, France; Université Côte d'Azur, LAMHESS, France
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Liu X, Fu X, Dai G, Wang X, Zhang Z, Cheng H, Zheng P, An Y. Comparative analysis of curative effect of bone marrow mesenchymal stem cell and bone marrow mononuclear cell transplantation for spastic cerebral palsy. J Transl Med 2017; 15:48. [PMID: 28235424 PMCID: PMC5324263 DOI: 10.1186/s12967-017-1149-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
Abstract
Background Bone marrow mesenchymal stem cells (BMMSCs) and bone marrow mononuclear cells (BMMNCs) are both used to treat spastic cerebral palsy. However, the differences in therapeutic effect remain unknown. Methods A total of 105 patients with spastic cerebral palsy were enrolled and randomly assigned to three groups: the BMMSC group, the BMMNC group and the control group. Patients in both transplantation groups received four intrathecal cell injections. Patients in the control group received Bobath therapy. The gross motor function measure (GMFM) and the fine motor function measure (FMFM) were used to evaluate the therapeutic efficacy before transplantation and 3, 6, and 12 months after transplantation. Results Three months after cell transplantation, scores in the A dimension of GMFM and the A and C dimensions of FMFM scores in the BMMSC group are all higher than those of the BMMNC and the control groups (P < 0.05). Six months after cell transplantation, scores in the A, B dimensions of GMFM and the A, B, C, D, and E dimensions of FMFM scores in the BMMSC group are higher than those of the BMMNC and the control groups (P < 0.05). Twelve months after cell transplantation, scores in the A, B, and C dimensions of GMFM and the A, B, C, D, and E dimensions of FMFM scores in the BMMSC group are all higher than those of the BMMNC and the control groups (P < 0.05). No obvious adverse effects were investigated during follow-up. Conclusions BMMSC transplantation for the treatment of cerebral palsy is safe and feasible, and can improve gross motor and fine motor function significantly. In addition, compared with BMMNC, the motor function of children improved significantly in terms of gross motor and fine motor functions. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1149-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuebin Liu
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Xiaojun Fu
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Guanghui Dai
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Xiaodong Wang
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Zan Zhang
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Hongbin Cheng
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Pei Zheng
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Yihua An
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China.
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Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study. Neural Plast 2017; 2016:4323792. [PMID: 28090357 PMCID: PMC5206446 DOI: 10.1155/2016/4323792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/16/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022] Open
Abstract
Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years' corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months' corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant's developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps.
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Wilcox BJ, Wilkins MM, Basseches B, Schwartz JB, Kerman K, Trask C, Brideau H, Crisco JJ. Joint-Specific Play Controller for Upper Extremity Therapy: Feasibility Study in Children With Wrist Impairment. Phys Ther 2016; 96:1773-1781. [PMID: 27197824 PMCID: PMC5088224 DOI: 10.2522/ptj.20150493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Challenges with any therapeutic program for children include the level of the child's engagement or adherence. Capitalizing on one of the primary learning avenues of children, play, the approach described in this article is to develop therapeutic toy and game controllers that require specific and repetitive joint movements to trigger toy/game activation. OBJECTIVE The goal of this study was to evaluate a specially designed wrist flexion and extension play controller in a cohort of children with upper extremity motor impairments (UEMIs). The aim was to understand the relationship among controller play activity, measures of wrist and forearm range of motion (ROM) and spasticity, and ratings of fun and difficulty. DESIGN This was a cross-sectional study of 21 children (12 male, 9 female; 4-12 years of age) with UEMIs. METHODS All children participated in a structured in-clinic play session during which measurements of spasticity and ROM were collected. The children were fitted with the controller and played with 2 toys and 2 computer games for 5 minutes each. Wrist flexion and extension motion during play was recorded and analyzed. In addition, children rated the fun and difficulty of play. RESULTS Flexion and extension goal movements were repeatedly achieved by children during the play session at an average frequency of 0.27 Hz. At this frequency, 15 minutes of play per day would result in approximately 1,700 targeted joint motions per week. Play activity was associated with ROM measures, specifically supination, but toy perception ratings of enjoyment and difficulty were not correlated with clinical measures. LIMITATIONS The reported results may not be representative of children with more severe UEMIs. CONCLUSIONS These outcomes indicate that the therapeutic controllers elicited repetitive goal movements and were adaptable, enjoyable, and challenging for children of varying ages and UEMIs.
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Affiliation(s)
- Bethany J Wilcox
- B.J. Wilcox, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 1 Hoppin St, CORO West, Ste 404, Providence, RI 02903 (USA).
| | - Megan M Wilkins
- M.M. Wilkins, PT, DPT, Meeting Street, Providence, Rhode Island
| | - Benjamin Basseches
- B. Basseches, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Joel B Schwartz
- J.B. Schwartz, BS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Karen Kerman
- K. Kerman, MD, Department of Pediatrics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Christine Trask
- C. Trask, PhD, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, and Department of Psychiatry, Rhode Island Hospital
| | - Holly Brideau
- H. Brideau, MS, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
| | - Joseph J Crisco
- J.J. Crisco, PhD, Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital
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Hartinger SM, Lanata CF, Hattendorf J, Wolf J, Gil AI, Obando MO, Noblega M, Verastegui H, Mäusezahl D. Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal control design. J Epidemiol Community Health 2016; 71:217-224. [PMID: 27612978 PMCID: PMC5318653 DOI: 10.1136/jech-2015-206536] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/07/2022]
Abstract
Objective Stimulation in early childhood can alleviate adverse effects of poverty. In a community-randomised trial, we implemented 2 home-based interventions, each serving as an attention control for the other. One group received an integrated household intervention package (IHIP), whereas the other group received an early child development (ECD) intervention. The primary objective of the study was to evaluate the effect of IHIP on diarrhoea and respiratory infections, the details of which are described elsewhere. Here, we present the impact of the ECD intervention on early childhood development indicators. Methods In this non-blinded community-randomised trial, an ECD intervention, adapted from the Peruvian government's National Wawa Wasi ECD programme, was implemented in 25 rural Peruvian Andean communities. We enrolled 534 children aged 6–35 months, from 50 communities randomised 1:1 into ECD and IHIP communities. In ECD communities, trained fieldworkers instructed mothers every 3 weeks over the 12 months study, to stimulate and interact with their children and to use standard programme toys. IHIP communities received an improved stove and hygiene promotion. Using a nationally validated ECD evaluation instrument, all children were assessed at baseline and 12 months later for overall performance on age-specific developmental milestones which fall into 7 developmental domains. Findings At baseline, ECD-group and IHIP-group children performed similarly in all domains. After 12 months, data from 258 ECD-group and 251 IHIP-group children could be analysed. The proportion of children scoring above the mean in their specific age group was significantly higher in the ECD group in all domains (range: 12–23%-points higher than IHIP group). We observed the biggest difference in fine motor skills (62% vs 39% scores above the mean, OR: 2.6, 95% CI 1.7 to 3.9). Conclusions The home-based ECD intervention effectively improved child development overall across domains and separately by investigated domain. Home-based strategies could be a promising component of poverty alleviation programmes seeking to improve developmental outcomes among rural Peruvian children. Trial registration number ISRCTN28191222; results.
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Affiliation(s)
- Stella Maria Hartinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Instituto de Investigación Nutricional, Lima, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennyfer Wolf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | | | - Hector Verastegui
- Instituto de Investigación Nutricional, Lima, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Neuroplasticity: Insights from Patients Harboring Gliomas. Neural Plast 2016; 2016:2365063. [PMID: 27478645 PMCID: PMC4949342 DOI: 10.1155/2016/2365063] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/08/2016] [Indexed: 12/16/2022] Open
Abstract
Neuroplasticity is the ability of the brain to reorganize itself during normal development and in response to illness. Recent advances in neuroimaging and direct cortical stimulation in human subjects have given neuroscientists a window into the timing and functional anatomy of brain networks underlying this dynamic process. This review will discuss the current knowledge about the mechanisms underlying neuroplasticity, with a particular emphasis on reorganization following CNS pathology. First, traditional mechanisms of neuroplasticity, most relevant to learning and memory, will be addressed, followed by a review of adaptive mechanisms in response to pathology, particularly the recruitment of perilesional cortical regions and unmasking of latent connections. Next, we discuss the utility and limitations of various investigative techniques, such as direct electrocortical stimulation (DES), functional magnetic resonance imaging (fMRI), corticocortical evoked potential (CCEP), and diffusion tensor imaging (DTI). Finally, the clinical utility of these results will be highlighted as well as possible future studies aimed at better understanding of the plastic potential of the brain with the ultimate goal of improving quality of life for patients with neurologic injury.
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Schuch CP, Jeffers MS, Antonescu S, Nguemeni C, Gomez-Smith M, Pereira LO, Morshead CM, Corbett D. Enriched rehabilitation promotes motor recovery in rats exposed to neonatal hypoxia-ischemia. Behav Brain Res 2016; 304:42-50. [PMID: 26876139 DOI: 10.1016/j.bbr.2016.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 01/21/2023]
Abstract
Despite continuous improvement in neonatology there is no clinically effective treatment for perinatal hypoxia ischemia (HI). Therefore, development of a new therapeutic intervention to minimize the resulting neurological consequences is urgently needed. The immature brain is highly responsive to environmental stimuli, such as environmental enrichment but a more effective paradigm is enriched rehabilitation (ER), which combines environmental enrichment with daily reach training. Another neurorestorative strategy to promote tissue repair and functional recovery is cyclosporine A (CsA). However, potential benefits of CsA after neonatal HI have yet to be investigated. The aim of this study was to investigate the effects of a combinational therapy of CsA and ER in attempts to promote cognitive and motor recovery in a rat model of perinatal hypoxic-ischemic injury. Seven-day old rats were submitted to the HI procedure and divided into 4 groups: CsA+Rehabilitation; CsA+NoRehabilitation; Vehicle+Rehabilitation; Vehicle+NoRehabilitation. Behavioural parameters were evaluated pre (experiment 1) and post 4 weeks of combinational therapy (experiment 2). Results of experiment 1 demonstrated reduced open field activity of HI animals and increased foot faults relative to shams in the ladder rung walking test. In experiment 2, we showed that ER facilitated acquisition of a staircase skilled-reaching task, increased number of zone crosses in open-field exploration and enhanced coordinated limb use during locomotion on the ladder rung task. There were no evident deficits in novel object recognition testing. Delayed administration of CsA, had no effect on functional recovery after neonatal HI. There was a significant reduction of cortical and hemispherical volume and hippocampal area, ipsilateral to arterial occlusion in HI animals; combinational therapy had no effect on these morphological measurements. In conclusion, the present study demonstrated that ER, but not CsA was the main contributor to enhanced recovery of motor ability after neonatal HI.
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Affiliation(s)
- Clarissa Pedrini Schuch
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Matthew Strider Jeffers
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Sabina Antonescu
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Carine Nguemeni
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Mariana Gomez-Smith
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | | | - Cindi M Morshead
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Dale Corbett
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Faculty of Medicine, Memorial University, St. John's, NL, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.
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Early environmental enrichment affects neurobehavioral development and prevents brain damage in rats submitted to neonatal hypoxia-ischemia. Neurosci Lett 2016; 617:101-7. [PMID: 26872850 DOI: 10.1016/j.neulet.2016.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/06/2016] [Accepted: 02/06/2016] [Indexed: 12/13/2022]
Abstract
Our previous results demonstrated improved cognition in adolescent rats housed in environmental enrichment (EE) that underwent neonatal hypoxia-ischemia (HI). The aim of this study was to investigate the effects of early EE on neurobehavioral development and brain damage in rats submitted to neonatal HI. Wistar rats were submitted to the HI procedure on the 7th postnatal day (PND) and housed in an enriched environment (8th-20th PND). The maturation of physical characteristics and the neurological reflexes were evaluated and the volume of striatum, corpus callosum and neocortex was measured. Data analysis demonstrated a clear effect of EE on neurobehavioral development; also, daily performance was improved in enriched rats on righting, negative geotaxis and cliff aversion reflex. HI caused a transient motor deficit on gait latency. Brain atrophy was found in HI animals and this damage was partially prevented by the EE. In conclusion, early EE stimulated neurobehavioral development in neonate rats and also protects the neocortex and the corpus callosum from atrophy following HI. These findings reinforce the potential of EE as a strategy for rehabilitation following neonatal HI and provide scientific support to the use of this therapeutic strategy in the treatment of neonatal brain injuries in humans.
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Early prediction of the neurological result at 12 months in newborns at neurological risk. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Altered contralateral sensorimotor system organization after experimental hemispherectomy: a structural and functional connectivity study. J Cereb Blood Flow Metab 2015; 35:1358-67. [PMID: 25966942 PMCID: PMC4527994 DOI: 10.1038/jcbfm.2015.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/10/2015] [Indexed: 12/18/2022]
Abstract
Hemispherectomy is often followed by remarkable recovery of cognitive and motor functions. This reflects plastic capacities of the remaining hemisphere, involving large-scale structural and functional adaptations. Better understanding of these adaptations may (1) provide new insights in the neuronal configuration and rewiring that underlies sensorimotor outcome restoration, and (2) guide development of rehabilitation strategies to enhance recovery after hemispheric lesioning. We assessed brain structure and function in a hemispherectomy model. With MRI we mapped changes in white matter structural integrity and gray matter functional connectivity in eight hemispherectomized rats, compared with 12 controls. Behavioral testing involved sensorimotor performance scoring. Diffusion tensor imaging and resting-state functional magnetic resonance imaging were acquired 7 and 49 days post surgery. Hemispherectomy caused significant sensorimotor deficits that largely recovered within 2 weeks. During the recovery period, fractional anisotropy was maintained and white matter volume and axial diffusivity increased in the contralateral cerebral peduncle, suggestive of preserved or improved white matter integrity despite overall reduced white matter volume. This was accompanied by functional adaptations in the contralateral sensorimotor network. The observed white matter modifications and reorganization of functional network regions may provide handles for rehabilitation strategies improving functional recovery following large lesions.
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Kim DA, Hong HS, Lee HY, Lee HS, Kang MS. Age specificity in general and rehabilitation medical services in children with cerebral palsy. Ann Rehabil Med 2014; 38:784-90. [PMID: 25566477 PMCID: PMC4280374 DOI: 10.5535/arm.2014.38.6.784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/23/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To review the medical utilization in children with cerebral palsy according to age and discern particularities Methods From January 2007 to December 2007, 10,659 children and adolescents between 1 and 18 years of age who had filed national insurance claims for a diagnosis of cerebral palsy were selected. Age was chosen as an independent variable, and the population was categorized into specific age groups to verify any differences in medical service utilization. Admission duration to rehabilitation, number of visits to rehabilitation outpatient clinics, numbers of admission dates and outpatient clinic visits for general medical services, number of rehabilitation utilizations, and type of rehabilitations treatment were selected as dependent variables. One-way ANOVA was used for statistical evaluation, and analysis was done with SAS software. Results In general medical use, adolescences diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for general medical services was highest for infants (p<0.001). In rehabilitation treatment, infants diagnosed with cerebral palsy had the highest mean admission duration (p<0.001). The mean visit day to outpatient clinics for rehabilitation treatment was highest for infants (p<0.001). Conclusion Significant differences in use of general and rehabilitation medical services among pediatric age groups with cerebral palsy were evident. This implies that particular attention is necessary when setting up a national medical care policy for patient with cerebral palsy.
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Affiliation(s)
- Dong-A Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyun-Sook Hong
- National Rehabilitation Research Institute, Seoul, Korea
| | - Hee-Yeon Lee
- National Rehabilitation Research Institute, Seoul, Korea
| | - Hye-Sun Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Min-Sung Kang
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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Herbón F, Garibotti G, Moguilevsky J. [Early prediction of the neurological result at 12 months in newborns at neurological risk]. An Pediatr (Barc) 2014; 83:123-9. [PMID: 25455915 DOI: 10.1016/j.anpedi.2014.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/05/2014] [Accepted: 10/09/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the Amiel-Tison neurological examination (AT) and cranial ultrasound at term for predicting the neurological result at 12 months in newborns with neurological risk. PATIENTS AND METHODS The study included 89 newborns with high risk of neurological damage, who were discharged from the Neonatal Intensive Care of the Hospital Zonal Bariloche, Argentina. The assessment consisted of a neurological examination and cranial ultrasound at term, and neurological examination and evaluation of development at 12 months. The sensitivity, specificity, positive and negative predictor value was calculated. The relationship between perinatal factors and neurodevelopment at 12 month of age was also calculated using logistic regression models. RESULTS Seventy children completed the follow-up. At 12 months of age, 14% had an abnormal neurological examination, and 17% abnormal development. The neurological examination and the cranial ultrasound at term had low sensitivity to predict abnormal neurodevelopment. At 12 months, 93% of newborns with normal AT showed normal neurological results, and 86% normal development. Among newborns with normal cranial ultrasound the percentages were 90 and 81%, respectively. Among children with three or more perinatal risk factors, the frequency of abnormalities in the neurological response was 5.4 times higher than among those with fewer risk factors, and abnormal development was 3.5 times more frequent. CONCLUSIONS The neurological examination and cranial ultrasound at term had low sensitivity but high negative predictive value for the neurodevelopment at 12 months. Three or more perinatal risk factors were associated with neurodevelopment abnormalities at 12 months of age.
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Affiliation(s)
- F Herbón
- Servicio de Neonatología, Hospital Zonal Bariloche, Bariloche, Argentina.
| | - G Garibotti
- Centro Regional Universitario Bariloche, Universidad Nacional del Comahue, Bariloche, Argentina
| | - J Moguilevsky
- Servicio de Imágenes, Hospital Zonal Bariloche, Bariloche, Argentina
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Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. GAME (Goals - Activity - Motor Enrichment): protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy. BMC Neurol 2014; 14:203. [PMID: 25287779 PMCID: PMC4194357 DOI: 10.1186/s12883-014-0203-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common physical disability of childhood and early detection is possible using evidence based assessments. Systematic reviews indicate early intervention trials rarely demonstrate efficacy for improving motor outcomes but environmental enrichment interventions appear promising. This study is built on a previous pilot study and has been designed to assess the effectiveness of a goal - oriented motor training and enrichment intervention programme, "GAME", on the motor outcomes of infants at very high risk of cerebral palsy (CP) compared with standard community based care. METHODS/DESIGN A two group, single blind randomised controlled trial (n = 30) will be conducted. Eligible infants are those diagnosed with CP or designated "at high risk of CP" on the basis of the General Movements Assessment and/or abnormal neuroimaging. A physiotherapist and occupational therapist will deliver home-based GAME intervention at least fortnightly until the infant's first birthday. The intervention aims to optimize motor function and engage parents in developmental activities aimed at enriching the home learning environment. Primary endpoint measures will be taken 16 weeks after intervention commences with the secondary endpoint at 12 months and 24 months corrected age. The primary outcome measure will be the Peabody Developmental Motor Scale second edition. Secondary outcomes measures include the Gross Motor Function Measure, Bayley Scales of Infant and Toddler Development, Affordances in the Home Environment for Motor Development - Infant Scale, and the Canadian Occupational Performance Measure. Parent well-being will be monitored using the Depression Anxiety and Stress Scale. DISCUSSION This paper presents the background, design and intervention protocol of a randomised trial of a goal driven, motor learning approach with customised environmental interventions and parental education for young infants at high risk of cerebral palsy. TRIAL REGISTRATION This trial is registered on the Australian New Zealand Clinical Trial register: ACTRN12611000572965.
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Affiliation(s)
- Catherine Morgan
- />School of Medicine, University Of Notre Dame Australia, PO Box 6427, Frenchs Forest, NSW 2086 Australia
- />Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, PO Box 6427, Frenchs Forest, NSW 2086 Australia
| | - Iona Novak
- />School of Medicine, University Of Notre Dame Australia, PO Box 6427, Frenchs Forest, NSW 2086 Australia
- />Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, PO Box 6427, Frenchs Forest, NSW 2086 Australia
| | - Russell C Dale
- />Department of Neurology, Children’s Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Andrea Guzzetta
- />Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Tuscany Italy
| | - Nadia Badawi
- />Grace Centre for Newborn Care, Children’s Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW 2145 Australia
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Abstract
SUMMARYRobotics Agent Coacher for Cerebral Palsy motor Function (RAC CP Fun) is an attempt to implement socially assistive robotics, and a motor learning approach in rehabilitating movement disorders with a central origin. The concept and architecture of RAC CP Fun implements the motor learning theory and behavioral approach, i.e. principles of repetition, stages of learning, appropriate feedback, random practice, and enriched environments. Eleven children with cerebral palsy (CP) and fourteen typically developed (TD) children participated in two procedures while interacting with a robot and performing motor exercises. The interaction level and motor performance of children were measured and compared. Children with CP exhibited a higher interaction level; however, their motor performance was lower than that of TD children. RAC CP Fun was found to be feasible to interact with children of pre-school age, to augment the motivation of the children with CP, and to involve the children in motor exercises.
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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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From R, Eilam R, Bar-Lev DD, Levin-Zaidman S, Tsoory M, LoPresti P, Sela M, Arnon R, Aharoni R. Oligodendrogenesis and myelinogenesis during postnatal development effect of glatiramer acetate. Glia 2014; 62:649-65. [PMID: 24481644 DOI: 10.1002/glia.22632] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/29/2013] [Accepted: 01/06/2014] [Indexed: 01/28/2023]
Abstract
Myelinogenesis in the mammal nervous system occurs predominantly postnatally. Glatiramer acetate (GA), a drug for the treatment for multiple sclerosis (MS), has been shown to induce immunomodulation and neuroprotection in the inflamed CNS in MS and in experimental autoimmune encephalomyelitis (EAE). Here we investigated whether GA can affect myelinogenesis and oligodendrogenesis in the developing nervous system under nonpathological conditions. Towards this end we studied myelination in mice injected daily by GA, at postnatal Days 7-21. Immunohistological and ultrastructural analyses revealed significant elevation in the number of myelinated axons as well as in the thickness of the myelin encircling them and their resulting g-ratios, in spinal cords of GA-injected mice compared with their PBS-injected littermates, at postnatal Day 14. Elevation in myelinated axons was detected also in the peripheral ventral roots of the motor nerves. GA induced also an increase in axonal diameter, implying an effect on the overall development of the nervous system. A prominent elevation in the amount of progenitor oligodendrocytes and their BrdU incorporation, as well as in mature oligodendrocytes indicated that the effect of GA is linked to increased proliferation and differentiation along the oligodendroglial maturation cascade. In addition, elevation in insulin-like growth factor (IGF-1) and brain-derived neurotrophic factor (BDNF) was found in the white matter of the GA-injected mice. Furthermore, a functional advantage in rotating rod test was exhibited by GA-injected mice over their littermates at postnatal Day 21. These cumulative findings corroborate the beneficial effect of GA on oligodendrogenesis and myelination.
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Affiliation(s)
- Renana From
- Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel, 76100
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Chernykh ER, Kafanova MY, Shevela EY, Sirota SI, Adonina EI, Sakhno LV, Ostanin AA, Kozlov VV. Clinical Experience with Autologous M2 Macrophages in Children with Severe Cerebral Palsy. Cell Transplant 2014; 23 Suppl 1:S97-104. [DOI: 10.3727/096368914x684925] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Stem cell-based therapy is considered to be a new approach for the treatment of cerebral palsy (CP). Given the potent anti-inflammatory activity and high regenerative potential of M2 macrophages, these cells may be an alternative source for cell transplantation. To evaluate the safety and efficacy of autologous M2 macrophages, we conducted a pilot clinical trial in 21 children with severe CP. The primary outcome measure was safety, which included assessment of mortality of any cause, immediate adverse reactions, and serious adverse effects and comorbidities during 5-year follow-up. The secondary outcome measure was functional improvement in Gross Motor Function Measure (66-item GMFM) test, Peabody Developmental Motor Scale-Fine Motor (PDMS-FM) test, Ashworth scale, MRC scale, and an easy-to-understand questionnaire for evaluation of cognitive functions in our modification. Intradural injection of M2 cells (in mean dose of 0.8 × 106/kg) into the lumbar spinal area did not induce any serious adverse events. No cases of mortality, psychomotor worsening, exacerbation of seizures, and long-term comorbidities, including tumors, were observed during a 5-year follow-up. After 3 months, GMFM score increased from 13.7 ± 7.8 to 58.6 ± 14.6, PDMS-FM score improved from 0.76 ± 0.42 to 5.05 ± 0.97, and the Ashworth score decreased from 3.8 ± 0.21 to 3.3 ± 0.24. Along with gross and fine motor function enhancement, an improvement of cognitive activity (from 1.62 ± 0.41 to 4.05 ± 0.64, according to questionnaire assessment) and reduction of seizure syndrome were registered as well. The neurological improvements did not diminish during the 5-year follow-up period. The data obtained suggest that cell therapy based on M2 macrophages is safe, does not induce early adverse effects and long-term comorbidities, and is accompanied with a significant improvement of motor and cognitive activities in severe CP patients. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.
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Affiliation(s)
- Elena R. Chernykh
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Marina Yu. Kafanova
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Ekaterina Ya. Shevela
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Sergei I. Sirota
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Elena I. Adonina
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Lyudmila V. Sakhno
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Alexander A. Ostanin
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
| | - Vladimir V. Kozlov
- Laboratory of Cellular Immunotherapy, Institute of Clinical Immunology of Russian Academy on Medical Sciences, Siberian Branch, Novosibirsk, Russia
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GILLICK BERNADETTET, KRACH LINDAE, FEYMA TIM, RICH TONYAL, MOBERG KELLI, THOMAS WILLIAM, CASSIDY JESSICAM, MENK JEREMIAH, CAREY JAMESR. Primed low-frequency repetitive transcranial magnetic stimulation and constraint-induced movement therapy in pediatric hemiparesis: a randomized controlled trial. Dev Med Child Neurol 2014; 56:44-52. [PMID: 23962321 PMCID: PMC3864983 DOI: 10.1111/dmcn.12243] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the feasibility and efficacy of five treatments of 6 Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) combined with constraint-induced movement therapy (CIMT) to promote recovery of the paretic hand in children with congenital hemiparesis. METHOD Nineteen children with congenital hemiparesis aged between 8 and 17 years (10 males, nine females; mean age 10 years 10 months, SD 2 years 10 months; Manual Ability Classification Scale levels I-III) underwent five sessions of either real rTMS (n=10) or sham rTMS (n=9) alternated daily with CIMT. CIMT consisted of 13 days of continuous long-arm casting with five skin-check sessions. Each child received a total of 10 hours of one-to-one therapy. The primary outcome measure was the Assisting Hand Assessment (AHA) and the secondary outcome variables were the Canadian Occupational Performance Measure (COPM) and stereognosis. A Wilcoxon signed-rank sum test was used to analyze differences between pre- and post-test scores within the groups. Analysis of covariance was used to compute mean differences between groups adjusting for baseline. Fisher's exact test was used to compare individual change in AHA raw scores with the smallest detectable difference (SDD) of 4 points. RESULTS All participants receiving treatment finished the study. Improvement in AHA differed significantly between groups (p=0.007). No significant differences in the secondary outcome measures were found. Eight out of 10 participants in the rTMS/CIMT group showed improvement greater than the SDD, but only two out of nine in the sham rTMS/CIMT group showed such improvement (p=0.023). No serious adverse events occurred. INTERPRETATION Primed, low-frequency rTMS combined with CIMT appears to be safe, feasible, and efficacious in pediatric hemiparesis. Larger clinical trials are now indicated.
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Affiliation(s)
- BERNADETTE T GILLICK
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN
| | - LINDA E KRACH
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN
| | - TIM FEYMA
- Pediatric Neurology, Gillette Children’s Specialty Healthcare, Saint Paul, MN
| | - TONYA L RICH
- Occupational Therapy, Gillette Children’s Specialty Healthcare, Saint Paul, MN
| | - KELLI MOBERG
- Occupational Therapy, Gillette Children’s Specialty Healthcare, Saint Paul, MN
| | - WILLIAM THOMAS
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - JESSICA M CASSIDY
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN
| | - JEREMIAH MENK
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - JAMES R CAREY
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN
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