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Hoyt CR, Sherman SK, Brown SK, Newbold DJ, Miller RL, Van AN, Shimony JS, Ortega M, Nguyen AL, Schlaggar BL, Dosenbach NUF. Toward a More Comprehensive Assessment of School Age Children with Hemiplegic Cerebral Palsy. Rehabil Process Outcome 2021; 10:11795727211010500. [PMID: 34497455 PMCID: PMC8282143 DOI: 10.1177/11795727211010500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Cerebral palsy (CP) is the leading cause of disability in children. While motor deficits define CP, many patients experience behavioral and cognitive deficits which limit participation. The purpose of this study was to contribute to our understanding of developmental delay and how to measure these deficits among children with CP. Methods: Children 5 to 15 years with hemiplegic CP were recruited. Cognition and motor ability were assessed. The brain injury associated with observed motor deficits was identified. Accelerometers measured real-world bilateral upper extremity movement and caregivers completed behavioral assessments. Results: Eleven children participated, 6 with presumed perinatal stroke. Four children scored below average intelligence quotient while other measures of cognition were within normal limits (except processing speed). Motor scores confirmed asymmetrical deficits. Approximately one third of scores indicated deficits in attention, behavior, or depression. Conclusions: Our findings corroborate that children with CP experience challenges that are broader than motor impairment alone. Despite the variation in brain injury, all participants completed study procedures. Implications: Our findings suggest that measuring behavior in children with CP may require a more comprehensive approach and that caregivers are amenable to using online collection tools which may assist in addressing the therapeutic needs of children with CP.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Catherine R Hoyt, Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-94-01, St. Louis, MO 63110, USA.
| | - Sarah K Sherman
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Shelby K Brown
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryland L Miller
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nico UF Dosenbach
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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Demers M, Martinie O, Winstein C, Robert MT. Active Video Games and Low-Cost Virtual Reality: An Ideal Therapeutic Modality for Children With Physical Disabilities During a Global Pandemic. Front Neurol 2020; 11:601898. [PMID: 33381077 PMCID: PMC7767913 DOI: 10.3389/fneur.2020.601898] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Current guidelines against spread of coronavirus (COVID-19) interrupt non-essential rehabilitation services. Thus, individuals with physical disabilities such as children with cerebral palsy can no longer benefit from physical rehabilitation during this undetermined period. Using either a synchronous or asynchronous format, in collaboration with a therapist via telerehabilitation, we suggest that active video games and low-cost virtual reality are a promising delivery mode for at-home rehabilitation in the context of a global pandemic. This therapeutic modality, incorporated into an at-home individualized treatment plan, provides a means to lessen the impact of an interruption in rehabilitation services while not loosing the pre-pandemic, in-person physical activity gains. Growing evidence supports active video games and low-cost virtual reality as viable therapeutic interventions for children with physical disabilities. These technologies are especially well-accepted by pediatric populations for the ludic and motivating features that lend themselves to nearly seamless incorporation into telerehabilitation. Advantages for rehabilitation of active video games and low-cost virtual reality include a rich, challenging, multi-modal training environment in which high numbers of movement repetitions can be accomplished, and a unique opportunity to foster engaged practice actions that go beyond household activities. We offer suggestions for the clinician about how to adopt active video games and low-cost virtual reality into your practice during a global pandemic.
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Affiliation(s)
- Marika Demers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Ophélie Martinie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Laval University, Quebec City, QC, Canada
| | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Maxime T. Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
- Department of Rehabilitation, Laval University, Quebec City, QC, Canada
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Katz RT. Life Care Planning - a Practical Illustration. Phys Med Rehabil Clin N Am 2019; 30:683-696. [PMID: 31227142 DOI: 10.1016/j.pmr.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Life care planning is a method of estimating future care costs for patients with catastrophic disabilities. The life care planner determines an annual budget for care, including further medical and rehabilitative interventions, durable medical goods, disposable medical goods and supplies, and recreational equipment. After determining an annual budget, the life care planner must use scientifically sound methods of determining the patient's life expectancy in order to create a lifetime budget.
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Affiliation(s)
- Richard T Katz
- Washington University School of Medicine, American Board of Physical Medicine and Rehabilitation, American Board of Independent Medical Examiners, American Board of Electrodiagnostic Medicine, AMA Guides, 6th Edition.
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Ross MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019; 220:348-353. [PMID: 30529344 DOI: 10.1016/j.ajog.2018.11.1107] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022]
Abstract
Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.
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Affiliation(s)
- Michael G Ross
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, CA.
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Day SM, Reynolds RJ, Kush SJ. Extrapolating published survival curves to obtain evidence-based estimates of life expectancy in cerebral palsy. Dev Med Child Neurol 2015; 57:1105-18. [PMID: 26174088 DOI: 10.1111/dmcn.12849] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 12/31/2022]
Abstract
Studies reporting long-term survival probabilities for cohorts of persons with cerebral palsy provide evidence-based information on the life expectancy of those cohorts. Some studies have provided estimates of life expectancy based on extrapolation of such evidence, whereas many others have opted not to do so. Here we review the basic methods of life table analysis necessary for performing such extrapolations, and apply these methods to obtain evidence-based estimates of life expectancy from several studies that do not report such estimates themselves.
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Affiliation(s)
- Steven M Day
- Mortality Research & Consulting Inc., City of Industry, CA, USA
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