Comprehensive Care in Cerebral Palsy

Effectiveness of Family-Professional Collaboration on Functional Goals Achievement of Children with Cerebral Palsy and Caregivers' Quality of Life and Burden: A Randomized Comparative Study

Background: Family-professional collaboration is important to enhance the outcomes for children with cerebral palsy and their caregivers. Aims: This study examined the effect of implementing a family-professional collaboration practice model on children with cerebral palsy and their caregivers. Materials and methods: A randomized, single-blind comparative study included 28 physical therapists, 44 children with cerebral palsy between the ages of 2 and 12 years old, and their caregivers. Physical therapists in the experimental group received training in how to implement collaboration in their therapy sessions over the course of two sessions (3 h each). The children's achievement goal-range rate was measured using the Goal Attainment Scaling, the caregivers' quality of life was assessed using the World Health Organization Quality of Life-Brief, and the caregiver burden was evaluated using the Zarit Burden Interview. Results: All children showed improvement on the Goal Attainment Scaling change rate (p = 0.002), with no significant differences between groups (p < 0.44). However, a group × time interaction was observed. The Children Goal Attainment Scaling rate decreased between the two assessment sessions for children in the control group, while the Goal Attainment Scaling change rate was steady for the experimental group. There were no main effects of time and group or interaction of time × group reported on World Health Organization Quality of Life-Brief domains and no main effect of time on the Zarit Burden Interview, but there was a main effect between groups (p = 0.03), with partial eta square = 0.11 in favor of the experimental group. Conclusions: The family-professional collaboration practice model could be a potential practice to positively improve the outcomes in children with cerebral palsy and their caregivers.

Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy

AIM

To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP).

METHOD

In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI).

RESULTS

Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61).

INTERPRETATION

Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care.

WHAT THIS PAPER ADDS

Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.

Providing holistic care to children with cerebral palsy treated with transnasal neural stem cell transplantation

Objective

Holistic care is a key element in nursing care. Aiming at the heterogeneous disease of cerebral palsy, researchers focused on children with cerebral palsy who received transnasal transplantation of neural stem cells as a specific group. Based on establishing a multidisciplinary team, comprehensive care is carried out for this type of patient during the perioperative period to improve the effectiveness and safety of clinical research and increase the comfort of children.

Methods

Between January 2018 and June 2023, 22 children with cerebral palsy underwent three transnasal transplants of neural stem cells.

Results

No adverse reactions related to immune rejection were observed in the 22 children during hospitalization and follow-up. All children tolerated the treatment well, and the treatment was superior. One child developed nausea and vomiting after sedation; three had a small amount of bleeding of nasal mucosa after transplantation. Two children had a low fever (≤38.5°C), and one had a change in the type and frequency of complex partial seizures. Moreover, 3 children experienced patch shedding within 4 h of patch implantation into the nasal cavity.

Conclusion

The project team adopted nasal stem cell transplantation technology. Based on the characteristics of transnasal transplantation of neural stem cells in the treatment of neurological diseases in children, a comprehensive and novel holistic care plan is proposed. It is of great significance to guide caregivers of children to complete proper care, further improve the safety and effectiveness of treatment, and reduce the occurrence of complications.

Systematic review and network meta-analysis of robot-assisted gait training on lower limb function in patients with cerebral palsy

OBJECTIVE

This study aimed to evaluate the effectiveness of robot-assisted gait training (RAGT) in treating lower extremity function in patients with cerebral palsy (CP) and compare the efficacy differences between different robotic systems.

METHODS

PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, CBM, and Wanfang databases were searched to collect randomized controlled trials of RAGT for lower extremity dysfunction in patients with CP from the time the databases were created until December 26, 2022. The D and E of Gross Motor Function Measure-88 (GMFM-88) assessed lower limb motor function. Berg Balance Scale (BBS) was used to assess balance function. Walking endurance and speed were assessed using the 6-minute walk test (6MWT) and walking speed. The modified Ashworth Scale (MAS) was used to assess the degree of muscle spasticity in the lower extremities. The Cochrane Risk Assessment Scale and the Physiotherapy Evidence Database (PEDro) scale were used for qualitative assessment in the studies included. RevMan 5.4 was used for data merging and statistical analysis. R 4.2.0 and ADDIS 1.16.8 were used to map the network relationships and to perform the network meta-analysis.

RESULTS

A total of 14 studies were included in the review. The meta-analysis showed that RAGT significantly improved GMFM-88 D and E, BBS, and 6MWT scores in CP patients compared with conventional rehabilitation. However, for walking speed and MAS, the intervention effect of RAGT was insignificant. The network meta-analysis showed that the best probability ranking for the effect of the 3 different robots on the GMFM-88 D score was LokoHelp (P = 0.66) > Lokomat (P = 0.28) > 3DCaLT (P = 0.06) and the best probability ranking for the GMFM-88 E score was LokoHelp (P = 0.63) > 3DCaLT (P = 0.21) > Lokomat (P = 0.16).

CONCLUSION

RAGT positively affects walking and balance function in patients with CP, while efficacy in improving gait speed and muscle spasticity is unknown. The best treatment among the different robots is LokoHelp. Future high-quality, long-term follow-up studies are needed to explore the clinical efficacy of RAGT in depth.

Early Cerebral Palsy Detection and Intervention

Early identification of cerebral palsy (CP) facilitates optimal care, support, and outcomes for children and their families. Ideally, infants with risk factors or developmental deviations should be evaluated early using standardized assessments of neurodevelopment and brain imaging. If a diagnosis of CP or high risk for CP (HRCP) is established, specialized, evidence-informed therapy and family support should be initiated. With task-specific motor skill training and an enriched environment, infants with CP show greater gross motor and cognitive gains. These enhanced outcomes are only achievable with early diagnosis and subsequent intervention.

Effect of Perioperative Comprehensive Nursing Intervention on Transcatheter Arterial Chemoembolization in Patients with Primary Hepatic Carcinoma

Objective

To study and analyze the effect of perioperative comprehensive nursing intervention on transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC).

Methods

One hundred and ten patients with PHC diagnosed in our hospital from May 2019 to January 2022 were randomly selected and divided into a control group (n = 55) and an observation group (n = 55) by random number sorting according to odd and even numbers. Patients in the control group received conventional nursing interventions and those in the observation group received comprehensive nursing interventions. The two groups were compared in terms of surgical status, quality of life (QoL), and nursing satisfaction.

Results

The operation time, postoperative bed rest time, and hospital stay in the observation group were significantly (P < 0.05) shorter than those in the control group; the observation group had significantly (P < 0.05) higher scores of quality of life, including somatic function, emotional function, role function, social function, and cognitive function than the control group; chemotherapy adverse reactions including fever, abdominal pain, urinary retention, and gastrointestinal reactions in the observation group were significantly less than those in the control group (P < 0.05); the total incidence of complications in the observation group was significantly (P < 0.05) lower than that in the control group. The total satisfaction with nursing care in the observation group was significantly (P < 0.05) higher than that in the control group.

Conclusion

The perioperative application of comprehensive nursing intervention in TACE for patients with PHC aids in the smooth operation, improves patients' QoL, lowers the risk of chemotherapy reactions and complications, and enhances patient satisfaction and nursing quality. These advantages justify a wider perioperative application of comprehensive nursing intervention in TACE clinical practice.

Computer-Aided Diagnosis of Children with Cerebral Palsy under Deep Learning Convolutional Neural Network Image Segmentation Model Combined with Three-Dimensional Cranial Magnetic Resonance Imaging

In this paper, we analyzed the application value and effect of deep learn-based image segmentation model of convolutional neural network (CNN) algorithm combined with 3D brain magnetic resonance imaging (MRI) in diagnosis of cerebral palsy in children. 3D brain model was segmented based on CNN algorithm to obtain the segmented MRI images of brain tissue, and the validity was verified. Then, 70 children with cerebral palsy were rolled into the observation group (n = 35), which received MRI for diagnosis after segmentation of brain tissue, and control group (n = 35), which were diagnosed by computed tomography (CT). The diagnosis results of the two groups were compared. The validity experiment verified that the image segmentation method based on CNN algorithm can obtain effective style graphics. In clinical trials, the diagnostic accuracy of 88.6% in the observation group was evidently superior to that of 80% in the control group (P < 0.05). In the observation group, one patient was diagnosed as normal, four patients had white matter lesions, 17 patients had corpus callosum lesions, and five patients had basal ganglia softening foci. In the control group, two patients were diagnosed as normal, two patients had white matter lesions, 19 patients had corpus callosum lesions, and four patients had basal ganglia softening foci. No notable difference was found between the two groups (P > 0.05). According to the research results, in the diagnosis of cerebral palsy in children, the image segmentation of brain 3D model based on CNN to obtain the MRI image of segmented brain tissue can effectively improve the detection accuracy. Moreover, the specific symptoms can be diagnosed clearly. It can provide the corresponding diagnostic basis for clinical diagnosis and treatment and was worthy of clinical promotion.

Electronic health record and patterns of care for children with cerebral palsy

AIM

To characterize the patterns of care of children with cerebral palsy (CP) in a tertiary healthcare system.

METHOD

Electronic health record data from 2009 to 2019 were extracted for children with CP. Machine learning hierarchical clustering was used to identify clusters of care. The ratio of in-person to care coordination visits was calculated for each specialty.

RESULTS

The sample included 6369 children with CP (55.7% males, 44.3% females, 76.2% white, 94.7% non-Hispanic; with a mean age of 8y 2mo [SD 5y 10mo; range 0-21y; median 7y 1mo]) at the time of diagnosis. A total of 3.7 million in-person visits and care coordination notes were identified across 34 specialties. The duration of care averaged 5 years 5 months with five specialty interactions and 21.8 in-person visits per year per child. Seven clusters of care were identified, including: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. Network analysis showed shared membership among several clusters.

INTERPRETATION

Coordination of care is a central element for children with CP. Medical informatics, machine learning, and big data approaches provide unique insights into care delivery to inform approaches to improve outcomes for children with CP. What this paper adds Seven primary clusters of care were identified: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. The in-person to care coordination visit ratio was 1:5 overall for healthcare encounters. Most interactions with care teams occur outside of in-person visits. The ratio of in-person to care coordination activities differ by specialty.