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Patsakos EM, Patel S, Simpson R, Nelson MLA, Penner M, Perrier L, Bayley MT, Munce SEP. Conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities: a scoping review. Front Psychol 2024; 15:1365205. [PMID: 38911955 PMCID: PMC11192198 DOI: 10.3389/fpsyg.2024.1365205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/02/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction To examine the scope of existing literature on the conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities. Methods A protocol was developed based on the Joanna Briggs Institute (JBI) scoping review method. MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and EBSCOhost CINAHL, were searched. Results Eight studies were selected for inclusion; four used quantitative methodology, and four used qualitative methods. Compassion was not defined a priori or a posteriori in any of the included studies. The concept of self-compassion was explicitly defined only for parents of youth with childhood-onset disabilities in three studies a priori. The most reported outcome measure was self-compassion in parents of youth with childhood-onset disabilities. Self-compassion among parents was associated with greater quality of life and resiliency and lower stress, depression, shame and guilt. Discussion There is limited evidence on the conceptualization, use, and outcomes associated with compassion among youth with childhood-onset disabilities. Self-compassion may be an effective internal coping process among parents of youth with childhood-onset disabilities. Further research is required to understand the meaning of compassion to youth with childhood-onset disabilities, their parents and caregivers. Systematic review registration https://doi.org/10.17605/OSF.IO/2GRB4.
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Affiliation(s)
- Eleni M. Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Stuti Patel
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Robert Simpson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle L. A. Nelson
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Melanie Penner
- Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mark T. Bayley
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E. P. Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Ding JY, Cleary SL, Morgan PE. Participation experiences of young people with cerebral palsy in key life situations: A qualitative study. Dev Med Child Neurol 2024. [PMID: 38616349 DOI: 10.1111/dmcn.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/24/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
AIMS To explore the participation experiences of adolescents and young adults with cerebral palsy (CP) in key life situations of young adulthood and investigate the impact of a government-funded, disability insurance scheme on participation and health service access. METHOD We conducted a qualitative descriptive study using semi-structured interviews. Sixteen young people with CP (aged 16-30 years; mean age = 24 years 4 months) participated. Interviews were audio-recorded and transcribed verbatim before thematic analysis. RESULTS An overarching theme of 'branching out into adulthood' was identified. Participants described early adulthood as a time of change, choice, and challenge. The sub-themes were: (1) making sense of my CP as an adult; (2) people's attitudes towards disability and the impacts on me; (3) roadblocks and workarounds; and (4) participation at the time of the COVID-19 pandemic. Participants reported complex views on the new disability insurance scheme. While access to services and support increased, participants experienced significant difficulty negotiating appropriate funding, resulting in frustration and reduced confidence in the scheme. INTERPRETATION Young people with CP experience complexity as they participate during young adulthood. Alongside exploring how their identity is intertwined with having CP, they face significant barriers to participation when navigating relationships, accessing services, and being involved in the community.
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Affiliation(s)
- Jacqueline Y Ding
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stacey L Cleary
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Prue E Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Sarmiento CA, Wyrwa JM, Glaros C, Holliman BD, Brenner LA. Experiences of young adults with cerebral palsy in pediatric care transitioning to adult care. Dev Med Child Neurol 2024. [PMID: 38523396 DOI: 10.1111/dmcn.15907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
AIM To increase understanding regarding the experiences and values of young adults with cerebral palsy (CP), and their caregivers, regarding pediatric rehabilitation-related care, including perceived barriers and potential facilitators to transition to adult care. METHOD This was a qualitative descriptive study that used 20 semi-structured interviews (13 caregivers and seven patient-caregiver dyads). RESULTS We identified four major themes: (1) the value and security of long-term relationships; (2) feeling 'rudderless' navigating the logistics of transition; (3) differences in pediatric versus adult models of care; and (4) perceived lack of provider expertise and comfort in adult care settings. Young adults with CP who had not yet transitioned to adult rehabilitation care and their caregivers placed high value on provider relationships and expertise, advanced planning, communication, and coordination of care. INTERPRETATION Identified barriers and potential facilitators to the transition to adult rehabilitation care reflected the uncertainty that accompanies leaving an established healthcare relationship. Challenges related to the logistics of this transition, differences in models of care, and perceived lack of provider comfort and expertise in adult care settings were also noted. Our findings could be used to develop and study patient-centered and family-centered transition processes for individuals with CP to promote age-appropriate and developmentally appropriate lifespan care.
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Affiliation(s)
- Cristina A Sarmiento
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Jordan M Wyrwa
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Chloe Glaros
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Department of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Lisa A Brenner
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
- Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Department of Neurology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
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Manikandan M, Jagdeo S, Weldon F, Harrington S, O'Sullivan R, Fortune J, Kerr C, M Ryan J. Mapping health services for adults with cerebral palsy in Ireland: a pilot study. HRB Open Res 2024; 5:61. [PMID: 37901656 PMCID: PMC10603314 DOI: 10.12688/hrbopenres.13609.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 10/31/2023] Open
Abstract
Background Cerebral palsy (CP) is a common cause of physical disability in childhood. The majority of children with CP survive to adulthood. Once discharged from children's services, adults with CP find it challenging to navigate health services. The aim of this study was to pilot and refine a methodology to map services for adults with CP in Ireland. Methods We used a multi-informant mapping methodology consisting of: 1. Defining health services; 2. Identifying informants; 3. Designing a survey; 4. Collecting data; 5. Data checking and analysis. We collected data on services from service users and service providers using an online survey. We verified data against information available online and by asking organisations to provide details about the service. Results Fifteen service users and nine service providers completed the online survey. Data on 265 unique services at 32 organisations were provided. The most commonly provided services were physiotherapy (12%) and occupational therapy (11%). We confirmed the name of 89 services (34%) against online information. We received further details from eight organisations about 27 services. Specifically, we received details about the organisation name for 27 of the 265 services (10%), service name for 25 services (9%), service type for 25 services (9%), a website for 19 services (7%), and data on eligibility criteria and types of supports provided for between 25 or 26 services (9% or 10%). Conclusion This pilot study highlighted the complexity of mapping services for adults with CP in Ireland. We recommend that an alternative methodology should be used to map services for adults with CP in Ireland.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Shalini Jagdeo
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Weldon
- Public and Patient Involvement contributor, Meath, Ireland
- Strategies for Change Co-ordinator, Independent Living Movement Ireland, Dublin, Ireland
| | - Sarah Harrington
- Public and Patient Involvement contributor, Cork, Ireland
- Adult Continuing Education, University College Cork, Cork, Ireland
| | | | - Jennifer Fortune
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- College of Health, Medicine and Life Sciences, Brunel University, London, UK
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Padley N, Moubayed D, Lanteigne A, Ouimet F, Clermont MJ, Fournier A, Racine E. Transition from Paediatric to adult health services: Aspirations and practices of human flourishing. Int J Qual Stud Health Well-being 2023; 18:2278904. [PMID: 37994797 PMCID: PMC11000676 DOI: 10.1080/17482631.2023.2278904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths. METHODS Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing. RESULTS 54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy). DISCUSSION AND CONCLUSION The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.
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Affiliation(s)
- Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Dina Moubayed
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amélie Lanteigne
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Marie-José Clermont
- Département de pédiatrie, CHU Sainte-Justine, Montréal, Québec, Canada
- Département de pédiatrie, Université de Montréal, Montréal, QC, Canada
| | - Anne Fournier
- Département de pédiatrie (section médecine de l'adolescence), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Département de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, QC, Canada
- Department of Medicine (Division of Experimental Medicine), McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, 3801 Rue University, Montréal, QC, Canada
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Mitchell DL, Shlobin NA, Winterhalter E, Lam SK, Raskin JS. Gaps in transitional care to adulthood for patients with cerebral palsy: a systematic review. Childs Nerv Syst 2023; 39:3083-3101. [PMID: 37552305 PMCID: PMC10643351 DOI: 10.1007/s00381-023-06080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The transition from pediatric to adult care can be complex and difficult to navigate for adolescents with cerebral palsy (CP). We aimed to assess the current state of transitional care for young persons with CP and delineate guidelines for best practice with opportunities for intervention. METHODS A systematic review was conducted using PRISMA guidelines to search PubMed, Embase, and Scopus databases. Articles were screened for relevance via title and abstract prior to full-text review. RESULTS Of 3151 resultant articles, 27 observational studies were included. Fourteen (52%) studies assessed clinical outcomes of patients with CP during and post-transition. Transition-associated poor outcomes included housing instability, unemployment, difficulty forming relationships, increased hospital admission rates, and decreased use of rehabilitation services. Factors associated with improved outcomes included family participation, promotion of self-efficacy, and meeting the adult team before transition. Nine (33%) studies conducted interviews with transition-age persons with CP. Key themes were a lack of transition preparedness, difficulty navigating the adult system, gaps in seamless care, and limited accessibility to specialists and environments suitable for patients with complex care needs. Four (15%) studies examined features of current transition services. Perceived barriers included poor communication within health service teams, limited adult providers accepting CP patients, and the lack of financial resources for specialized care. There was no standardized transition tool or approach. CONCLUSION These findings underscore the importance of a planned transition process in optimizing long-term medical and psychosocial outcomes for persons with CP. Further research, including translational, team-based, and community-engaged research, are needed.
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Affiliation(s)
- Devon L Mitchell
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Emily Winterhalter
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA.
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Jawed AI, Papakyrikos C, Stewart R, Villagran K, Zwirlein C, Zaim N, Casella JF. Lost and found, safe and sound: a case report surrounding the stabilization of a medically complex young adult patient with opioid use disorder through an acute wrapround care approach. J Addict Dis 2023; 41:341-349. [PMID: 35946477 DOI: 10.1080/10550887.2022.2109377] [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: 10/15/2022]
Abstract
Background: Hospitalization can be a critical time to stabilize chronically ill patients across levels that transcend medical and social determinants of health. The use of the biopsychosocial model can be instrumental in understanding both medically and psychosocially complex patient cases. An acute inpatient hospitalization provides an opportunity to mediate both intrinsic and extrinsic risk factors for both substance use disorder and suicide risk in the context of achieving medical stabilization and crisis mobilization. Case Presentation: Inpatient care of a 22-year-old African American female patient who was chronically ill involved tapping into existing resources within the larger academic hospital inclusive of both adult and pediatric expertise. This patient's care and treatment was multidisciplinary and involved a range of consults that further expanded both the depth and breadth of care and optimized stability from both medical and psychosocial standpoints. In fact, this patient's hospitalization presented a window of opportunity to facilitate a time of transition in chronic disease management and mobilize resources as part of securing wraparound care for her within a one-week timespan. Her care involved the integration of pediatrics (hematology, adolescent medicine), adult medicine (hematology, addiction medicine), and psychiatry. In addition to treating acute symptomology, underlying sources of pain stemming from her opioid use disorder were also alleviated. Furthermore, her care embodied the interface of chronic illness with opioid use, as her reported pain crises were determined to be motivated by intrinsic factors (e.g. poor coping skills from cumulative stressors) supporting her opioid use disorder. Conclusions: The biopsychosocial treatment approach taken for this patient also clearly delineated that physiological and mental health domains are interrelated aspects of chronic pain in chronic illness. Furthermore, this case also emphasized that chronically ill patients are at elevated risk of developing substance use disorders. This case study lends itself nicely to elucidating parity in physiological and mental health domains as crucial elements in promoting health and safety in patient care.
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Affiliation(s)
- Aysha I Jawed
- Department of Pediatric and OB/GYN Social Work, Charlotte R. Bloomberg Children's Center at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Cole Papakyrikos
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rosalyn Stewart
- Department of Pediatrics, Division of Pediatric Hospital Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kyle Villagran
- Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christina Zwirlein
- Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nadia Zaim
- Division of Child and Adolescent Psychiatry, Charlotte R. Bloomberg Children's Center at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - James F Casella
- Pediatric Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kumar DS, Perez G, Friel KM. Adults with Cerebral Palsy: Navigating the Complexities of Aging. Brain Sci 2023; 13:1296. [PMID: 37759897 PMCID: PMC10526900 DOI: 10.3390/brainsci13091296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The goal of this narrative review is to highlight the healthcare challenges faced by adults with cerebral palsy, including the management of long-term motor deficits, difficulty finding clinicians with expertise in these long-term impairments, and scarcity of rehabilitation options. Additionally, this narrative review seeks to examine potential methods for maintaining functional independence, promoting social integration, and community participation. Although the brain lesion that causes the movement disorder is non-progressive, the neurodevelopmental disorder worsens from secondary complications of existing sensory, motor, and cognitive impairments. Therefore, maintaining the continuum of care across one's lifespan is of utmost importance. Advancements in healthcare services over the past decade have resulted in lower mortality rates and increased the average life expectancy of people with cerebral palsy. However, once they transition from adolescence to adulthood, limited federal and community resources, and health care professionals' lack of expertise present significant obstacles to achieving quality healthcare and long-term benefits. This paper highlights the common impairments seen in adults with cerebral palsy. Additionally, it underscores the critical role of long-term healthcare and management to prevent functional decline and enhance quality of life across physical, cognitive, and social domains.
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Affiliation(s)
- Devina S. Kumar
- Burke Neurological Institute, White Plains, NY 10605, USA; (D.S.K.); (G.P.)
| | - Gabriel Perez
- Burke Neurological Institute, White Plains, NY 10605, USA; (D.S.K.); (G.P.)
| | - Kathleen M. Friel
- Burke Neurological Institute, White Plains, NY 10605, USA; (D.S.K.); (G.P.)
- Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
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Ouimet F, Fortin J, Bogossian A, Padley N, Chapdelaine H, Racine E. Transitioning from pediatric to adult healthcare with an inborn error of immunity: a qualitative study of the lived experience of youths and their families. Front Immunol 2023; 14:1211524. [PMID: 37600793 PMCID: PMC10432858 DOI: 10.3389/fimmu.2023.1211524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Transition from pediatric to adult healthcare is a multifaceted and consequential process with important health implications for youth. Although research on transition has grown significantly, research on transition for patients living with an inborn error of immunity (IEI) is scarce. We undertook a qualitative study to better understand the perspectives of youths and parents in an outpatient immunology clinic. Methdos Semi-structured interviews were conducted with 9 youths, 6 parents and 5 clinicians, all recruited from the same clinic. All youths recently transferred to adult care with or without an established diagnosis of IEI. Interviews were transcribed verbatim and thematic analysis was conducted. Two sets of themes were generated. The first set captured the positive and negative aspects experienced during transition, as well as recommendations to facilitate the process. The second set focused on key topics discussed in the interviews that were merged into overarching themes. Results Perspectives of participants were clustered into 6 overarching themes: (1) lack of knowledge about IEIs; (2) scattered transitions; (3) changing healthcare teams; (4) approaching an unknown environment; (5) transitioning to adulthood; (6) assuming responsibility for the management of the condition. Overall, the challenges encountered with respect to these themes had profound clinical and humanistic implications for patients such as generating significant distress. Discussion We discuss the unique challenges of the youths in our study in comparison to common problems reported by youths with chronic illness in the broader transition literature (for example: the change of healthcare team, the lack of information about the transition process and navigating the adult care system, growth towards self-management and the co-occurring developmental transition to adulthood). There is an urgency to attend to the specific problems created by the rarity of IEIs and related lack of knowledge about them as well as the need for multidisciplinary cross-clinic care during transition and beyond.
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Affiliation(s)
- François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Aline Bogossian
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- École de travail social, Faculté des arts et des sciences, Université de Montréal, Montréal, QC, Canada
| | - Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Hugo Chapdelaine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine et Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Pringsheim T, Batla A, Shalash A, Sahu JK, Cosentino C, Ebrahimi‐Fakhari D, Friedman J, Lin J, Mink J, Munchau A, Munoz D, Nardocci N, Perez‐Dueñas B, Sardar Z, Triki C, Ben‐Pazi H, Silveira‐Moriyama L, Troncoso‐Schifferli M, Hoshino K, Dale RC, Fung VS, Kurian MA, Roze E. Transitional Care for Young People with Movement Disorders: Consensus-Based Recommendations from the MDS Task Force on Pediatrics. Mov Disord Clin Pract 2023; 10:748-755. [PMID: 37205244 PMCID: PMC10186998 DOI: 10.1002/mdc3.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 05/21/2023] Open
Abstract
Background The International Parkinson and Movement Disorders Society (MDS) set up a working group on pediatric movement disorders (MDS Task Force on Pediatrics) to generate recommendations to guide the transition process from pediatrics to adult health care systems in patients with childhood-onset movement disorders. Methods To develop recommendations for transitional care for childhood onset movement disorders, we used a formal consensus development process, using a multi-round, web-based Delphi survey. The Delphi survey was based on the results of the scoping review of the literature and the results of a survey of MDS members on transition practices. Through iterative discussions, we generated the recommendations included in the survey. The MDS Task Force on Pediatrics were the voting members for the Delphi survey. The task force members comprise 23 child and adult neurologists with expertise in the field of movement disorders and from all regions of the world. Results Fifteen recommendations divided across four different areas were made pertaining to: (1) team composition and structure, (2) planning and readiness, (3) goals of care, and (4) administration and research. All recommendations achieved consensus with a median score of 7 or greater. Conclusion Recommendations on providing transitional care for patients with childhood onset movement disorders are provided. Nevertheless several challenges remain in the implementation of these recommendations, related to health infrastructure and the distribution of health resources, and the availability of knowledgeable and interested practitioners. Research on the influence of transitional care programs on outcomes in childhood onset movement disorders is much needed.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical NeurosciencesPsychiatry, Pediatrics and Community Health Sciences, University of CalgaryCalgaryABCanada
| | - Amit Batla
- Department of Clinical and Movement NeuroscienceUCL Queen Square Institute of NeurologyLondonUK
| | - Ali Shalash
- Department of NeurologyFaculty of medicine, Ain Shams UniveristyCairoEgypt
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Postgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Carlos Cosentino
- Department of Neurodegenerative DiseasesInstituto Nacional de Ciencias Neurologicas and School of Medicine, Universidad Nacional Mayor de San MarcosLimaPeru
| | | | - Jennifer Friedman
- Departments of Neurosciences and PediatricsUC San DiegoSan DiegoCAUSA
| | - Jean‐Pierre Lin
- Children's Neurosciences, Complex Motor Disorders Service (CMDS)Evelina London Children's Hospital, Guy's and St Thomas’ NHS Foundation Trust (GSTT), and Women and Children's Health Institute Faculty of Life Sciences & Medicine, Kings Health Partners, King's College LondonLondonUK
| | - Jonathan Mink
- Department of NeurologyUniversity of RochesterRochesterNYUSA
| | - Alexander Munchau
- Institute of Systems Motor Science, University of LübeckLübeckGermany
| | - Daniela Munoz
- Department of Paediatric NeurologySan Borja Arriaran Hospital. University of ChileSantiagoChile
| | - Nardo Nardocci
- Pediatric Neuroscience DepartmentFondazione IRCCS Istituto Neurologico “C Besta”MilanItaly
| | - Belen Perez‐Dueñas
- Department of Pediatric NeurologyHospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona. Centre for Biomedical Research of Rare Diseases (CIBERER), ISCIIIMadridSpain
| | - Zomer Sardar
- FCPS, Department of NeurologyColumbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNYUSA
| | - Chahnez Triki
- Department of child neurologyHedi Chaker Hospital, LR10ES15, Sfax Medical School, University of Sfax TunisiaSfaxTunisia
| | | | | | | | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for ChildrenTokyoJapan
| | - Russell C. Dale
- Children's Hospital at Westmead Clinical School, University of SydneySydneyNSWAustralia
| | - Victor S.C. Fung
- Movement Disorders Unit, Department of NeurologyWestmead Hospital & Sydney Medical School, University of SydneySydneyNSWAustralia
| | - Manju A. Kurian
- Developmental NeurosciencesZayed Centre for Research into Rare Disease in Children, GOS‐Institute of Child Health, UCLLondonUK
| | - Emmanuel Roze
- Sorbonne UniversityParis Brain Institute, Assistance Publique—Hôpitaux de Paris, DMU NeurosciencesParisFrance
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11
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Fremion E, Cowley R, Berens J, Staggers KA, Kemere KJ, Kim JL, Acosta E, Peacock C. Improved health care transition for young adults with developmental disabilities referred from designated transition clinics. J Pediatr Nurs 2022; 67:27-33. [PMID: 35882113 DOI: 10.1016/j.pedn.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home. DESIGN AND METHODS 408 YAIDD or their families completed the HCT Feedback Survey 2.0 upon establishing adult care. Logistic regression models were used to determine associations between a composite of six HCT Feedback Survey questions that most correlated with the 2019 National Survey of Children's Health transition questions. RESULTS YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program. CONCLUSIONS YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction. PRACTICAL IMPLICATIONS A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.
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Affiliation(s)
- Ellen Fremion
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA.
| | - Rachel Cowley
- Baylor College of Medicine, Student Affairs, One Baylor Plaza, Houston, TX 77030, USA
| | - John Berens
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Kristen A Staggers
- Baylor College of Medicine, Dan L Duncan Institute for Clinical and Translational Research, One Baylor Plaza, Houston, TX 77030, USA
| | - K Jordan Kemere
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Judy Lu Kim
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Elisha Acosta
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Cynthia Peacock
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
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Manikandan M, Casey C, Doyle A, Kerr C, Walsh M, Walsh A, M Ryan J. Use of health services and unmet needs among adults with cerebral palsy in Ireland. Dev Med Child Neurol 2022; 64:1270-1280. [PMID: 35396701 PMCID: PMC9546397 DOI: 10.1111/dmcn.15233] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
AIM To describe use of health services, unmet needs relating to health services, and identify factors associated with service use among adults with cerebral palsy (CP) in Ireland. METHOD Data relating to demographics, secondary diagnoses, current use of health services and assistive devices, and unmet needs for both were obtained on adults with CP from the National Physical and Sensory Disability Database. Logistic regression was used to identify factors associated with service use. RESULTS A total of 1268 adults with CP were included in this study. Over half were male (56%) and 78% lived with parents, siblings, or other family relatives. Physiotherapy, occupational therapy, and orthotics/prosthetic services were the most commonly used services, used by 57%, 48%, and 35% of the sample respectively. Unmet needs were highest for physiotherapy (23%) and occupational therapy services (13%). Age, sex, living arrangements, and wheelchair use were frequently associated with current service use. INTERPRETATION Adults with CP used a wide range of health services and unmet needs were reported for all services. The findings highlight a need for planning and development of services to meet their needs, regardless of their age, mobility level, or living arrangements. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) in Ireland used a wide range of therapeutic, respite, personal assistance, and support services. Unmet needs were highest for physiotherapy and occupational therapy services. Adults aged 25 years and above were less likely to use therapy services compared with younger adults. Adults living with parents, siblings, or family relatives were less likely to use personal assistance and physiotherapy services.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Claire Casey
- National Health Information SystemsHealth Research BoardIreland
| | - Anne Doyle
- Evidence CentreHealth Research BoardIreland
| | - Claire Kerr
- School of Nursing and MidwiferyQueen's University BelfastUnited Kingdom
| | - Michael Walsh
- National Clinical Programme for People with DisabilityClinical Design and Innovation Office, Health Service ExecutiveDublinIreland
| | - Aisling Walsh
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Jennifer M Ryan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
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13
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Manikandan M, Jagdeo S, Weldon F, Harrington S, O'Sullivan R, Fortune J, Kerr C, M Ryan J. Mapping health services for adults with cerebral palsy in Ireland: a pilot study. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13609.1] [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: Cerebral palsy (CP) is a common cause of physical disability in childhood. The majority of children with CP survive to adulthood. Once discharged from children’s services, adults with CP find it challenging to navigate health services. The aim of this study was to pilot and refine a methodology to map services for adults with CP in Ireland. Methods: We used a multi-informant mapping methodology consisting of: 1. Defining health services; 2. Identifying informants; 3. Designing a survey; 4. Collecting data; 5. Data checking and analysis. We collected data on services from service users and service providers using an online survey. We verified data against information available online and by asking organisations to provide details about the service. Results: Fifteen service users and nine service providers completed the online survey. Data on 265 unique services at 32 organisations were provided. The most commonly provided services were physiotherapy (12%) and occupational therapy (11%). We confirmed the name of 89 services (34%) against online information. We received further details from eight organisations about 27 services. Specifically, we received details about the organisation name for 27 of the 265 services (10%), service name for 25 services (9%), service type for 25 services (9%), a website for 19 services (7%), and data on eligibility criteria and types of supports provided for between 25 or 26 services (9% or 10%). Conclusion: This pilot study highlighted the complexity of mapping services for adults with CP in Ireland. Prior to conducting a future study, the scope of the map of services should be considered, and attempts should be made to improve the accuracy of information provided by informants and to engage organisations in verifying service details.
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South K, George M, Sadeghi H, Piane V, Smaldone A. Moving up: Healthcare transition experiences of adolescents and young adults with cystic fibrosis. J Pediatr Nurs 2022; 65:116-123. [PMID: 35367087 PMCID: PMC9246909 DOI: 10.1016/j.pedn.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The experience of healthcare transition from pediatric to adult care in cystic fibrosis (CF) remains poorly understood, particularly among racially and ethnically diverse adolescents and young adults (AYAs) with CF. The objective of this qualitative study was to explore the perspectives of a diverse sample of AYAs with CF at one urban academic medical center regarding healthcare transition. DESIGN AND METHODS Guided by qualitative descriptive methodology, we purposively selected AYAs who represented the pre and post transition experience: some AYAs had experienced the transition preparation program CF R.I.S.E. Demographic information and responsibility for self-management behaviors were collected using an online survey. Semi-structured video interviews were conducted following an iterative interview guide. A codebook directed inductive coding. QSR NVivo Version 12 software was used to organize the data. RESULTS 12 AYAs with CF were enrolled (25% female, 25% Black AYA, 33% Hispanic/Latina/o AYA, 50% White AYA; mean age 20.8 years). Three themes were identified: independent care of the whole self, preparing for change and the unknown and transition experiences vary. CONCLUSIONS Not all participants experienced a smooth transition. Participants identified suggestions for the development of transition preparation interventions, specifically around involving AYAs in transition decisions and beginning transition preparation early in adolescence. PRACTICE IMPLICATIONS Participants expressed uncertainty about transition when they felt little control over the process or lacked sufficient information about adult care. Therefore, comprehensive early transition preparation for all AYAs with CF with a focus on involving AYAs in transition decisions is recommended.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America.
| | - Maureen George
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
| | - Hossein Sadeghi
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Victoria Piane
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
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15
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Manikandan M, Kerr C, Lavelle G, Walsh M, Walsh A, Ryan JM. Health service use among adults with cerebral palsy: a mixed-methods systematic review. Dev Med Child Neurol 2022; 64:429-446. [PMID: 34705276 DOI: 10.1111/dmcn.15097] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/26/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
AIM To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services for this population. METHOD A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology. Five databases were searched to September 2020. Observational and qualitative studies were included. Two reviewers screened titles, abstracts, and full texts; extracted data; and assessed the quality of included studies. Separate meta-analyses were used to pool the proportion of adults using each service and frequency of use. A meta-aggregation approach was used to synthesize qualitative data. Quantitative and qualitative findings were integrated using the Andersen and Newman Model of health care utilization. RESULTS Fifty-seven studies (31 quantitative, 26 qualitative) of 14 300 adults with CP were included. The proportion of adults using services ranged from 7% (95% confidence interval [CI]: 2-13%) for urologists to 84% (95% CI: 78-90%) for general practitioners. Incidence of visits ranged from 67 (95% CI: 37-123) hospital admissions to 404 (95% CI: 175-934) general practitioner visits per 100 person-years. Qualitative themes highlighted issues regarding accessibility, caregivers' involvement, health workers' expertise, unmet ageing needs, transition, and health system challenges. INTERPRETATION Adults with CP used a wide range of health services but faced context-specific challenges in accessing required care. Appropriate service delivery models for adults with CP are required. This review emphasizes a need to develop an appropriate service model for adults with CP to meet their needs.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Walsh
- National Clinical Programme for People with Disability, Clinical Design and Innovation Office, Health Service Executive, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland.,College of Health and Life Sciences, Brunel University, London, UK
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16
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Cornec G, Brochard S, Drewnowski G, Desguerre I, Toullet P, Fontaine A, Le Lay Y, Boivin J, Bérard E, Bodoria M, Gautheron V, De la Cruz J. The Use and Outcomes of Motor Rehabilitation Services Among People With Cerebral Palsy Change Across the Lifespan. Front Neurol 2022; 12:771348. [PMID: 35281990 PMCID: PMC8905679 DOI: 10.3389/fneur.2021.771348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background and AimsThe provision of coordinated and multidisciplinary rehabilitation programs that adapt to the individual with cerebral palsy (CP) evolving rehabilitation needs throughout the different phases of life is highly challenging for healthcare systems. The aim of this study was to report the changes in motor rehabilitation (MR) environmental factors, service use and patient outcomes between children and adults with cerebral palsy and to identify if changes took place earlier or later than the standard division between pediatric and adult healthcare systems at 18 years.MethodsWe used data from the French ESPaCe survey to select a set of indicators for MR environmental factors, service use and patient outcomes, highlighted by patients and families in previous studies. We then compared the distribution of the indicator data between children and adults, as well as between four transition age groups: children under 12, adolescents up to 17 years, young adults, and adults over 25 years of age. We estimated odds ratios adjusted for motor involvement, associated impairments and informant type.ResultsA total of 997 respondents over 2 years of age were included in this study (484 children and 513 adults). Finding an available physiotherapist was very difficult for almost half of the children, and a greater proportion of adolescents and adults. Physiotherapy was provided in a private outpatient practice for twice as many adults over 25 years as children and adolescents. The weekly amount of physical therapy decreased as outpatient practice increased. Multidisciplinary rehabilitation decreased sharply from adolescence and was halved at adulthood. Satisfaction with the MR program decreased from childhood into adolescence and adulthood. Perceived impact of physiotherapy on people with CP and their main carers were less positive in adolescents.ConclusionsHealthcare policies should focus on accessibility issues at all ages, consider adolescents as a specific population, consider a wide transition phase (12–25 yo) and maintain a multidisciplinary approach at adulthood. There is a strong need for national rehabilitation strategies for individuals with CP.
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Affiliation(s)
- Gwenaël Cornec
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France
- Medical Research and Training Unit, Western Brittany University, Brest, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France
| | - Sylvain Brochard
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France
- Medical Research and Training Unit, Western Brittany University, Brest, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France
- Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
| | | | - Isabelle Desguerre
- Hôpital Necker – Enfants malades, Pediatrics-Radiology-Genetics, Paris, France
| | - Philippe Toullet
- Institut Motricité Cérébrale – Cercle de Documentation et d'Information pour la rééducation des Infirmes Moteurs Cérébraux, Paris, France
| | - Audrey Fontaine
- “A Pas de Géants”, Paris, France
- ISIR, UMR 7222 CNRS, Agathe Group INSERM U 1150, Sorbonne University, Paris, France
| | - Yann Le Lay
- Private Practice, Nantes, France
- IFM3R Institut Régional de Formation aux Métiers de la Rééducation et de la Réadaptation des Pays de la Loire, Nantes, France
| | | | | | | | - Vincent Gautheron
- Department of Pediatric Physical and Rehabilitation Medecine, CHU Bellevue - Saint-Etienne, LIBM, Université Jean Monnet Saint Etienne et Université de Lyon, Saint-Étienne, France
| | - Javier De la Cruz
- Hospital Universitario 12 Octubre, Madrid, Spain
- Health Research Institute Imas12, Madrid, Spain
- Mother & Child Health and Development Network (SAMID Network), National Health Institute (ISCIII), Madrid, Spain
- *Correspondence: Javier De la Cruz
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17
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Andreoli A, Klingbeil C. Implementing Pediatric Transition Education Initiative During Inpatient Admissions in the Epilepsy Monitoring Unit. J Pediatr Nurs 2021; 57:50-55. [PMID: 33242830 DOI: 10.1016/j.pedn.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adolescents with epilepsy are a population with unique needs when addressing transition to adult care. Scheduled, non-emergent admissions to the Epilepsy Monitoring Unit (EMU) have not yet been utilized to improve transition education. METHODS The overarching goal of this evidence-based practice project was to explore opportunities to enhance the transition education patients and families receive in the clinic setting by leveraging scheduled inpatient admissions for EEG monitoring to provide structured transition education. Twenty-one Neurology Clinic providers were surveyed about their perspectives on the transition process. Thirty-five adolescent patients (12-20 years old) received a pre-test regarding their condition, health maintenance and disease management, and a subsequent post-test measuring knowledge retention after education with a provider. Documentation in the electronic health record (EHR) using an institution created transition flowsheet and a standardized template was used to communicate through the EHR with the primary neurology team. FINDINGS The effectiveness of the intervention was supported as 100% of patients demonstrated increased knowledge after transition education. Providers' knowledge and support of transition efforts increased regarding tools and guidelines for transition of adolescents to adult care. DISCUSSION These results support the feasibility of providing transition education in the EMU with shared responsibility between inpatient and ambulatory providers. IMPLICATIONS FOR PRACTICE Improved use of the transition flowsheet in the EMU and by ambulatory setting providers will enhance the process of transition. Discussion of self-management with adolescent patients during all phases of health care will encourage independence and promote successful transition to adult health care.
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Affiliation(s)
- Ashley Andreoli
- Medical College of Wisconsin, Children's Wisconsin, WI, United States of America.
| | - Carol Klingbeil
- University of Wisconsin Milwaukee, WI, United States of America.
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18
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McGovern E, Pringsheim T, Medina A, Cosentino C, Shalash A, Sardar Z, Fung VSC, Kurian MA, Roze E. Transitional Care for Young People with Neurological Disorders: A Scoping Review with A Focus on Patients with Movement Disorders. Mov Disord 2020; 36:1316-1324. [PMID: 33200525 DOI: 10.1002/mds.28381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
Childhood-onset movement disorders represent a heterogenous group of conditions. Given the complexity of these disorders, the transition of care from pediatric to adult medicine is an important consideration. We performed a scoping review of the literature on transitional care in chronic neurological disease, exploring key transitional issues and proposed transitional care models. Our aim was to describe the current knowledge and gaps about the transition process of young adults with chronic neurological disorders, paying special attention to childhood onset movement disorders. A total of 64 articles were included in the qualitative synthesis; 56 articles reported on transitional care issues, and 8 articles reported on transitional care models. Only 2 articles included patients with movement disorders. The following 4 main transitional issues were identified following synthesis of the available literature: (1) inadequate preparation for the transition process, (2) inappropriate and inconsistent transition practices, (3) inadequate adult services, and (4) heightened emotional response surrounding transition. Of the reported transitional care models, multidisciplinary ambulatory care was the most common approach. In studies evaluating patient-related outcomes, positive health, educational, and vocational outcomes were found. The available literature provides insights on issues that can arise during transition that should be addressed to improve patient and caregiver comfort and satisfaction with care. Further research is needed to evaluate how transitional care programs affect outcomes and their cost effectiveness. More studies are required to determine the needs and outcomes specific to patients with childhood onset movement disorders. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eavan McGovern
- Dublin Neurological Institute, Mater University Hospital, Dublin, Ireland
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alex Medina
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Zomer Sardar
- Department of Neurology, Mayo Hospital, Lahore, Pakistan
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Emmanuel Roze
- Department of Neurology, Salpêtrière Hospital, Sorbonne University and Assistance Publique - Hôpitaux de Paris, Paris, France
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19
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Patel A, Jan S, Steinway C, Bullock A, Greenberg A, Thomas B, Fried LE, Brown L, DiGiovine M. Epilepsy Transition in Ambulatory Care: Experiences and Benefits of an Epilepsy Transition Team. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractEpilepsy is the fourth most common neurological disorder and affects people of all ages; however, at least 40% of children will continue to have seizures into adulthood. Children and youth with epilepsy (CYE) experience neurologic and extraneurologic changes that can negatively impact self-management skills necessary for optimal adult function. Those with intellectual disability have additional transition challenges. Improving the medical transition process for all CYE is vital and necessary. In this article, we will review some of the biologic, behavioral, psychologic, therapeutic, and social considerations for CYE complicating transition. We will then describe general approaches to transitioning CYE to adult care, specifically methods involving creating a framework with overarching transition aims in place, and share our experience at the Children's Hospital of Philadelphia implementing these approaches. Our comprehensive model for a formal transition policy, team structure, and ongoing assessment supporting CYE transitioning into adult care is a practical program that can be integrated into clinical care. Proper investment in the transition process will translate into measurable, significant long-term benefits for all involved.
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Affiliation(s)
- Amisha Patel
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Sophia Jan
- Division of General Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, Manhattan, New York, United States
| | - Caren Steinway
- Division of General Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, Manhattan, New York, United States
| | - Alexandra Bullock
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Adam Greenberg
- Department of Nursing, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Bethany Thomas
- Department of Neurology, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Lawrence E. Fried
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Lawrence Brown
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
| | - Marissa DiGiovine
- Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania, United States
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20
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Normann G, Arntz Boisen K, Uldall P, Brødsgaard A. Navigating being a young adult with cerebral palsy: a qualitative study. Int J Adolesc Med Health 2020; 34:187-195. [PMID: 32887183 DOI: 10.1515/ijamh-2020-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/21/2020] [Indexed: 01/10/2023]
Abstract
Objectives Young adults with cerebral palsy (CP) face potential challenges. The transition to young adulthood is characterized by significant changes in roles and responsibilities. Furthermore, young adults with chronic conditions face a transfer from pediatric care to adult healthcare. This study explores how living with CP affects young adults in general, and specifically which psychosocial, medical and healthcare needs are particularly important during this phase of life. Methods A qualitative study with data from individual, semi-structured, in-depth interviews with six young adults with CP (ages 21-31 years) were transcribed verbatim and analyzed. The participants were selected to provide a maximum variation in age, gender, Gross Motor Function Classification System score and educational background. A descriptive thematic analysis was used to explore patterns and identify themes. Results Three themes were identified: "Being a Young Adult", "Development in Physical Disability and New Challenges in Adulthood" and "Navigating the Healthcare System". The three themes emerged from 15 sub-themes. Our findings emphasized that young adults with CP faced psychosocial challenges in social relationships, participation in education and work settings and striving towards independence. The transition to young adulthood led to a series of new challenges that the young adults were not prepared for. Medical challenges included managing CP-related physical and cognitive symptoms and navigating adult health care services, where new physicians with insufficient knowledge regarding CP were encountered. Conclusion The young adults with CP were not prepared for the challenges and changes they faced during their transition into adulthood. They felt that they had been abandoned by the healthcare system and lacked a medical home. Better transitional care is urgently needed to prepare them for the challenges in young adulthood.
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Affiliation(s)
- Gitte Normann
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Uldall
- Department of Pediatrics and Adolescent Medicine, Neuropediatric Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics - 460, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
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21
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Boyce DM, Devinsky O, Meskis MA. Barriers to transition from pediatric to adult care for patients with Dravet syndrome: A focus group study of caregivers. Epilepsy Behav 2020; 109:107096. [PMID: 32422576 DOI: 10.1016/j.yebeh.2020.107096] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Caregivers of individuals with intellectual and developmental disabilities and epilepsy such as Dravet syndrome (DS) must navigate a complex web of state and community services through the transition from child-centered to adult-oriented healthcare. This study examined barriers to successful transition from the caregivers' perspective. Primary caregivers of teenagers or adults with DS who had contemplated or completed transition to adult care were eligible. A three-week, asynchronous, web-based focus group was conducted on Facebook. Data were analyzed in an iterative process based on a Grounded Theory approach. Participants reviewed findings for accuracy. Transition success was defined by how well it ensured adequate care for the child when caregivers became unable to provide it. Existing transition programs were described as "not for our kids." All caregivers reported that transition programs began too late. Challenges to identifying suitable providers were formidable, with 71% of adult patients still being seen by pediatric neurologists. Many adult physicians lacked a general knowledge of DS, yet caregivers perceived that adult physicians were unwilling to listen to caregivers, and few were comfortable accommodating patients with intellectual disabilities and challenging behaviors. Community programs often excluded patients with DS, and rural healthcare disparities created additional barriers. Analysis produced recommendations for improving the transition process including the creation of a certified Transition Navigator position in the clinical setting. The limitations of this focus group analysis include possible selection bias, but our study identified key issues and pathways to improve the transition process for patients with DS and their caregivers.
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Affiliation(s)
- Danielle M Boyce
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD, United States of America.
| | - Orrin Devinsky
- Department of Neurology, New York University, New York, NY, United States of America
| | - Mary Anne Meskis
- Dravet Syndrome Foundation, Cherry Hill, NJ, United States of America
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22
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Porto A, Anderson L, Kalinich T, Deane KC, Vogel LC, Zebracki K. Understanding transition for youth with spinal cord injury: Youth and caregiver perceptions. J Spinal Cord Med 2020; 43:505-511. [PMID: 30758272 PMCID: PMC7480524 DOI: 10.1080/10790268.2019.1574437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: The purpose of this study is to understand facilitators of and barriers to achieving positive transition results among youth with spinal cord injury (SCI), and to identify areas for intervention to improve transition outcomes. Design: This study utilized qualitative methods and analysis was completed using Interpretive Phenomenological Analysis. Participants: Participants included adolescents (n = 9, range = 13-18 years old), young adults (n = 14, range = 22-30 years old) with an SCI, and their respective caregivers (n = 17). Results: The majority of participants had paraplegia (78%) and complete injuries (52%). The majority of caregivers were mothers (88%). Two primary themes were identified: Facilitators of Transition and Barriers to Transition. From these, five subthemes were developed for each category. Conclusion: Youth with SCI and caregivers would benefit from organizations offering dynamic and progressive care options including social reintegration programs, peer-mentoring opportunities, and programs to teach individuals with SCI and families ways to develop motivation, resilience, and independent living skills. Last, better communication among healthcare providers and an increase of interdisciplinary and accessible adult healthcare facilities would foster greater transition successes for individuals with SCI.
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Affiliation(s)
| | - Lara Anderson
- Shriners Hospitals for Children, Chicago, Illinois, USA,Loyola University of Chicago, Chicago, Illinois, USA
| | - Tyler Kalinich
- Shriners Hospitals for Children, Chicago, Illinois, USA,University of Illinois, Champaign, Illinois, USA
| | - Kyle C. Deane
- Shriners Hospitals for Children, Chicago, Illinois, USA
| | - Lawrence C. Vogel
- Shriners Hospitals for Children, Chicago, Illinois, USA,Rush Medical College, Chicago, Illinois, USA
| | - Kathy Zebracki
- Shriners Hospitals for Children, Chicago, Illinois, USA,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA,Correspondence to: Kathy Zebracki, Shriners Hospitals for Children, 2211 N. Oak Park Ave., Chicago, IL60707, USA.
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23
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Bogossian A, Majnemer A, Racine E. Contextualized Autonomy in Transitional Care for Youth With Neurologic Conditions: The Role of the Pediatric Neurologist. J Child Neurol 2020; 35:536-542. [PMID: 32338583 DOI: 10.1177/0883073820918454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with neurologic conditions experience multiple life transitions. The transfer from pediatric to adult health care systems exemplifies one such complex and multifaceted transition that occurs in parallel with developmental, legal, and social changes that may influence the roles and responsibilities of youth and their caregivers. As a result, ethical situations, questions, and challenges may surface in transition care to which pediatric neurologists may be confronted. In this article, we focus on the topic of autonomy and situations that may arise in transition care in the context of pediatric neurology. Building from a clinical case, we present the concept of contextualized autonomy to work through the questions that arise in the case and propose ways of thinking through those challenging situations in transition care.
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Affiliation(s)
- Aline Bogossian
- School of Social Work, Faculty of Arts and Science, Université de Montréal, Pavillon Lionel-Groulx, Montréal, Quebec, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada.,Montreal Children's Hospital and RI-McGill University Health Centre & Centre for Interdisciplinary Research in Rehabilitation, Montréal, Quebec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Neurology and Neurosurgery, Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, Quebec, Canada
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24
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O'Connell A, Petty J. Preparing young people with complex needs and their families for transition to adult services. Nurs Child Young People 2020; 31:25-31. [PMID: 31468877 DOI: 10.7748/ncyp.2018.e1123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 11/09/2022]
Abstract
Improving survival rates for children and young people with complex health needs requires a robust system for transition to adult services. Effective planning is essential to ensure a smooth transition process that is in the best interests of the young person and their family. This article discusses the needs and requirements for planned and purposeful transition processes to support young people with complex healthcare needs and their families. It considers the preparation of adult services, the team, the young person and their parents in line with an integrated approach and the nurse's role. Recommendations for practice include the necessity for an integrated approach to ensure optimum outcomes and ascertaining the potential value of a nurse-led service in delivering the transition process. A carefully tailored planning strategy should be developed to prepare and support young people with complex health needs through transition.
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Affiliation(s)
| | - Julia Petty
- Children's nursing, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
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25
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Myers LL, Nerminathan A, Fitzgerald DA, Chien J, Middleton A, Waugh MC, Paget SP. Transition to adult care for young people with cerebral palsy. Paediatr Respir Rev 2020; 33:16-23. [PMID: 31987717 DOI: 10.1016/j.prrv.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/25/2023]
Abstract
Cerebral palsy (CP) is associated with a high burden of comorbid respiratory disease subsequent to multiple risk factors associated with increasing levels of disability. Correspondingly, respiratory disease is the leading cause of death in CP, including amongst young people who are transitioning or who have just transitioned between paediatric and adult healthcare services. Therefore, consideration of both preventive and therapeutic respiratory management is integral to transition in patients with CP, as summarised in this review.
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Affiliation(s)
- Lisa L Myers
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Arany Nerminathan
- Department of General Paediatrics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Discipline of Medicine, Sydney Medical School, University of Sydney, NSW, Australia
| | - Anna Middleton
- Physiotherapy Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Mary-Clare Waugh
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Simon Paul Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Brandon E, Ballantyne M, Penner M, Lauzon A, McCarvill E. Accessing primary health care services for transition-aged young adults with cerebral palsy; perspectives of young adults, parents, and physicians. JOURNAL OF TRANSITION MEDICINE 2019. [DOI: 10.1515/jtm-2019-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundYoung adults with childhood-onset disabilities experience challenges with accessing age appropriate primary health care services as they transition from pediatric to adult health care services. They often experience a negative impact on their health with associated long-term health and social concerns, disease complications and increased use of emergency services once transitioned to adult services. This is particularly challenging for youth with cerebral palsy (CP) due the complexity of their medical needs. The aim of this study was to explore experiences with accessing or providing primary care services for transitioned-aged young adults with CP from young adult, parent, pediatrician and primary care physician perspectives.MethodsA qualitative descriptive design was conducted to identify the challenges and facilitators for transitioned aged young adults with accessing primary, adult care services. Semi-structured interviews were conducted with 16 participants within the circle of care (4 adults with CP, 4 parents, 4 pediatricians and 4 primary healthcare physicians) for individuals with CP in Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis guided both the data collection and the data analysis processes.ResultsData analysis revealed that all participant groups reported transition challenges with respect to accessibility, the suitability of some primary care environments for caring for individuals with complex care needs, gaps in seamless care, and limited time and funding when receiving or providing primary care services to young adults with CP.DiscussionThere is a greater demand for adult healthcare providers now to deliver services for adults with childhood onset disabilities. Transition-aged young adults with CP and complex medical needs have increased challenges with accessing primary care services. Considering the following would improve primary care services transition for this population with complex medical needs: ongoing partnering between pediatric and adult health care streams to promote seamless care; connection to team-based primary care services where family physicians, subspecialties and interprofessional practitioners work together to provide joint care planning; salary compensation for increased service needs due to medical complexity; accessible sites; and development of guidelines for transitioning youth/young adults with complex care needs.
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Affiliation(s)
- Erin Brandon
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
- Lawrence S. Bloomberg Faculty of Nursing – University of Toronto, Toronto, ON, M5T 1P8, Canada
| | - Marilyn Ballantyne
- Lawrence S. Bloomberg Faculty of Nursing – University of Toronto, Toronto, ON, M5T 1P8, Canada
- Chief Nurse Executive and Clinician Investigator, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Melanie Penner
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Andrea Lauzon
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
- University Health Network-Toronto Rehab, Toronto, ON, Canada
| | - Erin McCarvill
- Bridgepoint Family Health Team, Toronto, ON, M4K 2N1, Canada
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27
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Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe). Ann Phys Rehabil Med 2019; 64:101314. [PMID: 31586683 DOI: 10.1016/j.rehab.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND User satisfaction is a key indicator of healthcare quality. OBJECTIVE We aimed to identify factors associated with satisfaction with motor rehabilitation (MR) in children and adults with cerebral palsy at a national level, using determinants related to patient characteristics, healthcare organisation and practice features. METHODS This study was part of ESPaCe, a national survey aimed at documenting the views of individuals with cerebral palsy and their families regarding MR services via a questionnaire, developed by a multidisciplinary group. The ESPaCe questionnaire included the Client Satisfaction Questionnaire (CSQ-8), whose total score was the primary outcome of this study. Survey participation was promoted nation-wide. The questionnaire could be completed by the person with cerebral palsy or their main carer. Analysis included the description of determinants across CSQ-8 quartiles and generalised linear modelling of the CSQ-8 score. RESULTS From June 2016 to June 2017, 1010 eligible participants (354 children, 145 adolescents and 511 adults) responded to the questionnaire, and 750 completed the CSQ-8. Univariate analysis suggested that multiple factors affected satisfaction with MR. On multivariate sequential adjustment, the factors that decreased satisfaction (all P<0.001) were being an adolescent, Gross Motor Function Classification System levels IV/V, frequent pain, receiving physiotherapy in private practice and poor access to a physiotherapist with specific CP training. Factors that increased satisfaction (all P<0.001) were presence of an MR coordinator, exchanges between healthcare professionals, provision of information regarding MR organisation, and goal setting and effective pain management by the physiotherapist. Organisation and practice features improved the predictive ability of patient characteristics (R2=0.40). CONCLUSION This study suggests that measures to improve the quality of healthcare for individuals with cerebral palsy should focus on improving pain management by the physiotherapist, establishing a therapeutic alliance, and greater provision of CP-specific practice education for healthcare professionals.
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Lilly H, Bitzel M, Pejnovic T, Schnell J, Doty A. Barriers and characteristics for successful transition to adult healthcare for individuals with cerebral palsy: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1662995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hannah Lilly
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Mackenzie Bitzel
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Tatiana Pejnovic
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Joanna Schnell
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Antonette Doty
- Physical Therapy Department, Walsh University, North Canton, OH, USA
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29
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Roquet M, Garlantezec R, Remy-Neris O, Sacaze E, Gallien P, Ropars J, Houx L, Pons C, Brochard S. From childhood to adulthood: health care use in individuals with cerebral palsy. Dev Med Child Neurol 2018; 60:1271-1277. [PMID: 30171608 DOI: 10.1111/dmcn.14003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status. METHOD In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed. RESULTS The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition. INTERPRETATION Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies. WHAT THIS PAPER ADDS Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.
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Affiliation(s)
- Marion Roquet
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France
| | | | - Olivier Remy-Neris
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | | | - Philippe Gallien
- Médecine Physique et de Réadaptation, CMPR Notre Dame De Lourde, Rennes, France
| | - Juliette Ropars
- Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France.,Service de Pédiatrie, CHRU Brest, Brest, France
| | - Laetitia Houx
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Christelle Pons
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Sylvain Brochard
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
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30
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Racine E, Caron R, Stanton-Jean M. Justice and Neurodevelopmental Disability: Moral-Political Philosophies, Policies, and Their Outcomes. Semin Pediatr Neurol 2018; 27:42-52. [PMID: 30293589 DOI: 10.1016/j.spen.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurodevelopmental disabilities, such as cerebral palsy and autism, touch a population which has been dubbed to be "doubly vulnerable." Individuals with neurodevelopmental disability have conditions that impair their cognition, communication, mobility, or social interactions, and they also rely on others to make decisions on their behalf. Accordingly, these children-as described in other contributions of this special issue-are particularly prone to suffer from systemic (ie, social, economic, and political) conditions that give or prevent access to quality and timely health care and social services as well as economic opportunities. In this article, we expose 2 different views on the principle of justice (justice as equality and justice as fairness). We then examine policy approaches and general outcomes of 3 countries (Sweden, the United States of America, and the United Kingdom), which have opted for different policy orientations. The United Kingdom's targeted approach to neurodevelopmental disability seems to be generating interesting results while the more general Swedish approach is not without merits, although perhaps more difficult to apply to other countries. Given knowledge gaps, there is great need to compare different policy approaches to neurodevelopmental disability and their real-world implications on the life of individuals and their families.
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Affiliation(s)
- Eric Racine
- From the *Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada; Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada; Department of Neurology and Neurosurgery, Experimental Medicine, and & Biomedical Ethics Unit, McGill University, Montreal, Canada.
| | - Roxanne Caron
- From the *Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada
| | - Michèle Stanton-Jean
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada; Centre de recherche en droit public, Université de Montréal, Montreal, Canada
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31
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Freeman M, Stewart D, Cunningham CE, Gorter JW. Information needs of young people with cerebral palsy and their families during the transition to adulthood: a scoping review. JOURNAL OF TRANSITION MEDICINE 2018. [DOI: 10.1515/jtm-2018-0003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe transition to adulthood is a developmental phase which occurs as young people move from adolescence into adulthood. Young people with disabilities, including cerebral palsy (CP), and their families have reported challenges during the transition to adulthood because they are required to move to adult supports and services, which are often fragmented and bring about new questions and expectations to find necessary supports. Young people and their parents have been found to lack information about where to find services in adulthood, how to access the services and what to ask during the transitional process. The aim of this scoping review was to explore the information needs of young people with CP and their families during the transition to adulthood. The goal is to map the current published evidence within the transition to adulthood literature base to explore what is known about information needs during the transition to adulthood of young people with CP and their parents. This review seeks to synthesize what is known about information content, timing, methods of provision and delivery. Databases searched were OVID Medline, CINAL, ERIC, EMBASE, PsycINFO, Web of Science, Social Science Abstracts and Sociological Abstracts. Initially 675 articles were retrieved. Four hundred and forty-two articles were selected for title review. Two hundred and five articles remained for abstract review. Seventeen articles were included for full-text review. Eleven articles were included in this review. Data were organized into five themes: (1) identified information needs during the transition to adulthood (content), (2) identified recommended providers of information during the transition to adulthood (who), (3) identified delivery methods of information during the transition to adulthood (how), (4) identified timing of information delivery of information during the transition to adulthood (when) and (5) location of information provided during the transition to adulthood (where). This review found that young people with CP, their families and adult providers all possess information needs during the transition to adulthood. Young people with CP and their families seek information about what adult services will look like and how to access supports. Adult providers require information about CP. Youth with CP prefer individualized information be delivered to them when needed rather than presented in group sessions or via paper handout. Other recommendations included the development of parent support networks to assist parents in the transition to adulthood. The opportunity to learn from real-life experiences was also viewed as an important source of information as well as method to provide information.
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Affiliation(s)
- Matthew Freeman
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Debra Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Charles E. Cunningham
- Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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32
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Paul M, O’Hara L, Tah P, Street C, Maras A, Ouakil DP, Santosh P, Signorini G, Singh SP, Tuomainen H, McNicholas F. A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services. BMC Med Ethics 2018; 19:73. [PMID: 30021635 PMCID: PMC6052672 DOI: 10.1186/s12910-018-0276-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. METHODS A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. RESULTS Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. CONCLUSIONS There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.
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Affiliation(s)
- Moli Paul
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Arden St, Stratford upon Avon, CV34 6NQ UK
| | - Lesley O’Hara
- Saint John of God Research Foundation clg, Stillorgan, Co. Dublin, Republic of Ireland
| | - Priya Tah
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Athanasios Maras
- Yulius Academie, Centrum voor Wetenschappelijk Onderzoek, Innovatie en Opleidingen, Dennenhout 1, 2994 GC Barendrecht, Netherlands
| | - Diane Purper Ouakil
- CHU Montpellier, Médecine Psychologique de l’Enfant et de l’Adolescent (MPEA1), Hôpital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Via Pilastroni 4, 25125 Brescia, Italy
| | | | - Helena Tuomainen
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Fiona McNicholas
- Lucena Clinic Rathgar , Dublin 6, Republic of Ireland
- University College Dublin, Belfield, Dublin 4, Republic of Ireland
- Our Lady’s Children Hospital Crumlin, Dublin 12, Republic of Ireland
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Allen D, Scarinci N, Hickson L. The Nature of Patient- and Family-Centred Care for Young Adults Living with Chronic Disease and their Family Members: A Systematic Review. Int J Integr Care 2018; 18:14. [PMID: 30127698 PMCID: PMC6095060 DOI: 10.5334/ijic.3110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 05/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIM The published literature addressing the nature of patient- and family-centred care (PFCC) among young adults (16-25 years old) living with chronic disease and their family members is diverse. The aim of this systematic review was to collect and interpretatively synthesise this literature to generate a conceptual understanding of PFCC in this age group. METHOD From an initial pool of 10,615 papers, 51 were systematically identified as relevant to the research question and appraised using the Critical Appraisal Skills Programme tools. A total of 24 papers passed the quality appraisal and proceeded to a qualitative meta-synthesis. RESULTS The qualitative meta-synthesis revealed three major elements of PFCC relevant to young adults living with chronic disease and their family members: (1) patients and practitioners felt able to engage with each other on an emotional and social level; (2) patients and families felt empowered to be part of the care process; and (3) patients and families experienced care as effective at addressing their individual needs. CONCLUSION There is agreement among young adult patients and families about what constitutes PFCC in a chronic disease setting, independent of the aetiology of the pathological process. Patients and families also have strong feelings about how practitioners can achieve PFCC in practice. These findings have implications for the delivery of health services to young adults living with chronic disease and their family members.
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Affiliation(s)
- David Allen
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
| | - Nerina Scarinci
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
| | - Louise Hickson
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
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Tilton AH, de Gusmao CM. Transition From Pediatric to Adult Neurologic Care. Continuum (Minneap Minn) 2018; 24:276-287. [PMID: 29432247 DOI: 10.1212/con.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW With advances in medical care, the number of youths surviving with medically complex conditions has been steadily increasing. Inadequate transition planning and execution can lead to gaps in care, unexpected emergency department visits, and an increase in health care costs and patient/caregiver anxiety. Many barriers that prevent adequate transition have been identified, including insufficient time or staff to provide transition services, inadequate reimbursement, resistance from patients and caregivers, and a dearth of accepting adult providers. RECENT FINDINGS Transition is distinct from transfer of care. Transition is a planned multistage process, while transfer refers to a point in time where responsibility of care shifts from one provider to another. Key differences exist between the pediatric and adult models of care. A successful transition should empower the patient to understand and take responsibility in managing his or her condition; foster independent functioning to the extent that is possible; integrate educational, legal, and community resources in the care plan; and identify appropriate adult health care providers at the time of transfer. Different models have been proposed to streamline the transition process, with improvement in patients' knowledge of their condition, self-efficacy, and confidence. SUMMARY Neurologists have a key role in supporting their patients in the transition to adulthood. This article reviews basic tenets and provides tools to assist in navigating the complex transition process. These tenets are intended to improve quality of care and decrease clinician burden and remain an active area of research.
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Bagatell N, Chan D, Rauch KK, Thorpe D. "Thrust into adulthood": Transition experiences of young adults with cerebral palsy. Disabil Health J 2016; 10:80-86. [PMID: 27756560 DOI: 10.1016/j.dhjo.2016.09.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 09/12/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The transition to adulthood, the gradual change in roles and responsibilities, is identified as a challenging time for adolescents and young adults with physical disabilities, including those with cerebral palsy. Health care, education, employment, independent living, and community engagement have been identified as areas of concern. However, relatively little research has been done to understand the experiences, perceptions, and needs of individuals with cerebral palsy as they transition toward adulthood. OBJECTIVE The objective of this study was to explore the transition experiences, perceptions, and needs of young adults with cerebral palsy living in one state in the southeastern United States. METHODS Focus groups with nine young adults with cerebral palsy (19-34 years) were conducted. The focus group interview explored the preparation for transition and experiences navigating adulthood. The audio-recorded groups were transcribed and analyzed using thematic analysis. RESULTS Young adults with cerebral palsy identified numerous challenges associated with navigating adulthood. The main themes were: 1) being thrust into adulthood; 2) navigating systems and services; 3) understanding and managing my body; and 4) dealing with stereotypes and prejudice. CONCLUSIONS The findings highlight the need for a holistic approach to transition with a focus on building capacity and empowerment. To navigate complex systems of care, "navigators" or "facilitators" are needed. Additionally, practitioners and service providers in adult systems need further education about cerebral palsy.
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Affiliation(s)
| | - Dara Chan
- University of North Carolina, Chapel Hill, USA
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Brown LW, Camfield P, Capers M, Cascino G, Ciccarelli M, de Gusmao CM, Downs SM, Majnemer A, Miller AB, SanInocencio C, Schultz R, Tilton A, Winokur A, Zupanc M. The neurologist's role in supporting transition to adult health care: A consensus statement. Neurology 2016; 87:835-40. [PMID: 27466477 DOI: 10.1212/wnl.0000000000002965] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 11/15/2022] Open
Abstract
The child neurologist has a critical role in planning and coordinating the successful transition from the pediatric to adult health care system for youth with neurologic conditions. Leadership in appropriately planning a youth's transition and in care coordination among health care, educational, vocational, and community services providers may assist in preventing gaps in care, delayed entry into the adult care system, and/or health crises for their adolescent patients. Youth whose neurologic conditions result in cognitive or physical disability and their families may need additional support during this transition, given the legal and financial considerations that may be required. Eight common principles that define the child neurologist's role in a successful transition process have been outlined by a multidisciplinary panel convened by the Child Neurology Foundation are introduced and described. The authors of this consensus statement recognize the current paucity of evidence for successful transition models and outline areas for future consideration.
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Affiliation(s)
- Lawrence W Brown
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.).
| | - Peter Camfield
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Melissa Capers
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Greg Cascino
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Ciccarelli
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Claudio M de Gusmao
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Stephen M Downs
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annette Majnemer
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Amy Brin Miller
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Christina SanInocencio
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Rebecca Schultz
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Anne Tilton
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annick Winokur
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Zupanc
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
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Lindsay S. Child and youth experiences and perspectives of cerebral palsy: a qualitative systematic review. Child Care Health Dev 2016; 42:153-75. [PMID: 26754030 DOI: 10.1111/cch.12309] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/30/2015] [Accepted: 10/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is one of the most common causes of physical disability in childhood, and many children with CP access rehabilitation services throughout their lives. The aim of this qualitative systematic review was to synthesize the experiences and perspectives of youth living with CP to inform the development of rehabilitation and social programmes. METHODS A thematic qualitative synthesis integrating qualitative evidence was undertaken where six electronic databases (MEDLINE, Embase, Healthstar, Cumulative Index to Nursing and Allied Health Literature, Proquest and PsychInfo) were searched from 1980 to September 2014. RESULTS Thirty-three articles involving 390 youth, aged from 2 to 25 years, across six countries were included. Themes were classified according to the International Classification of Functioning Child and Youth Version framework. Youth's accounts focused on social inclusion and the physical environment (i.e. services and supports, transportation, accessibility, accommodations, safety and weather), the role of family and peers and participation (i.e. leisure and recreation, school and civic engagement). Youth described how body structure and function (i.e. pain and physical functioning, mental health, fatigue and unpredictability of body function) affected them - often disrupting their biographies. Some youth described personal factors such as independence, coping and body image that affected their ability to cope with their condition. There was much less focus on youth's experiences of mobility, activities of daily living and assistive devices. CONCLUSIONS Youth with CP experience pain, fatigue and impairments to body function, along with social exclusion, which can affect their biographies. However, youth had strategies to revise their biographies to maintain personal and social normalcy.
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Affiliation(s)
- S Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Putz C, Döderlein L, Mertens EM, Wolf SI, Gantz S, Braatz F, Dreher T. Multilevel surgery in adults with cerebral palsy. Bone Joint J 2016; 98-B:282-8. [DOI: 10.1302/0301-620x.98b2.36122] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate. Methods This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution. Results Two objective gait variables were calculated pre- and post-operatively; the Gillette Gait Index (GGI) and the Gait Profile Score (GPS). The results were analysed in three groups according to their childhood surgical history (group 1 = no surgery, group 2 = surgery other than SEMLS, group 3 = SEMLS). Improvements in gait were shown by a significant decrease of GPS (p = 0.001). Similar results were obtained for both legs (GGI right side and left side p = 0.01). Furthermore, significant improvements were found in all subgroups although this was less marked in group 3, where patients had undergone previous SEMLS. Discussion SEMLS is an effective and safe procedure to improve gait in adults with cerebral palsy. However, a longer rehabilitation period is to be expected than found in children. SEMLS is still effective in adult patients who have undergone previous SEMLS in childhood. Take home message: Single-event multilevel surgery is a safe and effective procedure to improve gait disorders in adults with bilateral spastic cerebral palsy. Cite this article: Bone Joint J 2016;98-B:282–8.
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Affiliation(s)
- C. Putz
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - L. Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum
Aschau GmbH, Bernauerstrasse 18, 83229
Aschau i. Chiemgau, Germany
| | - E. M. Mertens
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - S. I. Wolf
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - S. Gantz
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
| | - F. Braatz
- Private University of Applied Sciences
Göttingen, Robert Koch Strasse 40, 37075
Göttingen, Germany
| | - T. Dreher
- Heidelberg University Hospital, Schlierbacher
Landstrasse 200a, 69118 Heidelberg, Germany
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Cassidy C, Campbell N, Madady M, Payne M. Bridging the gap: the role of Physiatrists in caring for adults with cerebral palsy. Disabil Rehabil 2015; 38:493-8. [DOI: 10.3109/09638288.2015.1044031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Racine E, Bell E, Yan A, Andrew G, Bell LE, Clarke M, Dubljevic V, Goldowitz D, Janvier A, McLachlan K, Muhajarine N, Nicholas D, Oskoui M, Rasmussen C, Rasmussen LA, Roberts W, Shevell M, Wade L, Yager JY. Ethics challenges of transition from paediatric to adult health care services for young adults with neurodevelopmental disabilities. Paediatr Child Health 2014; 19:65-8. [PMID: 24596475 DOI: 10.1093/pch/19.2.65] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Racine
- Neuroethics Research Unit; ; Département de médecine, Université de Montréal; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Emily Bell
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | | | - Gail Andrew
- Neurodevelopmental/Neuromotor Division, Department of Pediatrics, University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Lorraine E Bell
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec
| | - Margaret Clarke
- Departments of Pediatrics/Psychiatry, Alberta Children's Hospital, Calgary, Alberta
| | - Veljko Dubljevic
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Dan Goldowitz
- NeuroDevNet, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Annie Janvier
- Division of Neonatology and Clinical Ethics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Lisa Anne Rasmussen
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital, Montreal, Quebec
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | | | - Lucie Wade
- Ethics Program Office, Jewish General Hospital, Montreal, Quebec
| | - Jerome Y Yager
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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