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Zein A, Hassan AZM, Soliman AM, Mohamed MMA. Outcomes of surgical treatment of patellar instability in children with Down syndrome. J Orthop Surg Res 2024; 19:263. [PMID: 38664709 PMCID: PMC11044411 DOI: 10.1186/s13018-024-04730-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND patellar instability is a relatively frequent musculoskeletal disorder in children with Down syndrome (DS). However, such a condition has seldom been studied in the literature, even less its surgical treatment. Different techniques have been offered for this condition; the evidence for surgical options is scarce and primarily based on case reports or case series with few patients and heterogeneous techniques. Given this background, we aimed to evaluate the outcomes of a uniform kind of surgical procedure for such a condition that combined lateral soft tissue release, medial patellofemoral ligament (MPFL) reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty (if needed). MATERIALS AND METHODS This retrospective study involved 11 skeletally immature patients (12 knees; 9 males and 2 females), 5.5 to 14.1 years of age, with DS who had patellofemoral instability (PFI) and were managed by this technique between October 2018 and March 2020. Preoperative radiography, CT scan, and MRI were performed to evaluate the physis status, lower limb alignment, patellar height, trochlear morphology, and any associated knee pathology. A functional knee assessment was done by using the Kujala score and the modified Lysholm score. RESULTS The mean time of follow-up (± SD) was 47.7 ± 5.8 months (range: 39-56). Pre-operatively, the Kujala score (± SD) was 52.6 ± 14.3 (range: (31-74), and at final follow-up, it was 92.2 ± 4.4 (range: (88-98), showing a significant improvement (P < 0.001). The preoperative modified Lysholm score (± SD) was 54.3 ± 8.1 (range: 39-62), and at final follow-up it was 92.4 ± 5.3 (range: 82-96), showing a significant improvement (P < 0.001). All patients had a stable patella without a recurrence of instability and regained full ROM. There was no incidence of a patellar fracture or femoral physis injury. CONCLUSIONS Our proposed technique of combined soft tissue procedures, including lateral soft tissue release, MPFL reconstruction (using a partial-thickness quadriceps tendon autograft), the Roux-Goldthwait procedure, and V-Y quadricepsplasty, was an effective method for treating patellar instability in children with DS while avoiding physeal injury and patellar fracture. Functional scores and radiological outcomes were improved. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Assem Zein
- Department of Orthopaedics and Trauma Surgery, Minia University, Minia, Egypt.
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Abouzeir S, Gurgel-Georgelin M, Diemer F, Esclassan R, Noirrit-Esclassan E, Canceill T. Therapeutic solutions for anterior restorations in disabled patients: Systematic review and case report. SPECIAL CARE IN DENTISTRY 2024; 44:369-380. [PMID: 37470748 DOI: 10.1111/scd.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Treating anterior restorations is a real challenge for a dentist and conventional protocols are not always applicable. The aim of this study is to determine different therapeutic to conducting anterior restorations in disabled people. CASE REPORT We begin by presenting the case of a 23-year-old, handicapped man, who was brought in consultation to compensate for the loss of the left upper central incisor (#21). MATERIALS AND METHODS We then performed a systematic literature review in December 2022, in accordance with the PRISMA guidelines. The publications, on three databases, dealing with dental treatments on disabled people were selected whether they were clinical studies or case reports. RESULTS In the end, 14 publications were included. Most of the treatments described in the studies (n = 10; 71.43%) concern people aged under 19. The patients present different types of handicaps with various degrees of severity and the oral diseases described are as heterogeneous as the handicaps retrieved. DISCUSSION It is therefore difficult to make common treatment recommendations for all these variable profiles and situations. Most of patients in this study are very young, so there is a need for preventive and therapeutic care as earlier as possible, to preserve the vitality of their teeth and dental occlusion.
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Affiliation(s)
- Salomé Abouzeir
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
| | - Marie Gurgel-Georgelin
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm/Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), Toulouse, France
| | - Franck Diemer
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm/Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), Toulouse, France
| | - Rémi Esclassan
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
- Centre d'Anthropobiologie et de Génomique de Toulouse, Faculté de Médecine Purpan, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Emmanuelle Noirrit-Esclassan
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
| | - Thibault Canceill
- Faculté de Santé, Département Odontologie, Hôpitaux de Toulouse, Université Paul Sabatier, Toulouse Cedex 9, France
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm/Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), Toulouse, France
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Shaikh A, Li YQ, Lu J. Perspectives on pain in Down syndrome. Med Res Rev 2023; 43:1411-1437. [PMID: 36924439 DOI: 10.1002/med.21954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/08/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Down syndrome (DS) or trisomy 21 is a genetic condition often accompanied by chronic pain caused by congenital abnormalities and/or conditions, such as osteoarthritis, recurrent infections, and leukemia. Although DS patients are more susceptible to chronic pain as compared to the general population, the pain experience in these individuals may vary, attributed to the heterogenous structural and functional differences in the central nervous system, which might result in abnormal pain sensory information transduction, transmission, modulation, and perception. We tried to elaborate on some key questions and possible explanations in this review. Further clarification of the mechanisms underlying such abnormal conditions induced by the structural and functional differences is needed to help pain management in DS patients.
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Affiliation(s)
- Ammara Shaikh
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Yun-Qing Li
- Department of Anatomy, Histology, and Embryology & K. K. Leung Brain Research Centre, The Fourth Military Medical University, Xi'an, Shaanxi Province, China
- Department of Anatomy, Basic Medical College, Zhengzhou University, Zhengzhou, China
| | - Jie Lu
- Department of Human Anatomy, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
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El-Tallawy SN, Ahmed RS, Nagiub MS. Pain Management in the Most Vulnerable Intellectual Disability: A Review. Pain Ther 2023; 12:939-961. [PMID: 37284926 PMCID: PMC10290021 DOI: 10.1007/s40122-023-00526-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
This review is made up of two parts; the first part discussing intellectual disability (ID) in general, while the second part covers the pain associated with intellectual disability and the challenges and practical tips for the management of pain associated with (ID). Intellectual disability is characterized by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. ID is a disorder with no definite cause but has multiple risk factors, including genetic, medical, and acquired. Vulnerable populations such as individuals with intellectual disability may experience more pain than the general population due to additional comorbidities and secondary conditions, or at least the same frequency of pain as in the general population. Pain in patients with ID remains largely unrecognized and untreated due to barriers to verbal and non-verbal communication. It is important to identify patients at risk to promptly prevent or minimize those risk factors. As pain is multifactorial, thus, a multimodal approach using both pharmacotherapy and non-pharmacological management is often the most beneficial. Parents and caregivers should be oriented to this disorder, given adequate training and education, and be actively involved with the treatment program. Significant work to create new pain assessment tools to improve pain practices for individuals with ID has taken place, including neuroimaging and electrophysiological studies. Recent advances in technology-based interventions such as virtual reality and artificial intelligence are rapidly growing to help give patients with ID promising results to develop pain coping skills with effective reduction of pain and anxiety. Therefore, this narrative review highlights the different aspects regarding the current status of the pain associated with intellectual disability, with more emphasis on the recent pieces of evidence for the assessment and management of pain among populations with intellectual disability.
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Affiliation(s)
- Salah N. El-Tallawy
- King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Anesthesia Department, Faculty of Medicine, Minia University and NCI, Cairo University, Giza, Egypt
| | - Rania S. Ahmed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Raskoff SZ, Thurm A, Miguel HO, Kim SYH, Quezado ZMN. Pain research and children and adolescents with severe intellectual disability: ethical challenges and imperatives. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:288-296. [PMID: 36563701 PMCID: PMC10038826 DOI: 10.1016/s2352-4642(22)00346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022]
Abstract
Children with severe intellectual disabilities encounter inequities in pain-related care, yet little pain research involves this population. A considerable issue with pain research in this population is its ethical complexity. This Viewpoint delineates the ethical challenges of pain research involving children (aged 2-12 years) and adolescents (aged 13-21 years) with severe intellectual disabilities. There are two main issues. First, some of the standard methods for assessing pain and pain sensitivity are not suitable for individuals with severe intellectual disability, who are often non-verbal and unable to understand or follow instructions. Second, children and adolescents with severe intellectual disability cannot provide informed consent or assent to participate in pain research, and their dissent is not always recognised. The existing ethical guidelines for pain research by the International Association for the Study of Pain provide helpful, but general, guidance. This Viewpoint supplements these guidelines and uses a well established framework for assessing the ethics of clinical research to highlight points relevant to designing, doing, reviewing, and evaluating research involving children and adolescents with severe intellectual disability, focusing on issues that are unaddressed in existing guidance.
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Affiliation(s)
- Sarah Z Raskoff
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
| | - Audrey Thurm
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Helga O Miguel
- Department of Perioperative Medicine, The Clinical Center, National Institute of Mental Health, Bethesda, MD, USA
| | - Scott Y H Kim
- Department of Bioethics, National Institute of Mental Health, Bethesda, MD, USA
| | - Zenaide M N Quezado
- Department of Perioperative Medicine, The Clinical Center, National Institute of Mental Health, Bethesda, MD, USA
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Defrin R, Benromano T, Pick CG. Unique Pain Responses in Different Etiological Subgroups of Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:417-430. [PMID: 36018766 DOI: 10.1352/1944-7558-127.5.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
We studied whether there exist variations in pain responses between different intellectual and developmental disability (IDD) etiologies. Self-reports and facial expressions (Facial Action Coding System = FACS) were recorded during experimental pressure stimuli and compared among 31 individuals with IDD-13 with cerebral palsy (CP), nine with Down syndrome (DS), nine with unspecified origin (UIDD)-and among 15 typically developing controls (TDCs). The CP and DS groups had higher pain ratings and FACS scores compared to the UIDD and TDC groups, and steeper stimulus-response functions. The DS group exhibited the most diverse facial expressions. There were variations in the foci of facial expressions between groups. It appears that different IDD etiologies display distinct pain responses.
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Affiliation(s)
- Ruth Defrin
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
| | - Tali Benromano
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
| | - Chaim G Pick
- Ruth Defrin, Tali Benromano, and Chaim G. Pick, Tel-Aviv University, Tel-Aviv, Israel
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Dicieri-Pereira B, Gomes MF, Giannasi LC, Nacif SR, Oliveira EF, Salgado MAC, de Oliveira Amorim JB, Oliveira W, Bressane A, de Mello Rode S. Down syndrome: orofacial pain, masticatory muscle hypotonia, and sleep disorders. Sleep 2022; 45:6652371. [DOI: 10.1093/sleep/zsac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
The aim of the present study was to investigate orofacial pain in individuals with Down syndrome (DS) and determine possible associations with masticatory muscle hypotonia (MMH), maximum mouth opening (MMO), and sleep disorders. Twenty-three individuals with DS underwent a standardized clinical examination using Axis I of the Diagnostic Criteria for Temporomandibular Disorders, for the diagnosis of pain in the masseter and temporal muscles and temporomandibular joint (TMJ). MMH was investigated using electromyography of the temporal and masseter muscles and the measurement of maximum bite force (MBF). MMO was measured using an analog caliper. Sleep disorders (obstructive sleep apnea [OSA], snoring index [SI], and sleep bruxism index [SBI]) were investigated using type II polysomnography. Statistical analysis was performed. Nonsignificant differences were found in muscle and TMJ pain between the sexes. However, myalgia and referred myofascial pain in the left masseter muscle were more frequent in males (69%) than females (40%). Electrical activity of the temporal (left: p = .002; right: p = .004) and masseter (left: p = .008) muscles was significantly lower in males than in females. MBF range was lower in males than females, indicating the highest MMH among males. OSA, SI, and SBI were identified in both sexes, but with no statistically significant differences. We concluded that myalgia and referred myofascial pain were found in some individuals with DS, especially in males. Arthralgia was found mainly in females. Temporal and masseter myalgia may have exerted an influence on the severity of MMH in males, particularly on the left side.
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Affiliation(s)
- Bruna Dicieri-Pereira
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Monica Fernandes Gomes
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Lilian Chrystiane Giannasi
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | | | - Ezequiel Fernandes Oliveira
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Miguel Angel Castillo Salgado
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - José Benedito de Oliveira Amorim
- Center for Biosciences Applied to Patients with Special Needs (CEBAPE), Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Wagner Oliveira
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Adriano Bressane
- Environmental engineering department, Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
| | - Sigmar de Mello Rode
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São José dos Campos Campus, São Paulo State University (UNESP) , São Paulo , Brazil
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AlJameel AH, AlKawari H. Oral Health-Related Quality of Life (OHRQoL) of Children with Down Syndrome and Their Families: A Cross-Sectional Study. CHILDREN 2021; 8:children8110954. [PMID: 34828667 PMCID: PMC8625239 DOI: 10.3390/children8110954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022]
Abstract
As individuals with Down syndrome often suffer from oro-facial abnormalities which can affect their oral health as well as their and their family’s quality of life, this link was examined in the present study. Using a descriptive cross-sectional design, 63 parents of children with Down syndrome who attended two special daycare centres in Riyadh, Saudi Arabia, were surveyed using a self-administered validated questionnaire. The findings yielded by the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17 revealed that in 34.9% children and 46% of their families, quality of life was affected by oral health. Moreover, 54% children experienced physical pain, which was severe in 22.2% of the cases. Further analyses revealed that families’ emotional lives were negatively affected by children’s oral health status. Therefore, as oral health in children with Down syndrome exerts significant adverse impacts on different aspects of their lives and those of their families, timely provision of required oral health care is warranted.
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Affiliation(s)
- AlBandary Hassan AlJameel
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence:
| | - Huda AlKawari
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
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Defrin R, Beshara H, Benromano T, Hssien K, Pick CG, Kunz M. Pain Behavior of People with Intellectual and Developmental Disabilities Coded with the New PAIC-15 and Validation of Its Arabic Translation. Brain Sci 2021; 11:brainsci11101254. [PMID: 34679319 PMCID: PMC8533720 DOI: 10.3390/brainsci11101254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Pain management necessitates assessment of pain; the gold standard being self-report. Among individuals with intellectual and developmental disabilities (IDD), self-report may be limited and therefore indirect methods for pain assessment are required. A new, internationally agreed upon and user-friendly observational tool was recently published—the Pain Assessment in Impaired Cognition (PAIC-15). The current study’s aims were: to test the use of the PAIC-15 in assessing pain among people with IDD and to translate the PAIC-15 into Arabic for dissemination among Arabic-speaking professionals. Pain behavior following experimental pressure stimuli was analyzed among 30 individuals with IDD and 15 typically developing controls (TDCs). Translation of the PAIC followed the forward–backward approach; and reliability between the two versions and between raters was calculated. Observational scores with the PAIC-15 exhibited a stimulus–response relationship with pressure stimulation. Those of the IDD group were greater than those of the TDC group. The overall agreement between the English and Arabic versions was high (ICC = 0.89); single items exhibited moderate to high agreement levels. Inter-rater reliability was high (ICC = 0.92). Both versions of the PAIC-15 are feasible and reliable tools to record pain behavior in individuals with IDD. Future studies using these tools in clinical settings are warranted.
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Affiliation(s)
- Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (H.B.); (K.H.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence: ; Tel.: +972-3-6405431; Fax: +972-3-6405436
| | - Heba Beshara
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (H.B.); (K.H.)
| | - Tali Benromano
- Department of Anatomy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Kutaiba Hssien
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (H.B.); (K.H.)
| | - Chaim G. Pick
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Anatomy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 69978, Israel
| | - Miriam Kunz
- Department of Psychology and Sociology, Medical Faculty, University of Augsburg, 86159 Augsburg, Germany;
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Vogel ER, Staffa SJ, DiNardo JA, Brown ML. Dosing of Opioid Medications During and After Pediatric Cardiac Surgery for Children With Down Syndrome. J Cardiothorac Vasc Anesth 2021; 36:195-199. [PMID: 34526241 DOI: 10.1053/j.jvca.2021.08.019] [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: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether children with Down syndrome (DS) receive higher doses of opioid medications compared with children without DS for repair of complete atrioventricular canal (CAVC). DESIGN A retrospective chart review of children with and without DS who underwent primary repair of CAVC. The exclusion criteria included unbalanced CAVC and patients undergoing biventricular staging procedures. The primary outcome was oral morphine equivalents (OME) received in the first 24 hours after surgery. The secondary outcomes included intraoperative OME, OME at 48 and 72 hours, nonopioid analgesic and sedative medications received, pain scores, time to extubation, and length of stay. SETTING A pediatric academic medical center in the United States. PARTICIPANTS One hundred thirty-one patients with DS and 24 without, all <two years old, who underwent a CAVC repair. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Patients with DS were older than patients without DS (median 96.3 days [interquartile range {IQR} 70.7-128.2] v 75.9 days [IQR 49.8-107.3], p = 0.033) but otherwise not statistically different in the baseline characteristics. There was no difference in OME received in the first 24 hours postoperatively between groups (3.01 mg/kg [IQR 1.23-5.43] v 3.57 mg/kg [IQR 1.54-7.06], p = 0.202). OME at 48 and 72 hours was lower in the DS group compared with the control group. Similar amounts of opioid and non-opioid analgesics and sedatives were otherwise given to both groups of patients. Median pain scores did not differ between groups. CONCLUSIONS These results suggested that patients with DS undergoing CAVC repair do not have increased opioid requirements compared with a similar control group.
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Affiliation(s)
- Elizabeth R Vogel
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA.
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Rabach I, Peri F, Minute M, Aru E, Lucafò M, Di Mascio A, Cozzi G, Barbi E. Sedation and analgesia in children with cerebral palsy: a narrative review. World J Pediatr 2019; 15:432-440. [PMID: 31098933 DOI: 10.1007/s12519-019-00264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications. DATA SOURCES We reviewed the available literature to highlight the specific risk factors and area of criticism, that should be further improved. We searched the Cochrane Library, Medline, Pubmed from 1987 to September 2018 using key words such as 'cerebral palsy and children and pain' or 'sedation and cerebral palsy and children'. RESULTS While different pain scales are useful in recognizing pain expressions, anxiety scales are not available. Moreover, studies on non-pharmacological techniques do not always have comparable results. Several risk factors, from anatomic abnormalities to liver and kidney functioning, should be kept in mind before proceeding with sedation. CONCLUSIONS Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy (pharmacological and non-pharmacological) should be used in different settings.
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Affiliation(s)
- Ingrid Rabach
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Francesca Peri
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy. .,University of Trieste, Trieste, Italy.
| | - Marta Minute
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | | | - Marianna Lucafò
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy.,University of Trieste, Trieste, Italy
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Foley CM, Deely DA, MacDermott EJ, Killeen OG. Arthropathy of Down syndrome: an under-diagnosed inflammatory joint disease that warrants a name change. RMD Open 2019; 5:e000890. [PMID: 31245048 PMCID: PMC6560675 DOI: 10.1136/rmdopen-2018-000890] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023] Open
Abstract
There is an increased incidence and prevalence of arthropathy in children with Down syndrome. However, it is rarely reported or recognised at onset, and remains under-diagnosed. Children with arthropathy of Down syndrome (A-DS) are presenting with significant joint damage and disability at diagnosis.
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Affiliation(s)
- Charlene M Foley
- National Centre for Paediatric Rheumatology, Our Lady's Children's Hospital, Crumlin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Derek A Deely
- National Centre for Paediatric Rheumatology, Our Lady's Children's Hospital, Crumlin, Ireland
| | - Emma Jane MacDermott
- National Centre for Paediatric Rheumatology, Our Lady's Children's Hospital, Crumlin, Ireland
| | - Orla G Killeen
- National Centre for Paediatric Rheumatology, Our Lady's Children's Hospital, Crumlin, Ireland.,National Children's Research Centre, Dublin, Ireland
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Levman J, MacDonald A, Baumer N, MacDonald P, Stewart N, Lim A, Cogger L, Shiohama T, Takahashi E. Structural magnetic resonance imaging demonstrates abnormal cortical thickness in Down syndrome: Newborns to young adults. NEUROIMAGE-CLINICAL 2019; 23:101874. [PMID: 31176294 PMCID: PMC6551568 DOI: 10.1016/j.nicl.2019.101874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 12/11/2022]
Abstract
Down syndrome (DS) is a genetic disorder caused by an extra copy of all or part of chromosome 21 and is characterized by intellectual disability. We performed a retrospective analysis of 47 magnetic resonance imaging (MRI) examinations of participants with DS (aged 5 to 22 years) and compared them with a large cohort of 854 brain MRIs obtained from neurotypical participants (aged 5 to 32 years) with the objective of assessing the clinical presentation of Down syndrome, towards better understanding the neurological development associated with the condition. An additional cohort of 26 MRI exams from patients with DS and 139 exams from neurotypical participants (aged 0–5 years) are included as part of a supplementary analysis. Regionally distributed cortical thickness measurements, including average measurements as well as standard deviations (intra-regional cortical thickness variability) were extracted from each examination. The largest effect sizes observed were associated with increased average cortical thickness in the postcentral gyrus with specific abnormalities observed in Brodmann's areas 1 and 3b in DS, which was observed across all age ranges. We also observed strong effect sizes associated with decreased cortical thickness variability in the lateral orbitofrontal gyrus, the postcentral gyrus and more in DS participants. Findings suggest regionally irregular gray matter development in DS that can be detected with MRI. Large scale study of the clinical presentation of Down Syndrome Abnormally increased mean cortical thicknesses identified in key regions. Abnormally decreased variability in cortical thicknesses identified within key regions Findings may be connected with abnormal pruning in Down Syndrome.
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Affiliation(s)
- Jacob Levman
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Mathematics, Statistics and Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada.
| | - Allissa MacDonald
- Department of Biology, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Nicole Baumer
- Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Patrick MacDonald
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Natalie Stewart
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Ashley Lim
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Liam Cogger
- Department of Mathematics, Statistics and Computer Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada
| | - Tadashi Shiohama
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, 401 Park Dr., Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Foley C, Killeen OG. Musculoskeletal anomalies in children with Down syndrome: an observational study. Arch Dis Child 2019; 104:482-487. [PMID: 30472668 PMCID: PMC6557226 DOI: 10.1136/archdischild-2018-315751] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Musculoskeletal complications of Down syndrome (DS) are common but infrequently reported. The combination of ligamentous laxity and low muscle tone contributes to increased risk of a number of musculoskeletal disorders and a delay in acquisition of motor milestones. The primary aim of this study was to describe musculoskeletal anomalies reported in a national cohort of children with DS. METHODS This was an observational study. Children with DS, aged 0-21 years, were invited to attend a musculoskeletal assessment clinic conducted by a paediatric physician. Relevant musculoskeletal history and clinical findings were documented. RESULTS Over an 18-month period, 503 children with DS were examined (56% male). The median age was 8.1 years (0.6-19.2). Pes planus was almost universal, occurring in 91% of the cohort. A range of other musculoskeletal anomalies were observed, with inflammatory arthritis (7%) and scoliosis (4.8%) occurring most frequently after pes planus. Delay in ambulation was common; the median age to walk was 28 months (12-84). CONCLUSION Children with DS are at increased risk of a number of potentially debilitating musculoskeletal problems. These conditions can present in variable manners or be completely asymptomatic. Pes planus is common; therefore, early consideration of orthotics and lifelong appropriate supportive footwear should be considered. Delayed ambulation is frequently noted. A significant proportion of children with DS have arthritis; however, despite a high prevalence, it is often missed, leading to delayed diagnosis. An annual musculoskeletal assessment for all children with DS could potentially enable early detection of problems, allowing for timely multidisciplinary team intervention and better clinical outcomes.
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Affiliation(s)
- Charlene Foley
- National Centre for Paediatric Rheumatology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland,National Children’s Research Centre, Dublin, Ireland
| | - Orla G Killeen
- National Centre for Paediatric Rheumatology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland,National Children’s Research Centre, Dublin, Ireland
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Abstract
Patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.
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Affiliation(s)
- Florian Strasser
- Oncology and Palliative Medicine, Section Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland
| | - Paul Walker
- Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Leoni C, Triumbari EKA, Vollono C, Onesimo R, Podagrosi M, Giorgio V, Kuczynska E, Veltri S, Tartaglia M, Zampino G. Pain in individuals with RASopathies: Prevalence and clinical characterization in a sample of 80 affected patients. Am J Med Genet A 2019; 179:940-947. [DOI: 10.1002/ajmg.a.61111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Chiara Leoni
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Elizabeth Katherine Anna Triumbari
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Catello Vollono
- Department of Geriatrics, Unit of Neurophysiopathology and Sleep Medicine, Neurosciences and OrthopedicsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Roberta Onesimo
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Maria Podagrosi
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Valentina Giorgio
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Eliza Kuczynska
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Stefania Veltri
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
- Department of Neuroscience, Unit of NeuropsychiatryOspedale Pediatrico Bambino Gesù Rome Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research DivisionOspedale Pediatrico Bambino Gesù Rome Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
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Abstract
OBJECTIVES To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. DESIGN Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations. Morphine bolus dosing was used as needed, and total dose was tracked. Infusions were continued for 24 hours or until patients were extubated, whichever came first. Postinfusion, blood samples were continued for 24 hours for further evaluation of kinetics. If patients continued to require opioid, a nonmorphine alternative was used. Morphine concentrations were determined using a unique validated liquid chromatography tandem-mass spectrometry assay using dried blood spotting as opposed to large whole blood samples. Morphine concentration versus time data was modeled using population pharmacokinetics. SETTING A 16-bed cardiac ICU at an university-affiliated hospital. PATIENTS Forty-two patients (20 Down syndrome, 22 controls) were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The pharmacokinetics of morphine in pediatric patients with and without Down syndrome following cardiac surgery were analyzed. No significant difference was found in the patient characteristics or variables assessed including morphine total dose or time on infusion. Time mechanically ventilated was longer in children with Down syndrome, and regarding morphine pharmacokinetics, the covariates analyzed were age, weight, presence of Down syndrome, and gender. Only age was found to be significant. CONCLUSIONS This study did not detect a significant difference in morphine pharmacokinetics between Down syndrome and non-Down syndrome children with congenital heart disease.
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Barney CC, Tervo R, Wilcox GL, Symons FJ. A Case-Controlled Investigation of Tactile Reactivity in Young Children With and Without Global Developmental Delay. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:409-421. [PMID: 28846038 DOI: 10.1352/1944-7558-122.5.409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessing tactile function among children with intellectual, motor, and communication impairments remains a clinical challenge. A case control design was used to test whether children with global developmental delays (GDD; n = 20) would be more/less reactive to a modified quantitative sensory test (mQST) compared to controls (n = 20). Reactivity was indexed by blinded behavioral coding across vocal, facial, and gross motor responses during the mQST. On average the children with GDD were significantly more reactive than controls to most tactile sensory modalities including light touch (p = .034), pin prick (p = .008), cool (p = .039), pressure (p = .037), and repeated von Frey (p = .003). The results suggest the mQST approach was feasible and highlights the GDD sample was more reactive than controls to a range of stimuli.
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Affiliation(s)
- Chantel C Barney
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - Raymond Tervo
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - George L Wilcox
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
| | - Frank J Symons
- Chantel C. Barney, Gillette Children's Specialty Healthcare, St. Paul, MN; Raymond Tervo, Neurodevelopmental Pediatrician, Mayo Clinic, Rochester, MN; George L. Wilcox, Department of Neuroscience, University of Minnesota; and Frank J. Symons, Department of Educational Psychology, University of Minnesota
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Pain and Cognitive Functioning in Adults with Down Syndrome. PAIN MEDICINE 2017; 18:1264-1277. [PMID: 28034975 DOI: 10.1093/pm/pnw280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The aim of the present study was to examine whether cognitive functioning (i.e., memory and executive functioning) is related to self-reported presence of pain (i.e., affirmative answer to the question whether the individual feels pain) and experience of pain (i.e., intensity and affect) in adults with Down syndrome (DS). Design, Setting, and Subjects Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) in the Netherlands. Methods File-based medical information was evaluated. Self-reported presence and experience of pain were assessed during a test session, both in rest and after movement (affect with the facial affective scale [FAS], intensity with the numeric rating scale [NRS]). Neuropsychological tests for memory and executive functioning were used. Results Participants with lower memory scores were more likely to report the presence of pain, while controlling for age, gender, physical conditions that may cause pain, language comprehension, and vocabulary ( p = .030, 58.4% classification rate, N = 154). No statistically significant associations were found between executive functioning and self-reported presence of pain or between cognitive functioning and self-reported pain experience. Conclusions Memory seems to be related to the self-reported presence of pain in adults with DS after explicit inquiry, although the clinical use of this model is yet limited. Therefore, further research is needed for insight into the role of cognitive processes in self-report (e.g., involving aspects such as acquiescence and repeated measurements) to evaluate whether neuropsychological examination could contribute to pain assessment in DS.
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Affiliation(s)
- Nanda C de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- MOVE Research Institute Amsterdam.,Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies.,EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Heleen M Evenhuis
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Benromano T, Pick CG, Granovsky Y, Defrin R. Increased Evoked Potentials and Behavioral Indices in Response to Pain Among Individuals with Intellectual Disability. PAIN MEDICINE 2017; 18:1715-1730. [DOI: 10.1093/pm/pnw349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hennequin M, Allison PJ, Faulks D, Orliaguet T, Feine J. Chewing Indicators between Adults with Down Syndrome and Controls. J Dent Res 2016; 84:1057-61. [PMID: 16246941 DOI: 10.1177/154405910508401117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Down syndrome induces a neuromotor deficiency that affects the orofacial musculature, and thus could be implicated in the feeding difficulties affecting people with this disease. This study aimed to investigate the differences in chewing indicators between a group of 11 adults with Down syndrome and a group of 12 healthy subjects without Down syndrome. Chewing ability was evaluated by means of video recordings taken during a standardized meal that included 10 natural foods. The variables collected were masticatory time, number of masticatory cycles, chewing frequency, number of open masticatory cycles, and number of food refusals. There were several differences in both directions for masticatory time and number of masticatory cycles between the two groups. In addition, with the exception of purée, the group with Down syndrome had significantly lower mean chewing frequency than the reference group, and was unable to eat all the foods presented.
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Affiliation(s)
- M Hennequin
- EA 3847, Faculty of Dentistry, University of Auvergne, 11 boulevard Charles de Gaulle, 63000 Clermont-Ferrand, France.
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Zhong X, Singh N, Boyd L, Lawson C. Patient-Centered Strategies to Improve Radiographic Practice for Patients with Down Syndrome: A Systematic Review. J Med Imaging Radiat Sci 2016; 47:367-372. [PMID: 31047263 DOI: 10.1016/j.jmir.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/18/2016] [Accepted: 09/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Down syndrome is a common human genetic disorder caused by trisomy of chromosome 21. Individuals with Down syndrome can present with a range of health issues during their lives that may require imaging for diagnosis. Radiographers, therefore, play a significant role in the management and communication of Down syndrome patients' health. PURPOSE This review identified patient-centered strategies that radiographers should use to provide quality imaging services for Down syndrome patients, who may have limited verbal ability and behavioral issues. METHOD A systematic review using the established PRISMA guidelines was undertaken of current literature obtained through the Ovid and Scopus databases. A total of 189 articles were found, of which 41 were categorized and analyzed in detail. FINDINGS A high level of care for Down syndrome patients will require longer than usual procedures, and the patients will not respond well to being rushed or ignored. Down syndrome patients have difficulty verbalizing, yet they understand more than is often thought. Individuals may require increased imaging time to give them time to respond, especially to pain. Patients are at risk of injury with AAI or other pathologies, and caution should be taken with flexion and extension spine x-rays. Radiographs may reveal undisclosed physical abuse. CONCLUSION Specific strategies with verbal and nonverbal communication help to facilitate communication, reduce anxiety and fear, and improve compliance with Down syndrome patients. Patients may require an increased level of care; increased imaging time; and allowing support people to be present during the examination process.
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Affiliation(s)
- Xiao Zhong
- Medical Imaging, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lori Boyd
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Celeste Lawson
- Professional Communication Program, School of Education and the Arts, Central Queensland University, Rockhampton, Queensland, Australia.
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Krekmanova L, Hakeberg M, Robertson A, Braathen G, Klingberg G. Perceived oral discomfort and pain in children and adolescents with intellectual or physical disabilities as reported by their legal guardians. Eur Arch Paediatr Dent 2016; 17:223-30. [DOI: 10.1007/s40368-016-0231-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/15/2016] [Indexed: 12/01/2022]
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A Case-controlled Investigation of Pain Experience and Sensory Function in Neuronal Ceroid Lipofuscinosis. Clin J Pain 2016; 31:998-1003. [PMID: 25569218 DOI: 10.1097/ajp.0000000000000192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This case-control study explored pain experience and expression among individuals with neuronal ceroid lipofuscinosis (NCL) through parental report, tactile sensory testing, and infrared thermography (IRT). MATERIALS AND METHODS Participants with NCL (n=8; M=14.8 y) and their unaffected siblings (n=8; M=23.5 y) were characterized in terms of pain response to a brief tactile sensory test (light touch, Von Frey monofilament). During sensory testing, behavioral expression was measured using the Battens Observational Pain Scale and infrared thermography (IRT) was used to quantify changes in skin/eye temperature. RESULTS Children with NCL experienced pain frequently and from multiple sources that negatively impacted their lives. Children with NCL were reactive to the sensory testing as indexed by significant increased IRT temperature change (P<0.001). Across combined sensory conditions, individuals with NCL were significantly more reactive (Battens Observational Pain Scale total score) to sensory testing compared with siblings (P<0.05). Similarly, IRT difference scores between sensory conditions revealed a significant increase in temperature for individuals with NCL compared with siblings (P<0.001). DISCUSSION Ongoing reported pain was a problem for the children with NCL in this sample. Increased pain expression during the repeated Von Frey filament suggests that the pathophysiology of the ongoing pain may be centrally mediated.
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Abstract
Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and assessment of pain in infants and children and discuss the manifestations of pain in children with chronic illness, recurrent pain syndromes, and cognitive impairment, including the difficulties of pain management in these patients. Non-pharmacological interventions, as adjuncts to pharmacological management for acute anxiety and pain, are described by age and development. We discuss the pharmacological management of acute pain and anxiety, reviewing invasive and non-invasive routes of administration, pharmacology, and adverse effects.
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Affiliation(s)
- Baruch S Krauss
- Division of Emergency Medicine, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Lorenzo Calligaris
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Steven M Green
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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de Knegt N, Defrin R, Schuengel C, Lobbezoo F, Evenhuis H, Scherder E. Quantitative sensory testing of temperature, pain, and touch in adults with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 47:306-317. [PMID: 26460852 DOI: 10.1016/j.ridd.2015.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/18/2015] [Accepted: 08/26/2015] [Indexed: 06/05/2023]
Abstract
The spinothalamic pathway mediates sensations of temperature, pain, and touch. These functions seem impaired in children with Down syndrome (DS), but have not been extensively examined in adults. The objective of the present study was to compare the spinothalamic-mediated sensory functions between adults with DS and adults from the general population and to examine in the DS group the relationship between the sensory functions and level of intellectual functioning. Quantitative sensory testing (QST) was performed in 188 adults with DS (mean age 37.5 years) and 142 age-matched control participants (median age 40.5 years). Temperature, pain, and touch were evaluated with tests for cold-warm discrimination, sharp-dull discrimination (pinprick), and tactile threshold, respectively. Level of intellectual functioning was estimated with the Social Functioning Scale for Intellectual Disability (intellectual disability level) and the Wechsler Preschool and Primary Scale of Intelligence--Revised (intelligence level). Overall, the difference in spinothalamic-mediated sensory functions between the DS and control groups was not statistically significant. However, DS participants with a lower intelligence level had a statistically significant lower performance on the sharp-dull discrimination test than DS participants with higher intelligence level (adjusted p=.006) and control participants (adjusted p=.017). It was concluded that intellectual functioning level is an important factor to take into account for the assessment of spinothalamic-mediated sensory functioning in adults with DS: a lower level could coincide with impaired sensory functioning, but could also hamper QST assessment.
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Affiliation(s)
- Nanda de Knegt
- Department of Clinical Neuropsychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Ruth Defrin
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Center for Dentistry Amsterdam (ACTA) , Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
| | - Heleen Evenhuis
- Department of General Practice, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - Erik Scherder
- Department of Clinical Neuropsychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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Valkenburg AJ, Tibboel D, van Dijk M. Pain sensitivity of children with Down syndrome and their siblings: quantitative sensory testing versus parental reports. Dev Med Child Neurol 2015; 57:1049-55. [PMID: 26095920 DOI: 10.1111/dmcn.12823] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 01/17/2023]
Abstract
AIM The aim of this study was to compare thermal detection and pain thresholds in children with Down syndrome with those of their siblings. METHOD Sensory detection and pain thresholds were assessed in children with Down syndrome and their siblings using quantitative testing methods. Parental questionnaires addressing developmental age, pain coping, pain behaviour, and chronic pain were also utilized. RESULTS Forty-two children with Down syndrome (mean age 12y 10mo) and 24 siblings (mean age 15y) participated in this observational study. The different sensory tests proved feasible in 13 to 29 (33-88%) of the children with Down syndrome. These children were less sensitive to cold and warmth than their siblings, but only when measured with a reaction time-dependent method, and not with a reaction time-independent method. Children with Down syndrome were more sensitive to heat pain, and only 6 (14%) of them were able to adequately self-report pain, compared with 22 (92%) of siblings (p<0.001). INTERPRETATION Children with Down syndrome will remain dependent on pain assessment by proxy, since self-reporting is not adequate. Parents believe that their children with Down syndrome are less sensitive to pain than their siblings, but this was not confirmed by quantitative sensory testing.
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Affiliation(s)
- Abraham J Valkenburg
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
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de Knegt NC, Lobbezoo F, Schuengel C, Evenhuis HM, Scherder EJA. Self-Reporting Tool On Pain in People with Intellectual Disabilities (STOP-ID!): a Usability Study. Augment Altern Commun 2015; 32:1-11. [DOI: 10.3109/07434618.2015.1100677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McGuire BE, Defrin R. Pain perception in people with Down syndrome: a synthesis of clinical and experimental research. Front Behav Neurosci 2015; 9:194. [PMID: 26283936 PMCID: PMC4519755 DOI: 10.3389/fnbeh.2015.00194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/10/2015] [Indexed: 12/18/2022] Open
Abstract
People with an intellectual disability experience both acute and chronic pain with at least the same frequency as the general population. However, considerably less is known about the pain perception of people with Down syndrome. In this review paper, we evaluated the available clinical and experimental evidence. Some experimental studies of acute pain have indicated that pain threshold was higher than normal but only when using a reaction time method to measure pain sensitivity. However, when reaction time is not part of the calculation of the pain threshold, pain sensitivity in people with Down syndrome is in fact lower than normal (more sensitive to pain). Clinical studies of chronic pain have shown that people with an intellectual disability experience chronic pain and within that population, people with Down syndrome also experience chronic pain, but the precise prevalence of chronic pain in Down syndrome has yet to be established. Taken together, the literature suggests that people with Down syndrome experience pain, both acute and chronic, with at least the same frequency as the rest of the population. Furthermore, the evidence suggests that although acute pain expression appears to be delayed, once pain is registered, there appears to be a magnified pain response. We conclude by proposing an agenda for future research in this area.
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Affiliation(s)
- Brian E McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland Galway, Ireland
| | - Ruth Defrin
- Department of Physical Therapy at the Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University Tel-Aviv, Israel
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Satgé D, Clémenson P, Nishi M, Clémenson A, Hennequin M, Pacaut C, Mortier J, Culine S. A mucoepidermoid carcinoma in a young man with intellectual disability: review of oral cancer in people with intellectual disability. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e22-7. [DOI: 10.1016/j.oooo.2012.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 10/15/2012] [Accepted: 10/20/2012] [Indexed: 01/06/2023]
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Abstract
PURPOSE OF REVIEW Pain is a near-universal experience and research suggests that chronic pain, defined as pain lasting longer than 3 months, affects around 20% of the general population. However, there is relatively little awareness of the problem of pain amongst people with an intellectual disability. RECENT FINDINGS Recent prevalence studies indicated that chronic pain affects around 15% of people with an intellectual disability. Although prevalence can be estimated based on third-party reports, there are methodological limitations that suggest this way of detecting pain may be unreliable. Other methods, such as structured behavioural observation, offer a reliable and valid alternative. Once pain has been recognized, however, there has been limited research to evaluate pain management interventions for people with an intellectual disability, especially in the area of self-management. SUMMARY There is good evidence to support behavioural observation methods for recognition of pain in people with limited ability to communicate about their pain. Psychological interventions for pain management are widely used in the general population and may also have a useful role in assisting people with an intellectual disability who are affected by persistent pain. However, there is an ongoing paucity of research in this area.
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McKenzie K, Smith M, Purcell AM. The reported expression of pain and distress by people with an intellectual disability. J Clin Nurs 2012; 22:1833-42. [DOI: 10.1111/j.1365-2702.2012.04269.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Satgé D, Nishi M, Culine S, Hennequin M. Awareness on oral cancer in people with intellectual disability. Oral Oncol 2012; 48:e44-5. [PMID: 22868078 DOI: 10.1016/j.oraloncology.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 07/05/2012] [Accepted: 07/07/2012] [Indexed: 11/27/2022]
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Valkenburg AJ, van der Kreeft SM, de Leeuw TG, Stolker RJ, Tibboel D, van Dijk M. Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists. Paediatr Anaesth 2012; 22:682-9. [PMID: 22272712 DOI: 10.1111/j.1460-9592.2012.03800.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intellectually disabled children are more likely to undergo surgical interventions and almost all have comorbidities that need to be managed. Compared with controls, intellectually disabled children tend to receive less intraoperative analgesia and fewer of them are assessed for postoperative pain. AIM To evaluate perceptions and practices of anesthesiologists in the Netherlands concerning pain management in intellectually disabled children. METHODS/MATERIALS We surveyed members of the Section on Pediatric Anesthesiology of the Netherlands Society of Anesthesiology in 2005 and 2009, using a self-designed questionnaire. RESULTS The response rate was 47% in both years. In 2005, 32% of the anesthesiologists rated intellectually disabled children as 'more sensitive to pain' than nonintellectually disabled children--vs 25% in 2009. But no more than 7% in 2005 vs 6% in 2009 agreed with the statement 'children with intellectually disabled children need more analgesia'. Most anesthesiologists gave similar doses of intraoperative opioids for intellectually disabled and nonintellectually disabled children, 92% in 2005 vs 89% in 2009. In 2005, only 3% applied a pain assessment tool validated for intellectually disabled children, vs 4% in 2009. CONCLUSIONS Anesthesiologists in the Netherlands take a different approach when caring for intellectually disabled children and they were not aware of pain observation scales for these children. However, the majority think that intellectually disabled children are not more sensitive to pain or require more analgesia. These opinions did not change over the 4-year period. One way to proceed is to implement validated pain assessment tools and to invest in education.
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Affiliation(s)
- Abraham J Valkenburg
- Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Peebles KA, Price TJ. Self-injurious behaviour in intellectual disability syndromes: evidence for aberrant pain signalling as a contributing factor. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:441-52. [PMID: 21917053 PMCID: PMC3272540 DOI: 10.1111/j.1365-2788.2011.01484.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND In most individuals, injury results in activation of peripheral nociceptors (pain-sensing neurons of the peripheral nervous system) and amplification of central nervous system (CNS) pain pathways that serve as a disincentive to continue harmful behaviour; however, this may not be the case in some developmental disorders that cause intellectual disability (ID). Moreover, individuals affected by ID disorders may initiate self-injurious behaviour to address irritating or painful sensations. In normal individuals, a negative feedback loop decreases sensation of pain, which involves descending inhibitory neurons in the CNS that attenuate spinal nociceptive processing. If spinal nociceptive signalling is impaired in these developmental disorders, an exaggerated painful stimulus may be required in order to engage descending anti-nociceptive signals. METHODS Using electronic databases, we conducted a review of publications regarding the incidence of chronic pain or altered pain sensation in ID patients or corresponding preclinical models. RESULTS There is a body of evidence indicating that individuals with fragile X mental retardation and/or Rett syndrome have altered pain sensation. These findings in humans are supported by mechanistic studies using genetically modified mice harbouring mutations consistent with the human disease. Thus, once self-injurious behaviour is initiated, the signal to stop may be missing. Several developmental disorders that cause ID are associated with increased incidence of gastroesophageal reflux disease (GERD), which can cause severe visceral pain. Individuals affected by these disorders who also have GERD may self-injure as a mechanism to engage descending inhibitory circuits to quell visceral pain. In keeping with this hypothesis, pharmacological treatment of GERD has been shown to be effective for reducing self-injurious behaviour in some patients. Hence, multiple lines of evidence suggest aberrant nociceptive processing in developmental disorders that cause ID. CONCLUSIONS There is evidence that pain pathways and pain amplification mechanisms are altered in several preclinical models of developmental disorders that cause ID. We present hypotheses regarding how impaired pain pathways or chronic pain might contribute to self-injurious behaviour. Studies evaluating the relationship between pain and self-injurious behaviour will provide better understanding of the mechanisms underlying self-injurious behaviour in the ID population and may lead to more effective treatments.
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Affiliation(s)
- K A Peebles
- Department of Pharmacology, University of Arizona, Tucson, Arizona 85724, USA
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Walker S. Perioperative care of neonates with Down's syndrome: should it be different? Br J Anaesth 2012; 108:177-9. [DOI: 10.1093/bja/aer452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Trisomy of the G protein-coupled K+ channel gene, Kcnj6, affects reward mechanisms, cognitive functions, and synaptic plasticity in mice. Proc Natl Acad Sci U S A 2012; 109:2642-7. [PMID: 22308328 DOI: 10.1073/pnas.1109099109] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
G protein-activated inwardly rectifying K+ channels (GIRK) generate slow inhibitory postsynaptic potentials in the brain via G(i/o) protein-coupled receptors. GIRK2, a GIRK subunit, is widely abundant in the brain and has been implicated in various functions and pathologies, such as learning and memory, reward, motor coordination, and Down syndrome. Down syndrome, the most prevalent cause of mental retardation, results from the presence of an extra maternal chromosome 21 (trisomy 21), which comprises the Kcnj6 gene (GIRK2). The present study examined the behaviors and cellular physiology properties in mice harboring a single trisomy of the Kcnj6 gene. Kcnj6 triploid mice exhibit deficits in hippocampal-dependent learning and memory, altered responses to rewards, hampered depotentiation, a form of excitatory synaptic plasticity, and have accentuated long-term synaptic depression. Collectively the findings suggest that triplication of Kcnj6 gene may play an active role in some of the abnormal neurological phenotypes found in Down syndrome.
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Evans E, Einfeld S, Mowat D, Taffe J, Tonge B, Wilson M. The behavioral phenotype of Mowat-Wilson syndrome. Am J Med Genet A 2012; 158A:358-66. [PMID: 22246645 DOI: 10.1002/ajmg.a.34405] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 10/29/2011] [Indexed: 01/25/2023]
Abstract
Mowat-Wilson syndrome (MWS) is caused by a heterozygous mutation or deletion of the ZEB2 gene. It is characterized by a distinctive facial appearance in association with intellectual disability (ID) and variable other features including agenesis of the corpus callosum, seizures, congenital heart defects, microcephaly, short stature, hypotonia, and Hirschsprung disease. The current study investigated the behavioral phenotype of MWS. Parents and carers of 61 individuals with MWS completed the Developmental Behavior Checklist. Data were compared with those for individuals selected from an epidemiological sample of people with ID from other causes. The behaviors associated with MWS included a high rate of oral behaviors, an increased rate of repetitive behaviors, and an under-reaction to pain. Other aspects of the MWS behavioral phenotype are suggestive of a happy affect and sociable demeanor. Despite this, those with MWS displayed similarly high levels of behavioral problems as those with intellectual disabilities from other causes, with over 30% showing clinically significant levels of behavioral or emotional disturbance. These findings have the potential to expand our knowledge of the role of the ZEB2 gene during neurodevelopment. Furthermore, they are a foundation for informing interventions and management options to enhance the independence and quality of life for persons with MWS.
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Affiliation(s)
- Elizabeth Evans
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
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Valkenburg AJ, van Dijk M, de Leeuw TG, Meeussen CJ, Knibbe CA, Tibboel D. Anaesthesia and postoperative analgesia in surgical neonates with or without Down's syndrome: is it really different? Br J Anaesth 2011; 108:295-301. [PMID: 22201181 DOI: 10.1093/bja/aer421] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reports conflict on optimal postoperative analgesic treatment in children with intellectual disability. We retrospectively compared postoperative analgesics consumption between neonates with and without Down's syndrome in relation to anaesthesia requirements and pain scores. METHODS We analysed hypnotic and analgesic drug administration, pain scores [COMFORT-Behaviour (COMFORT-B) scale], and duration of mechanical ventilation during the first 48 h after surgical repair of congenital duodenal obstruction in neonates, between 1999 and 2011. Data of 15 children with Down's syndrome were compared with data of 30 children without Down's syndrome. RESULTS General anaesthesia requirements did not differ. The median (inter-quartile range) maintenance dose of morphine during the first 24 h after operation was 9.5 (7.8-10.1) µg kg(-1) h(-1) in the Down's syndrome group vs 7.7 (5.0-10.0) µg kg(-1) h(-1) in the control group (P=0.46). Morphine doses at postoperative day 2 and COMFORT-B scores at day 1 did not significantly differ between the two groups. COMFORT-B scores at day two were lower in children with Down's syndrome (P=0.04). The duration of postoperative mechanical ventilation did not statistically differ between the two groups (P=0.89). CONCLUSIONS In this study, neonates with and without Down's syndrome received adequate postoperative analgesia, as judged from comparable analgesic consumption and pain scores. We recommend prospective studies in children of different age groups with Down's syndrome and in other groups of intellectually disabled children to provide further investigation of the hypothesis that intellectual disability predisposes to different analgesic requirements.
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Affiliation(s)
- A J Valkenburg
- Department of Paediatric Surgery, Erasmus University Medical Centre, Sophia Children'sHospital, 3015 GJ Rotterdam, The Netherlands.
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Walsh M, Morrison TG, McGuire BE. Chronic pain in adults with an intellectual disability: Prevalence, impact, and health service use based on caregiver report. Pain 2011; 152:1951-1957. [DOI: 10.1016/j.pain.2011.02.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 02/01/2011] [Accepted: 02/10/2011] [Indexed: 11/30/2022]
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Kotulska K, Larysz-Brysz M, LePecheur M, Marcol W, Olakowska E, Lewin-Kowalik J, London J. APP/SOD1 overexpressing mice present reduced neuropathic pain sensitivity. Brain Res Bull 2011; 85:321-8. [DOI: 10.1016/j.brainresbull.2011.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 04/23/2011] [Accepted: 05/08/2011] [Indexed: 10/18/2022]
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[Postoperative pain assessment in special patient groups: part II. Children with cognitive impairment]. Schmerz 2011; 25:256-65. [PMID: 21692007 DOI: 10.1007/s00482-011-1061-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Postoperative pain assessment in children with cognitive impairment poses major challenges to healthcare professionals.Children with moderate to severe cognitive impairment are generally unable to communicate effectively and to self-report the level of pain. Difficulties assessing pain have led to their exclusion from clinical trials and rendered them vulnerable to insufficient treatment of pain.The realization of pain is a particularly important step forward for a better care of children with cognitive impairment.Scales based on a child's own perception of pain and its severity play a limited role in this vulnerable population and pain assessment tools which rely on observing pain behavior are essential. The r-FLACC, which is reliable and valid, includes specific behavioral descriptors and can be used simply and effectively postoperatively in clinical practice. Our task has to be assessing pain as a routine procedure in cognitively impaired children as a keystone for an improved and successful pain management in this very sensitive patient population.
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The expression and assessment of emotions and internal states in individuals with severe or profound intellectual disabilities. Clin Psychol Rev 2011; 31:293-306. [PMID: 21382536 DOI: 10.1016/j.cpr.2011.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 11/20/2022]
Abstract
The expression of emotions and internal states by individuals with severe or profound intellectual disabilities is a comparatively under-researched area. Comprehensive or standardized methods of assessing or understanding the emotions and internal states within this population, whose ability to communicate is significantly compromised, do not exist. The literature base will be discussed and compared to that applicable to the general population. Methods of assessing broader internal states, notably depression, anxiety, and pain within severe or profound intellectual disabilities are also addressed. Finally, this review will examine methods of assessing internal states within genetic syndromes, including hunger, social anxiety, and happiness within Prader-Willi, Fragile-X and Angelman syndrome. This will allow for identification of robust methodologies used in assessing the expression of these internal states, some of which may be useful when considering how to assess emotions within individuals with intellectual disabilities.
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Pain in Children with Down Syndrome: Assessment and Intervention by Parents. Pain Manag Nurs 2010; 11:259-67. [DOI: 10.1016/j.pmn.2009.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 11/17/2022]
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de Knegt N, Scherder E. Pain in adults with intellectual disabilities. Pain 2010; 152:971-974. [PMID: 21112699 DOI: 10.1016/j.pain.2010.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Nanda de Knegt
- Department of Clinical Neuropsychology, VU University, Amsterdam, Netherlands
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Kankkunen P, Jänis P, Vehviläinen-Julkunen K. Pain assessment among non-communicating intellectually disabled people described by nursing staff. Open Nurs J 2010; 4:55-9. [PMID: 21347212 PMCID: PMC3043272 DOI: 10.2174/1874434601004010055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to describe pain assessment among non-communicating intellectually disabled people living in long term care described by nursing staff. The target group of the study consisted of the nursing staff working at seven mental retardation units in different parts of Finland. The data were collected during spring 2008 by a semi-structured questionnaire (Non-communicating Children’s Pain Checklist – Revised, N=222), and the response rate was 82% (n=181). The data were analyzed by statistical methods (Kruskall-Wallis test, Mann-Whitney U test) and by content analysis. The findings were described as parameters, frequencies, percentages, and as statistical significance. The nursing staff considered their competence in identifying pain in non-communicating intellectually disabled people to be adequate, and they were of the opinion that enough attention is paid to pain. Almost all nursing staff assessed pain and the effect of treatment of pain on the basis of behavioural changes. Two thirds assessed the pain based on physiological changes. However, no pain assessment tools were used to assess pain and the effects of managing it. Two thirds of the staff considered the pain threshold to be high among non-communicating intellectually disabled people. The findings of this study can be utilized in nursing practice and research, as well as in further education for pain assessment. Additional studies are needed to develop pain assessment to be more systematic among non-communicating intellectually disabled people.
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Affiliation(s)
- Päivi Kankkunen
- Itä-Suomen Yliopisto, Kuopion Kampus, Hoitotieteen Laitos, PL 1627 70211, Kuopio, Finland
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Valkenburg AJ, van Dijk M, de Klein A, van den Anker JN, Tibboel D. Pain management in intellectually disabled children: Assessment, treatment, and translational research. ACTA ACUST UNITED AC 2010; 16:248-57. [DOI: 10.1002/ddrr.117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Symons FJ, Harper V, Shinde SK, Clary J, Bodfish JW. Evaluating a sham-controlled sensory-testing protocol for nonverbal adults with neurodevelopmental disorders: self-injury and gender effects. THE JOURNAL OF PAIN 2010; 11:773-81. [PMID: 20418171 DOI: 10.1016/j.jpain.2009.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/27/2009] [Accepted: 11/19/2009] [Indexed: 11/16/2022]
Abstract
UNLABELLED Ambiguous or blunted responses to sensory and painful stimuli among individuals with severe intellectual disabilities and comorbid communicative impairments put them at risk for having their experience of pain discounted and their expression of pain misinterpreted. Valid measurement procedures of behavioral expression are critical for this vulnerable group of individuals. We investigated a sham-controlled sensory-testing protocol as an approach to guard against observer bias during nonverbal behavioral recording for individuals with intellectual disabilities. Participants were 44 (52% male) adults (mean age = 46, sd = 10) with moderate (14%) and severe to profound (86%) intellectual impairment. The facial behavior of the participants before, during, and after 5 sensory-stimulation modalities (pin prick, light touch, deep pressure, cool, warm) was coded by 3 raters using the Facial Action Coding System (FACS). For each participant, the 5 active sensory trials were randomized with sham trials during which no stimulation was applied. Observers were blinded to active vs sham stimulation status. FACS scores increased significantly during active sensory trials (P < .05) compared with sham trials. There were significant effects for gender, with females more expressive than males (P < .05). There were also significant effects for the presence of self-injurious behavior (SIB), with individuals with SIB more expressive than individuals without SIB (P < .05). The results suggest that the procedure was valid (ie, distinguished between active vs sham sensory stimulation) and provides additional evidence that individuals with significant intellectual impairments are sensitive to tactile stimulation consistent with quantitative sensory-testing protocols. PERSPECTIVE This article presents a novel application of a modified approach to quantitative sensory testing for nonverbal adults with intellectual and developmental disabilities. This approach could be important in helping determine sensory issues related to tactile and nociceptive processes among a highly vulnerable group of individuals.
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Affiliation(s)
- Frank J Symons
- Department of Educational Psychology, University of Minnesota, 56 River Road, Minneapolis, MN 55455, USA.
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