1
|
Elekanachi RU, Lajoie A, Tavukcu S, Snider LM, Dahan-Oliel N. The experience of caregiving for children with rare musculoskeletal conditions: a qualitative study in arthrogryposis multiplex congenita. Orphanet J Rare Dis 2024; 19:235. [PMID: 38877508 PMCID: PMC11179382 DOI: 10.1186/s13023-024-03224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/19/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of rare musculoskeletal conditions that is associated with complex healthcare needs and long-term follow up. The literature reports significant direct, indirect, and psychosocial costs for caregivers of children with neuromuscular conditions. Due to mobility limitations and frequent hospital visits, caring for a child with AMC is complex. Other challenges experienced by caregivers include financial strain, job changes, changes in interpersonal relationships and abandonment. This study was aimed at exploring the lived experience of caregivers of children with AMC. METHODS The present study is part of a larger global mixed methods study. In the initial quantitative aspect of the study, caregivers (n = 158) of children and youths with AMC (aged 0-21 years) responded to a cost of care survey on an electronic platform. Of the 158 participants, 13 caregivers then further consented to participate in the qualitative aspect of the study in which a 60-min semi-structured, individual interview was conducted remotely. Open-ended questions were developed to gain a deeper understanding of the direct and indirect costs of care, their impact on the caregivers' lives and the quality of the care-giving experience. Interviews were transcribed, and a coding scheme was developed drawing from both the existing literature and the content of the interviews. A deductive and inductive thematic analysis was used to analyze the qualitative data using the NVivo® qualitative data analysis software. RESULTS AND CONCLUSION Five themes describing the experiences of caregivers of children with AMC emerged from the analysis of the qualitative data: 1. Impact of the caregiving experience; 2. Cost of childcare; 3. Support system for care; 4. Managing and navigating care; 5. Supporting the child's growth and development. In addition to the results of the thematic analysis, specific recommendations shared by the caregivers included the need for support groups and provision of support to youths to prepare them for adolescence. These findings will inform resource allocation, policymaking, and support services for children with rare conditions, their caregivers and families.
Collapse
Affiliation(s)
- R U Elekanachi
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.
| | - A Lajoie
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
| | - S Tavukcu
- Shriners Hospitals for Children, Montreal, Canada
| | - L M Snider
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
| | - N Dahan-Oliel
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
- Shriners Hospitals for Children, Montreal, Canada
| |
Collapse
|
2
|
Cachecho S, Boruff J, Wong T, Lacombe F, Dahan-Oliel N. Psychosocial wellbeing among children and adults with arthrogryposis: a scoping review. Health Qual Life Outcomes 2021; 19:263. [PMID: 34844631 PMCID: PMC8628374 DOI: 10.1186/s12955-021-01896-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of congenital conditions characterized by joint contractures in two or more body areas. Management of AMC starts early in life and focuses on improving mobility and function through intensive rehabilitation and surgical interventions. Psychosocial wellbeing is an important determinant of health and the psychosocial experience of individuals with AMC should be considered in the management of this condition. The aim of this scoping review was to explore what is known about the psychosocial wellbeing of children and adults with AMC, to identify the outcome measures used and to explore the factors associated with psychosocial outcomes in this population. METHODS A comprehensive search in four databases was conducted. Articles discussing psychosocial outcomes and outcome measures used with children or adults with AMC were included. Data on the measures used, psychosocial outcomes, and factors associated with psychosocial outcomes, were extracted and analyzed descriptively and synthesized narratively. RESULTS Seventeen articles were included in this scoping review, ten including the pediatric population, six including adults and one article including both children and adults with AMC. The most commonly used outcome measures were the PODCI in the pediatric studies, and the SF-36 in studies on adults. In the pediatric studies, psychosocial outcomes were often secondary, compared to the studies on adults. Results showed that in both children and adults, psychosocial outcomes are comparable with the levels of the general population. Qualitative studies reflected the affective needs of this population and issues with emotional wellbeing. Factors such as fatigue and pain were associated with poorer psychosocial outcomes in adults with an impact on social relationships, intimacy and family planning. CONCLUSION Validated outcome measures, qualitative approaches and longitudinal studies are needed to better understand the psychosocial outcomes in AMC over time. Psychosocial support should be part of the multidisciplinary management of AMC throughout the lifespan.
Collapse
Affiliation(s)
- Sarah Cachecho
- Shriners Hospital for Children-Canada, Montreal, Canada.
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Trudy Wong
- Shriners Hospital for Children-Canada, Montreal, Canada
| | - Francis Lacombe
- Orthotist-Prosthetist and Patient Partner, St-Zotique, Canada
| | - Noemi Dahan-Oliel
- Shriners Hospital for Children-Canada, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| |
Collapse
|
3
|
Agranovich OE, Savina MV, Blagoveshchensky ED. [Compensatory and adaptive mechanisms in children with congenital multiple arthrogryposis in the absence of active flexion in the elbow joint]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2021; 98:31-37. [PMID: 33605127 DOI: 10.17116/kurort20219801131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arthrogryposis is one of the most severe congenital orthopedic diseases, characterized by multiple joint contractures, hypoplasia or aplasia of the skeletal muscles of the extremities, as well as severe motor disorders. The use of compensatory strategies allows patients to improve the ability to self-care. OBJECTIVE To study the compensatory strategies in children with arthrogryposis with absent of active flexion in the elbow joint and estimate their dynamic after surgical treatment. MATERIAL AND METHODS We performed a clinical examination of 236 patients with arthrogryposis with deformities of the upper extremities due to arthrogryposis at the age of 10 months to 16 years. The examination was carried out before the operation, as well as at various times (from 1 month to 8 years) after. In 87 cases (67 patients), restoration of active elbow flexion was performed by transposition of latissimus dorsii or pectoralis major to the biceps position. The activity of the muscles involved that most commonly used in compensatory strategies (synergy of m. biceps brachii and m. deltoideus or m.biceps brachii and m. quadriceps femoris) in 10 patients (from 3 to 10 y.o.), was evaluated before and after (from 2 months to 2 years) surgery by surface electromyography. RESULTS It was found that children's compensatory strategies are formed at the age of 6 months to 1 y.o.6 months after surgery, the using of compensatory strategies becomes more rare, and 12-18 months after surgery, when the strength of the forearm muscles was 4 points, they were not used at all. CONCLUSIONS Compensatory strategies in children with the absence of active and preservation of passive flexion in the elbow joint are diverse. They depend on the amplitude of passive and active movements in the shoulder, the function of the hand and deformities of the lower extremities. These strategies in children with arthrogryposis are unstable and completely disappear when active movements in the elbow joint are restored in the functional range.
Collapse
Affiliation(s)
- O E Agranovich
- H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Saint Petersburg, Russia
| | - M V Savina
- H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Saint Petersburg, Russia
| | - E D Blagoveshchensky
- H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Saint Petersburg, Russia.,Higher School of Economics, Moscow, Russia
| |
Collapse
|
4
|
Griffet J, Dieterich K, Bourg V, Bourgeois E. Amyoplasia and distal arthrogryposis. Orthop Traumatol Surg Res 2021; 107:102781. [PMID: 33321243 DOI: 10.1016/j.otsr.2020.102781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
Arthrogryposis multiplex congenita (AMC) consists of congenital joint contractures that affect at least two joints. There are two types: in the first, arthrogryposis is an additional sign in the context of various pathologies (neuromuscular diseases); in the second, it is the main and constant symptom. In the first type, the progression of the causal underlying disease must be considered. In the second type, there are two specific forms: Amyoplasia corresponds to a significant congenital absence of muscles (epigenetic disease or vascular origin) while distal arthrogryposis has a genetic component and is transmissible. The orthopedic surgeon's purpose, which is usually to enhance movement, is not appropriate for an arthrogryposis patient. One must keep in mind that without muscle, movement is impossible. The goal differs between the upper and lower limbs: for the upper limb, it is to allow grasping, and, if possible, to bring the hand to the mouth; for the lower limb, it is to ensure ambulation with plantigrade support, and the knees extended, which is the only stable position possible with little to no muscles. The rehabilitation, orthoses and/or surgical techniques are chosen to achieve this singular aim. While it may appear modest, it is crucial for patients. The goal is to achieve useful mobility, not maximum mobility. This multidisciplinary treatment, which evolves over time, must be explained to the family to get its adherence.
Collapse
Affiliation(s)
- Jacques Griffet
- Service d'orthopédie infantile, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Centre de référence de l'arthrogrypose, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Université Grenoble-Alpes, Université Joseph-Fournier, Grenoble, France.
| | - Klaus Dieterich
- Service de génétique, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Centre de référence de l'arthrogrypose, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Université Grenoble-Alpes, Université Joseph-Fournier, Grenoble, France
| | - Véronique Bourg
- Service de médecine physique et réadaptation pédiatrique, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Centre de référence de l'arthrogrypose, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France
| | - Emeline Bourgeois
- Service d'orthopédie infantile, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France; Centre de référence de l'arthrogrypose, hôpital Couple-Enfant, CHU de Grenoble-Alpes, Grenoble-Alpes, France
| |
Collapse
|
5
|
Dahan-Oliel N, Collins J, Rauch D, Bukovy G, Hamdy R, Rauch F. Bone densities and bone geometry in children and adolescents with arthrogryposis. Bone 2020; 137:115454. [PMID: 32464275 DOI: 10.1016/j.bone.2020.115454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/07/2020] [Accepted: 05/23/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe bone densitometry results using lumbar spine dual-energy X-ray absorptiometry and forearm peripheral quantitative computed tomography (pQCT) in children with arthrogryposis multiplex congenita (AMC). STUDY DESIGN Prospective study. RESULTS Lumbar spine areal bone mineral density (BMD) was measured in 58 participants (mean age 6.8 years, range 1 month to 19.7 years; 26 males). The diagnostic subgroup was Amyoplasia in 27 participants, distal arthrogryposis (unclassified, n = 13; type 2A, n = 1; type 2B, n = 2; type 8, n = 2) in 18 patients, an unclassified form of arthrogryposis in 6 patients, and a syndromic form of arthrogryposis in 7 patients. The mean lumbar spine areal BMD was -0.4 (SD: 1.5) which was significantly below 0 (p < 0.05, one-sample t-test). The mean lumbar spine bone mineral apparent density z-score (+0.4 [SD: 1.4]), a measure that is largely independent of bone size, was not significantly different from 0 (P > 0.05). A subset of 22 patients aged 6 years or older (mean age 10.9 years, 11 males) had forearm pQCT analysis. Mean z-scores for trabecular and cortical volumetric BMD at the radius were similar to healthy controls. Radius periosteal bone circumference and bone mineral content were appropriate for height. These densitometric results did not differ between patients with Amyoplasia or individuals with other diagnoses. CONCLUSIONS Low areal BMD in children and adolescents with AMC reflects their smaller bone size rather than a specific bone mass deficit. These data do not suggest that children and adolescents with AMC in general require regular monitoring by bone densitometry unless there are specific clinical concerns.
Collapse
Affiliation(s)
- Noemi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Damian Rauch
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Gloria Bukovy
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children, Montreal, Quebec, Canada; Faculty of Medicine, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW The orthopaedic treatment of children with arthrogryposis multiplex congenita has evolved steadily over the past two decades. Interrelated factors have spurred this on, including better appreciation of the functional potential of persons with arthrogryposis, development of newer procedures specific for the arthrogrypotic deformities, and outcomes studies that provide understanding of the overall capabilities of adults with arthrogryposis and follow-up to determine which treatments were beneficial and which were not. This article briefly sketches out of some of these advances and indicates areas that need further development. RECENT FINDINGS Outcome studies show that the majority of adults with arthrogryposis are ambulatory but less than half are fully independent. Adults frequently experience ongoing pain, particularly foot and back pain, limiting ambulation and standing. Advancements in the upper extremity treatment include improving elbow function, wrist repositioning, and improving thumb positioning. In the lower extremities, correction of hip and knee contractures leads to improved ambulatory potential, and treating clubfeet with serial casting decreases poor outcomes. SUMMARY Clinical evaluation, both physical examination and assessment of the patient's needs, are important in directing treatment in arthrogryposis. Further outcomes studies are needed to continue to refine procedures and define the appropriate candidates.
Collapse
|
7
|
Castro S, Leite CF, Coenen M, Buchalla CM. The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS. CAD SAUDE PUBLICA 2019; 35:e00000519. [PMID: 31365697 DOI: 10.1590/0102-311x00000519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022] Open
Abstract
Functioning and disability are concepts in increasing use in clinical settings and in public health. From the public health perspective, the use of functioning as a third health indicator could show more than the frequency of a disease and its death rates, offering information on how the population performs its activities and participation. Clinically, the functioning assessment can provide information for patient-centered health care and specific clinical interventions according to their functioning profile. WHODAS 2.0 is a generic tool to assess health and functioning according to the ICF functioning model. It is an alternative to assess functioning in a less time-consuming way, whereas the duration of the application is one of the main ICF critiques. This paper aims to present some of WHODAS 2.0 inconsistencies and weaknesses as well as strategies to cope with them. In this paper, we present some weaknesses related to the WHODAS layout; wording and scoring process. Some suggestions for strategies to correct these weaknesses are presented, as well.
Collapse
|
8
|
Dahan-Oliel N, Cachecho S, Barnes D, Bedard T, Davison AM, Dieterich K, Donohoe M, Fąfara A, Hamdy R, Hjartarson HT, S Hoffman N, Kimber E, Komolkin I, Lester R, Pontén E, van Bosse HJP, Hall JG. International multidisciplinary collaboration toward an annotated definition of arthrogryposis multiplex congenita. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:288-299. [PMID: 31282072 PMCID: PMC6771513 DOI: 10.1002/ajmg.c.31721] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) has been described and defined in thousands of articles, but the terminology used has been inconsistent in clinical and research communities. A definition of AMC was recently developed using a modified Delphi consensus method involving 25 experts in the field of AMC from 8 countries. Participants included health care professionals, researchers, and individuals with AMC. An annotation of the definition provides more in-depth explanations of the different sentences of the AMC definition and is useful to complement the proposed definition. The aim of this study was to provide an annotation of the proposed consensus-based AMC definition. For the annotation process, 17 experts in AMC representing 10 disciplines across 7 countries participated. A paragraph was developed for each sentence of the definition using an iterative process involving multiple authors with varied and complementary expertise, ensuring all points of view were taken into consideration. The annotated definition provides an overview of the different topics related to AMC and is intended for all stakeholders, including youth and adults with AMC, their families, and clinicians and researchers, with the hopes of unifying the understanding of AMC in the international community.
Collapse
Affiliation(s)
- Noémi Dahan-Oliel
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sarah Cachecho
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | | | - Tanya Bedard
- Clinical Genetics, Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Ann M Davison
- Biology Department, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Klaus Dieterich
- Department of Medical Genetics, Reference Center for Developmental Anomalies, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Maureen Donohoe
- Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware
| | - Alicja Fąfara
- Faculty of Health Science, Jagiellonian University Medical College, Institute of Physiotherapy, Arthrogryposis Treatment Centre, University Children's Hospital, Krakow, Poland
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Montreal, Quebec, Canada.,Division of Pediatric Orthopaedics, McGill University, Montreal, Quebec, Canada
| | - Helgi T Hjartarson
- Department of Neuropediatrics, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | | | - Eva Kimber
- Department of Pediatrics, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Igor Komolkin
- Department of Children Surgery, Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
| | - Ruth Lester
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Eva Pontén
- Department of Pediatric Orthopaedic Surgery, Institute of Women's and Children's Health, Karolinska University Hospital, Solna, Sweden
| | - Harold J P van Bosse
- Department of Orthopaedics, Temple University, Philadelphia, Pennsylvania.,Shriners Hospital for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Judith G Hall
- Department of Pediatrics and Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Sawatzky B, Jones T, Miller R, Noureai H. The relationship between joint surgery and quality of life in adults with arthrogryposis: An international study. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:469-473. [PMID: 31260181 DOI: 10.1002/ajmg.c.31720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
Individuals with Arthrogryposis Multiplex Congenita (AMC) are born with multiple joint contractures in multiple body areas, typically manifested as clubfeet, extended or flexed knees and/or elbows, and internal shoulder rotation, and clasped hands. They require multiple surgeries as children, but there is little data that reports their aging and future quality of life (QOL). This study describes the relationship between AMC-related surgically-managed joints in childhood and adulthood, and QOL as adults. Participants (n = 83) from 14 countries completed an online questionnaire followed by a telephone/Skype interview as adults. Data points collected regarding total number of surgeries, affected joints, country of origin, sex, age, and SF-36's Physical Capacity Score (PCS) for QOL were analyzed using a beta regression model to explore which factors may potentially influence adult QOL. The average number of surgeries per participant was 9.8, with at least 50% performed during childhood. 78, 45, and 31% of participants had foot, knee, and hip surgeries, respectively. The model demonstrated that knee and/or shoulder surgeries were more likely to have a negative correlation with PCS; elbow surgery, however, showed a positive correlation, as elbow function may impact independent function. However, future expansion of this data set to a longitudinal registry would provide better ongoing surgery-specific data.
Collapse
Affiliation(s)
- Bonita Sawatzky
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Talon Jones
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Miller
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hirmand Noureai
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Sawatzky B, Dahan‐Oliel N, Davison A, Hall J, Van Bosse H, Mortenson WB. Development of an online registry for adults with arthrogryposis multiplex congenita: A protocol paper. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:454-460. [DOI: 10.1002/ajmg.c.31706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Bonita Sawatzky
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
| | - N. Dahan‐Oliel
- Department of Rehabilitation Therapy, Shriner's Hospital for Children Montreal Quebec Canada
| | | | - Judith Hall
- Department of Medical GeneticsUniversity of British Columbia Vancouver British Columbia Canada
| | | | - W. Ben Mortenson
- Occupational Science and Occupational TherapyUniversity of British Columbia Vancouver British Columbia Canada
| | | |
Collapse
|