Children with cerebral palsy: A cross-sectional study of their sleep and their caregiver's sleep quality, psychological health and well-being

Comparing Physical Activity and Quality of Life of Caregivers of Children With Physical Disabilities and Typically Developing Children

There are conflicting reports of the level of physical activity (PA) and its relationship to quality of life (QoL) among caregivers of children with physical disabilities (CwPD). In this cross-sectional study, we aimed to compare the PA levels and QoL of two groups of caregivers - a CwPD group and caregivers of typically developing children (CwTD). We included 32 family caregivers in the CwPD group (22 women, 10 men; M age = 42.1, SD = 6.2 years) and 32 caregivers in the CwTD group (24 women, 8 men; M age = 42.3, SD = 6.1 years). We assessed PA with the International Physical Activity Scale-Short Form (IPAQ-SF) and self-reported activity diaries, and we assessed QoL with the Short-Form 36 (SF-36) questionnaire. Although the IPAQ scores and sitting times of caregivers in these two groups were not statistically different (p > .05), many parameters of self-reported activity diary data and total energy expenditure were significantly higher in the CwPD than the CwTD group (p < .05, effect size = .53-1.10). The CwPD group reported a lower QoL according to the SF-36 and its sub-scores (p < .05, effect size = .54-.77), and higher PA levels than those in the CwTD group. In the CwPD group, moderate, vigorous, and total PA scores were mildly to moderately associated with the total Qol score, and many of its subscores (r = .36 to .60, p < .05). The lower quality of life observed in CwPD, despite high-intensity physical activity levels, suggested that investigators and care providers should consider QoL in the CwPD group to be multifactorial and that here is a need for caregiver interventions to enhance QoL in this underserved population.

The relationship between sleep quality and anxiety and depression among older caregivers of centenarians in China: A cross-sectional study

To explore the relationship between sleep quality and anxiety and depression in older caregivers. From April 2020 to November 2022, GAD-7, GDS-15, and PSQI were used to measure anxiety, depression, and sleep quality. The correlation of each variable was explored by regression analysis. Among 442 caregivers ≥ 65 years old, the prevalence of sleep disorders, anxiety, and depression was 40.5 %, 20.2 %, and 26.4 %. After adjustment for multiple potential confounders, anxiety (OR1.1; 95 % CI 1-1.2) and depression (OR 1.29; 95 % CI 1.21-1.38) were associated with sleep disorders. Daytime dysfunction components of PSQI measurements were associated with anxiety(P < 0.05). Meanwhile, sleep efficiency, sleep medication use, and daytime dysfunction components of PSQI measurements were associated with depression(P < 0.05). Therefore, the sleep quality of older caregivers is strongly related to anxiety and depression. It is necessary to provide sleep guidance or professional intervention for older caregivers to reduce anxiety and depression.

Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review

OBJECTIVES

To identify caregiver and children factors associated with caregiver burden on primary caregivers of children with cerebral palsy (CP).

DESIGN

Systematic review DATA SOURCES: Seven electronic databases, including PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, CINAHL and Embase, were systematically searched up to 1 February 2023.

ELIGIBILITY CRITERIA

Original observational studies reporting caregiver burden and related factors among caregivers of children with CP.

DATA ABSTRACTION AND SYNTHESIS

Two reviewers independently screened results and assessed the quality of studies. Title, abstract, full-text screening and data abstraction were done independently by two reviewers. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The quality of evidence for factors was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

16 articles were included in the review. All studies were cross-sectional and examined caregiver-reported burden measures. The Zarit Burden Interview was the most commonly used questionnaire. Depression of caregiver and severity of illness in children with CP were moderate quality of evidence for factors contributing to caregiver burden.

CONCLUSIONS

Higher caregiver burden is associated with more depressive feelings and worse life quality of the caregiver, and with more severe physical disability of the children. Future studies should focus on high-quality longitudinal research and appropriate assistance to reduce caregiver burden and improve the quality of caregiving for children with CP.

PROSPERO REGISTRATION NUMBER

CRD42021268284.

Robot-Assisted Gait Training with Trexo Home: Users, Usage and Initial Impacts

Robotic gait training has the potential to improve secondary health conditions for people with severe neurological impairment. The purpose of this study was to describe who is using the Trexo robotic gait trainer, how much training is achieved in the home and community, and what impacts are observed after the initial month of use. In this prospective observational single-cohort study, parent-reported questionnaires were collected pre- and post-training. Of the 70 participants, the median age was 7 years (range 2 to 24), 83% had CP, and 95% did not walk for mobility. Users trained 2–5 times/week. After the initial month, families reported a significant reduction in sleep disturbance (p = 0.0066). Changes in bowel function, positive affect, and physical activity were not statistically significant. These findings suggest that families with children who have significant mobility impairments can use a robotic gait trainer frequently in a community setting and that sleep significantly improves within the first month of use. This intervention holds promise as a novel strategy to impact multi-modal impairments for this population. Future work should include an experimental study design over a longer training period to begin to understand the relationship between training volume and its full potential.

Barriers and Facilitators to Seeking Sleep Solutions for Children With Cerebral Palsy: A Qualitative Study

Background: Published evidence to date suggests that sleep problems are common in children with cerebral palsy (CP). This qualitative study is a follow up to a previously published quantitative phase on the experience and impact of sleep problems in this population. Aims: The aim of this study was to explore the experience and impact of sleep disturbance and seeking of sleep solutions for parents of school aged children with CP. Materials and Methods: Semi-structured 19 qualitative interviews were conducted with parents of children with CP aged 6-12 years. Interview data were transcribed verbatim and the thematic analysis techniques by Braun and Clarke was used to identify themes. Results: Thematic analysis identified 7 themes: (1) My Child Doesn't Fit into the Box, (2) A Mother's Ears are Always On, (3) Sleep Disturbance is like Water Torture, (4) Sleep is One of Many Spot Fires, I Put it on the Backburner, (5) Luck, Money or Jumping Up and Down, (6) There is Never One Silver Bullet and (7) Help: The Earlier the Better. The key finding was that parents of children with CP often described their child's needs being distinct from what is provided by systems and services. Conclusion: Parents face significant challenges sourcing effective sleep solutions for their child with CP. Sleep is often not a priority for either the parent or the clinician as other health problems take precedence. Parents reflected that early sleep intervention for their child was or would have been helpful. The barriers and facilitators to sleep care identified in this study should be used to inform clinical change in care for children with CP. Sleep needs to be prioritized in healthcare for children.