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Rinde ER, Anderzén-Carlsson A, Jahnsen RB, Andersen RD. Children with Cerebral Palsy and Their Parents Have Different Experiences of Pain Management: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1055. [PMID: 39334588 DOI: 10.3390/children11091055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Aim: The aim of this study is to explore and compare experiences of pain management strategies for children with CP from the perspectives of children themselves and their parents. Methods: A secondary inductive analysis of previously collected qualitative data was performed. Fourteen children with CP and one parent of each child were interviewed separately about the management of the child's pain. A dyadic data analysis was used to compare parents' and children's perspectives. Findings: The main thematic categories of pain management identified were self-care, psychological strategies, physical interventions and professional treatment. Experiences described by the child and parent differed within all participating dyads but to different degrees. On a group level, children described more use of psychological strategies than parents did. Parents described more professional treatment strategies. Conclusions: Parents and children described different experiences of pain management strategies, and both perspectives are needed to understand the child's situation.
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Affiliation(s)
- Elisabeth Rønning Rinde
- Division of Habilitation, Telemark Hospital Trust, 3710 Skien, Norway
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Agneta Anderzén-Carlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, 2406 Elverum, Norway
| | - Reidun Birgitta Jahnsen
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
- NorCP, Department of Clinical Neurosciences for Children, Oslo University Hospital, 0450 Oslo, Norway
| | - Randi Dovland Andersen
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
- Department of Research, Telemark Hospital Trust, 3710 Skien, Norway
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Lyons-Warren AM, Guez-Barber D, Thomas SP, Tantry EK, Mahat A, Aravamuthan B. Sensory Symptoms Across the Lifespan in People With Cerebral Palsy. Pediatr Neurol 2024; 157:157-166. [PMID: 38924827 PMCID: PMC11257800 DOI: 10.1016/j.pediatrneurol.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND To estimate the prevalence of sensory symptoms in people with cerebral palsy (CP) across the lifespan. METHODS In this cross-sectional study, the self-reported Sensory Processing Scale Inventory (SPS-I) was administered via Research Electronic Data Capture (REDCap) between February 1, 2022, and August 15, 2022, to people with CP or their caregivers enrolled in the online MyCP Community Registry. We determined the association between SPS-I scores and age (Pearson correlation) and functional status as assessed using five validated functional classification systems for CP (analysis of variance [ANOVA]). We hypothesized that sensory symptoms would differ between younger and older individuals with CP. RESULTS Of 155 responses (28% response rate, age one to 76 years, 34% male), 97% reported at least one bothersome sensory symptom. Total sensory symptoms decreased with age (R2 = 0.12, P < 0.0001), driven by decreases in hyposensitivity symptoms (R2 = 0.32, P < 0.0001), primarily tactile hyposensitivity (R2 = 0.29, P < 0.0001). Sensory symptoms increased with greater functional impairment across all functional domains (ANOVA, P < 0.0001). However, the age-specific decrease in hyposensitivities was most pronounced in people with the greatest gross motor functional impairment (R2 = 0.70, P = 0.0004). CONCLUSION Our findings suggest that hyposensitivity, primarily tactile sensitivity, decreases with age in people with CP. Future work should assess whether decreased hyposensitivity contributes to other age-related changes in CP like increased pain.
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Affiliation(s)
- Ariel M Lyons-Warren
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Danielle Guez-Barber
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sruthi P Thomas
- H. Ben Taub Department of Physical Medicine and Rehabilitation and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Evelyne K Tantry
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Aditya Mahat
- Department of Pediatric-Neurology, Children's Mercy Hospital, Kansas City, Missouri
| | - Bhooma Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
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Smith MG, Gibson RJ, Russo RN, Karanicolas S, Harvey AR. Examining tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy: stakeholder preference and recommendations for modification. Qual Life Res 2024; 33:2247-2259. [PMID: 38795198 PMCID: PMC11286630 DOI: 10.1007/s11136-024-03693-1] [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] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To firstly identify tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy (CP), and secondly identify suggestions to improve their relevance, comprehensiveness, comprehensibility and feasibility for the CP population. Improving assessment of the impact of pain on emotional functioning can enhance quality of life by improving access to interventions for pain-related physical disability, anxiety and depression. METHODS Ethics approval was granted through the Women's and Children's Health Network Human Research Ethics Committee (2022/HRE00154). A mixed methods study with people with lived experience and clinicians, and guided by the Consensus-based Standards for Measurement Instruments (COSMIN), was undertaken. An online survey identified the highest rated tools for validation and/or modification for young people with CP and chronic pain. Focus groups and interviews investigated content validity and feasibility of the tools identified as highest rated. RESULTS The Fear of Pain Questionnaire for Children-SF (FOPQ-C-SF) and Modified Brief Pain Inventory (mBPI) were the highest rated for pain coping and multidimensional assessment (respectively) from the online survey (n = 61) of eight tools presented. Focus group and interview data (n = 30), including 58 unique modification suggestions, were coded to six categories: accessibility, comprehensibility, feasibility, relevance, presentation and comprehensiveness. CONCLUSION Potential modifications have been identified to improve the appropriateness and feasibility of the FOPQ-C-SF and mBPI for children and young people with CP. Future research should implement and test these modifications, prioritising the involvement of people with lived experience to ensure their needs are met alongside clinicians.
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Affiliation(s)
- Meredith Grace Smith
- School of Allied Health Science and Practice, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.
| | - Rachel J Gibson
- School of Allied Health Science and Practice, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Remo N Russo
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Paediatric Rehabilitation Department, Women's and Children's Hospital, Adelaide, Australia
| | | | - Adrienne R Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Nakamura N, Kawabe Y, Momose T, Oba M, Yamamoto K, Takamasu T, Suzuki M, Nakamura N, Koba M. Adoption of an Enhanced Recovery after Surgery Protocol for Neuromuscular Scoliosis Shortens Length of Hospital Stay. Spine Surg Relat Res 2024; 8:427-432. [PMID: 39131418 PMCID: PMC11310540 DOI: 10.22603/ssrr.2023-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/04/2023] [Indexed: 08/13/2024] Open
Abstract
Introduction We aimed to implement the enhanced recovery after surgery (ERAS) protocol for pediatric neuromuscular scoliosis (NMS) surgery and to examine the effectiveness of this program in this study. Methods Subjects were children with NMS who underwent scoliosis surgery at our department by a surgeon using a single posterior approach. A series of 27 cases before the introduction of ERAS and 27 cases during program stabilization were included in the study. Patient backgrounds did not show significant differences before and after introducing ERAS. Perioperative data, complications, length of hospital stay (LOS), and readmission within 90 days were investigated and statistically analyzed. Results When the pre- and post-ERAS induction groups were compared, no significant differences in anesthesia induction time (p=0.979), pelvic fixation (p=0.586), fusion levels (p=0.479), intraoperative hypothermia duration (p=0.154), end-of-surgery body temperature (p=0.197), operative time (p=0.18), postoperative main Cobb angle (p=0.959), main Cobb angle correction rate (p=0.91), postoperative spino-pelvic obliquity (SPO) (p=0.849), and SPO correction rate (p=0.267) were observed. However, significant differences in using V-flap technique (p=0.041), intraoperative blood loss (p=0.001), and LOS (p=0.001) were observed. Intraoperative blood loss was weakly correlated with LOS (p=0.432 and 0.001). No statistically significant difference existed between the V-flap method and LOS (p=0.265). Multiple regression analysis using LOS as the objective variable and ERAS protocols and intraoperative blood loss as explanatory variables revealed that the effect of ERAS on LOS was greater than that of intraoperative blood loss. No statistically significant differences in the readmission rates within 90 days were found. Conclusions After the introduction of ERAS, LOS decreased without an increase in complications or readmissions within 90 days.
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Affiliation(s)
- Naoyuki Nakamura
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuichiro Kawabe
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takako Momose
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masatoshi Oba
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Tetsuya Takamasu
- Department of Pediatrics and Nutrition Support Team (NST), Kanagawa Children's Medical Center, Yokohama, Japan
| | - Mayuko Suzuki
- Department of Nursing and NST, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nobuto Nakamura
- Department of Anesthesiology and NST, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Miki Koba
- Department of Nutrition and NST, Kanagawa Children's Medical Center, Yokohama, Japan
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Bakuwa TC, Saloojee G, Slemming W. "This can certainly work…": stakeholder perspectives of the feasibility of a caregiver-led training program for caregivers of children with cerebral palsy in a rural setting in Malawi. Front Public Health 2024; 12:1390645. [PMID: 39026596 PMCID: PMC11256784 DOI: 10.3389/fpubh.2024.1390645] [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: 02/26/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Caregiver training is a key component of rehabilitation for children with complex lifelong disabilities such as cerebral palsy. However critical shortages of therapists in low- and middle-income countries like Malawi, reduce access to therapy. Introducing expert caregivers to assist with the provision of basic training on the condition for fellow caregivers offers a potential solution. However, there is a paucity of evidence regarding the implementation of such strategies in low-resource settings. The aim of this study was to explore perspectives of stakeholders regarding the feasibility of implementing a caregiver-led and delivered training program for caregivers of children with cerebral palsy in Malawi. Methods Over 5 days in January 2023, a caregiver-led training program, the "Malamulele Onward Carer-to-Carer Training Program," was conducted in Blantyre, Malawi. A South African master trainer traveled to Malawi and delivered the program to potential stakeholders including caregivers of children with cerebral palsy; physiotherapists; and community-based organization representatives. Stakeholder perspectives regarding the acceptability, demand, practicality and adaptation of the program were obtained through a combination of focus group discussions, in-depth interviews, and daily field notes. Data from the focus group discussions and in-depth interviews were analyzed using thematic analysis. Results The caregiver-led training program was deemed acceptable despite two areas identified as potential areas of concern; that the expert caregivers may cross practice boundaries and that their fellow caregivers may look down upon them. A demand for this program was expressed because of perceived relative advantages and relevance to caregiver needs. Participants indicated that the intervention could be easily delivered using local materials, absorbed and supported by existing community structures. Conclusion A caregiver-led training program offers an innovative way of supporting caregivers of children with complex disabilities such as cerebral palsy in low-resource settings. The stakeholder engagement demonstrated the positive perspectives of all stakeholders. The areas for modification and adaptation highlighted by the stakeholders will be useful in strengthening the implementation of the program in Malawi.
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Affiliation(s)
- Takondwa Connis Bakuwa
- Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Division of Community Pediatrics, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Gillian Saloojee
- Department of Physiotherapy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Wiedaad Slemming
- Division of Community Pediatrics, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Children’s Institute, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Johannesburg, South Africa
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Sabater-Gárriz Á, Montoya P, Riquelme I. Enhanced EEG power density during painful stretching in individuals with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 150:104760. [PMID: 38795555 DOI: 10.1016/j.ridd.2024.104760] [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: 12/28/2023] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Pain perception mechanisms in cerebral palsy remain largely unclear. AIMS This study investigates brain activity in adults with cerebral palsy during painful and non-painful stretching to elucidate their pain processing characteristics. METHODS AND PROCEDURES Twenty adults with cerebral palsy and 20 controls underwent EEG in three conditions: rest, non-painful stretching, and painful stretching. Time-frequency power density of theta, alpha, and beta waves in somatosensory and frontal cortices was analyzed, alongside baseline pressure pain thresholds. OUTCOMES AND RESULTS Cerebral palsy individuals exhibited higher theta, alpha, and beta power density in both cortices during painful stretching compared to rest, and lower during non-painful stretching. Controls showed higher power density during non-painful stretching but lower during painful stretching. Cerebral palsy individuals had higher pain sensitivity, with those more sensitive experiencing greater alpha power density. CONCLUSIONS AND IMPLICATIONS These findings confirm alterations in the cerebral processing of pain in individuals with cerebral palsy. This knowledge could enhance future approaches to the diagnosis and treatment of pain in this vulnerable population.
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Balearic ASPACE Foundation, Marratxí, Spain; Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Montoya
- Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Inmaculada Riquelme
- Health Research Institute of the Balearic Islands (IUNICS-IdISBa), University of the Balearic Islands, Palma de Mallorca, Spain; Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain.
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Silva LTD, Frusca-DO-Monte CM, Almeida GS, Silva VCD, Lorenzato CS, Bendo CB, Menezes JVNB, Torres-Pereira CC, Fraiz FC. Quality of life in children and adolescents with blood coagulation disorders and hemoglobinopathies. Braz Oral Res 2024; 38:e052. [PMID: 38922212 PMCID: PMC11376638 DOI: 10.1590/1807-3107bor-2024.vol38.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/29/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of this study was to evaluate the impact of oral conditions and health-related quality of life (HRQoL) on oral health-related quality of life (OHRQoL) in children and adolescents with blood coagulation disorders and hemoglobinopathies (BCDH). The study was cross-sectional and included 61 individuals aged 2 to 18 years with BCDH. Exams for dental caries (dmft/DMFT index), oral hygiene (simplified oral hygiene index - OHI-S), and gingival health (modified gingival index - MGI) were performed. The pediatric quality of life inventory™ (PedsQL™) generic core scale and oral health scale were used to measure HRQoL and OHRQoL. Spearman's correlation coefficient (ρ) and the Mann-Whitney test (α = 0.05) were conducted to assess the relationship between covariates and the PedsQL™ oral health scale. The mean PedsQL™ oral health scale score was 76.66 (SD = 21.36). Worse OHRQoL was correlated with poor oral hygiene (ρ = -0.383; p: 0.004), poor gingival health (ρ = -0.327; p = 0.014), and better HRQoL (ρ = 0.488; p < 0.001). Greater untreated dental caries experience was associated with worse OHRQoL (p = 0.009). Worse oral health status in children and adolescents with BCDH negatively impacts OHRQoL, and OHRQoL and quality of life analyzed from a generic perspective are positively correlated constructs in this population.
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Affiliation(s)
- Leandro Tavares da Silva
- Universidade Federal do Paraná - UFPR, School of Dentistry, Department of Stomatology, Curitiba, PR, Brazil
| | | | - Gabriela Silva Almeida
- Universidade Federal do Paraná - UFPR, School of Dentistry, Department of Stomatology, Curitiba, PR, Brazil
| | - Victor Cordeiro da Silva
- Universidade Federal do Paraná - UFPR, School of Dentistry, Department of Stomatology, Curitiba, PR, Brazil
| | | | - Cristiane Baccin Bendo
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Pediatric Dentistry, Belo Horizonte, MG, Brazil
| | | | | | - Fabian Calixto Fraiz
- Universidade Federal do Paraná - UFPR, School of Dentistry, Department of Stomatology, Curitiba, PR, Brazil
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Kittelson T, Kittelson-Aldred A, Justad JM, Hoffman LA, Coombs NC. The Montana Postural Care Project: A pilot study implementing posture care management in a rural, low-resource region. Heliyon 2024; 10:e31752. [PMID: 38841462 PMCID: PMC11152931 DOI: 10.1016/j.heliyon.2024.e31752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Background Mobility impairment limits control of posture and body alignment. This leads to altered body shapes, co-occurring problems with pain and sleep, cardiopulmonary concerns, digestive health issues, and emergent health outcomes, which further complicate functions of daily living. 24-hour posture care management was developed to remedy these challenges by restoring body symmetry. Objective To determine the feasibility of introducing posture care management to a rural-based, medically complex patient population, evaluate response of body symmetry, and examine its impact on pain and sleep quality. Methods This pilot study employed a longitudinal, quasi-experimental study design from March 2016 to September 2018. The posture care management intervention introduced positioning support for use when lying down, a personalized training workshop for caregiver teams, and in-home initial and follow-up assessments to provide materials and collaboratively develop a personalized care plan. Participants were followed pre-post for 6-9 months. Results A total of 73 participants enrolled in the study; 55 (75 %) completed. The majority were male (55 %) with a median age of 11. Most caregivers were immediate family members, and most participants had 1+ diagnosis characterized as a neurodevelopmental disorder. A majority of participants improved body symmetry (56-76 %), and 53 % with comparable information saw improvement in body symmetry with no worsening of pain or sleep quality. Conclusion This study established the feasibility of administering posture care management in North America. These findings provide preliminary evidence of improvements in body symmetry and address concerns that posture care management can interfere with pain and sleep. Future research should consider levels of caregiver engagement and explore remote-monitored options of a posture care management intervention.
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Affiliation(s)
- Tamara Kittelson
- Posture 24/7, Minneapolis, MN, USA
- Specialty Occupational Therapy, LLC, Minneapolis, MN, USA
| | | | - Jean M. Justad
- Montana Developmental Disability Program, Department of Public Health and Human Services, Helena, MT, USA
| | | | - Nicholas C. Coombs
- School of Public & Community Health Sciences, University of Montana, Missoula, MT, USA
- Piedmont Research Strategies, Greensboro, NC, USA
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Harvey A, Smith N, Smith M, Ostojic K, Berryman C. Chronic pain in children and young people with cerebral palsy: a narrative review of challenges, advances, and future directions. BMC Med 2024; 22:238. [PMID: 38862988 PMCID: PMC11167894 DOI: 10.1186/s12916-024-03458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Cerebral palsy (CP), the most common physical disability of childhood, is often accompanied by a range of comorbidities including pain. Pain is highly prevalent in children and young people with CP, yet has been poorly understood, inaccurately assessed, and inadequately managed in this vulnerable population. This narrative review presents recent research advances for understanding and managing pain in children and young people with CP, focusing on chronic pain, and highlights future research directions. MAIN BODY Pain prevalence rates in CP vary due to different methodologies of studies. Recent systematic reviews report up to 85% of children experience pain; higher in older children, females, and those with dyskinesia and greater motor impairment. Research examining the lived experience perspectives of children and their families demonstrate that even those with mild motor impairments have pain, children want to self-report pain where possible to feel heard and believed, and management approaches should be individualized. Notably, many children with cognitive and communication impairments can self-report their pain if adjustments are provided and they are given a chance. Past inadequacies of pain assessment in CP relate to a focus on pain intensity and frequency with little focus on pain interference and coping, a lack of tools appropriate for the CP population, and an assumption that many children with cognitive and/or communication limitations are unable to self-report. Recent systematic reviews have identified the most reliable and valid assessment tools for assessing chronic pain. Many were not developed for people with CP and, in their current form, are not appropriate for the spectrum of physical, communication, and cognitive limitations seen. Recently, consensus and co-design in partnership with people with lived experience and clinicians have identified tools appropriate for use in CP considering the biopsychosocial framework. Modifications to tools are underway to ensure feasibility and applicability for the spectrum of abilities seen. CONCLUSION Recent research advances have improved our understanding of the prevalence, characteristics and lived experience of chronic pain, and refined assessment methods in children and young people with CP. However, the very limited evidence for effective and novel management of chronic pain in this population is where research should now focus.
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Affiliation(s)
- Adrienne Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Nadine Smith
- Kids Rehab, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Meredith Smith
- School of Allied Health Science and Practice, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Katarina Ostojic
- Community Paediatrics Research Group, Sydney Medical School, The University of Sydney, Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2050, Australia
| | - Carolyn Berryman
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, North Tce, Adelaide, South Australia, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Medical Research Institute (SAHMRI), North Tce, Adelaide, South Australia, 5005, Australia
- Paediatric Chronic Pain Service, Women's and Children's Hospital, King William Rd, North Adelaide, South Australia, 5006, Australia
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Smith NL, Gibson N, Bear N, Thornton AL, Imms C, Smith MG, Harvey AR. Measurement properties and feasibility of chronic pain assessment tools for use with children and young people with cerebral palsy. Disabil Rehabil 2024:1-15. [PMID: 38856092 DOI: 10.1080/09638288.2024.2362398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Chronic pain assessment tools exist for children, but may not be valid, reliable, and feasible for populations with functional, cognitive or communication limitations, for example, cerebral palsy (CP). This study aimed to (i) identify chronic pain assessment tools used with children and young people and rate their measurement properties; (ii) develop a CP specific feasibility rating tool to assess the feasibility of tools in CP; and (iii) categorise tools according to reporting method. MATERIALS AND METHODS Assessment tools were identified by literature review. Their measurement properties were rated using the COnsensus based standards for the Selection of health Measurement INstruments. The CP specific Feasibility Rating Tool was developed and used to rate the tools. RESULTS Fifty-seven chronic pain assessment tools were identified. Six have content validity for CP, four of these use proxy-report. Forty-two tools were considered feasible for people with CP; 24 self report and 18 observational/proxy-report. Only the Paediatric Pain Profile has content validity and feasibility for people with CP unable to self-report. CONCLUSIONS There are few valid, reliable and feasible tools to assess chronic pain in CP. Further research is required to modify tools to enable people with cognitive limitations and/or complex communication to self-report pain.
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Affiliation(s)
- Nadine L Smith
- Kids Rehab WA, Perth Children's Hospital, Nedlands, WA, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, WA, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Crawley, WA, Australia
| | - Noula Gibson
- Kids Rehab WA, Perth Children's Hospital, Nedlands, WA, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, WA, Australia
| | - Natasha Bear
- Institute for Health Research, Notre Dame University, Perth, WA, Australia
| | - Ashleigh L Thornton
- Kids Rehab WA, Perth Children's Hospital, Nedlands, WA, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Christine Imms
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Meredith G Smith
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- Novita Disability Services, Adelaide, SA, Australia
| | - Adrienne R Harvey
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Cooper C, Linden M, Kerr C. Social participation in adults with cerebral palsy: a systematic review of the evidence-base. Disabil Rehabil 2024; 46:2720-2733. [PMID: 37497638 DOI: 10.1080/09638288.2023.2236026] [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: 06/28/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To identify and synthesise the current evidence on social participation in adults with cerebral palsy (CP). METHODS Four databases (PubMed, CINAHL Plus, PsycINFO, Web of Science) were systematically searched between December 2021 and February 2022. Pre-specified eligibility criteria were applied to all identified studies resulting in the inclusion of 16 articles. Data extraction was performed using a standardised tool and quality appraisal was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis approach was taken for data analysis. RESULTS The 16 included studies were rated as high (n = 11) and medium quality (n = 5). Numbers of participants included in the studies ranged from 7 to 335. Definitions of social participation were discussed. Common themes were identified: the impact of home and work environments on social participation, the importance of age-appropriate support and interventions, and the impact of limited autonomy on social participation. CONCLUSIONS Adults with CP experience limited social participation due to lack of appropriate support in childhood, issues across the lifespan including physical limitations when ageing, and factors such as societal expectations and inaccessible environments which limit opportunities for autonomy. Social participation may be improved by supporting families to provide opportunities in childhood, providing timely interventions, and by enhancing autonomy.
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Affiliation(s)
- Claire Cooper
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Mark Linden
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Kerr
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Koch A, Kasprzyk M, Musielak B, Jóźwiak M. Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy. J Child Orthop 2024; 18:315-321. [PMID: 38831856 PMCID: PMC11144373 DOI: 10.1177/18632521241233165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/31/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy. Methods We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire. Results We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally. Conclusion Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy. Level of evidence IV case series.
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Affiliation(s)
| | - Maciej Kasprzyk
- Maciej Kasprzyk, Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545 Poznań, Poland.
| | - Bartosz Musielak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jóźwiak
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
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Shekari Z, Sadeghian Afarani R, Fatorehchy S, Bakhshi E, Shahshahani S, Mousavi E. Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy. Pediatr Neurol 2024; 155:84-90. [PMID: 38608553 DOI: 10.1016/j.pediatrneurol.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management. METHODS A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance. RESULTS There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072). SIGNIFICANCE Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.
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Affiliation(s)
- Zahra Shekari
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Sadeghian Afarani
- Masters' Student, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saeid Fatorehchy
- Assistant Professor, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Professor, Department of Biostatistics and Epidemiology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Soheila Shahshahani
- Associate Professor, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elahe Mousavi
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Jarlman E, Hägglund G, Alriksson-Schmidt AI. Foot and lower leg pain in children and adults with cerebral palsy: a population-based register study on 5,122 individuals. BMC Musculoskelet Disord 2024; 25:391. [PMID: 38762469 PMCID: PMC11102238 DOI: 10.1186/s12891-024-07486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Pain is common in individuals with cerebral palsy (CP) and the most reported pain site is the foot/lower leg. We analyzed the prevalence of pain in the foot/lower leg and the associations with age, sex, gross motor function, and clinical findings in individuals with CP. METHOD This was a cross-sectional register-study, based on data reported to the Swedish Cerebral Palsy Follow-up Program (CPUP). All participants in CPUP, four years-of-age or older, were included. Pearson chi-square tests and logistic regression were used to analyze the prevalence and degree of pain in the foot/lower leg. RESULTS In total, 5,122 individuals were included from the CPUP database: 58% were males and 66% were under 18 years-of-age. Overall, 1,077 (21%) reported pain in the foot/lower leg. The odds ratios (ORs) of pain were higher in females (OR 1.31, 95% confidence interval (CI) 1.13-1.53), individuals who could ambulate (Gross Motor Function Classification System Level I (OR 1.84, CI 1.32-2.57) and II (OR 2.01, CI 1.46-2.79) compared to level V), and in individuals with decreased range of motion of the ankle (dorsiflexion 1-10 degrees (OR 1.43, CI 1.13-1.83) and ≤ 0 degrees (OR 1.46, CI 1.10-1.93) compared to ≥ 20 degrees). With increasing age the OR of pain increased (OR 1.02, CI 1.01-1.03) as well as the reported pain intensity (p < 0.001). CONCLUSIONS Pain in the foot and lower leg appears to be a significant problem in individuals with CP, particularly in those who walk. As with pain in general in this population, both pain intensity and frequency increase with age. The odds of pain in the foot and lower leg were increased in individuals with limited dorsiflexion of the ankle. Given the cross-sectional design causality cannot be inferred and it is unknown if pain causes decreased range of motion of the ankle or if decreased range of motion causes pain. Further research is needed on causal pathways and importantly on prevention.
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Affiliation(s)
- Ebba Jarlman
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden.
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
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Ridilla S, Wang H, Sylvester L, Arnold S. Pain and self-pressure relief in adolescents with cerebral palsy. Assist Technol 2024; 36:241-247. [PMID: 38289978 DOI: 10.1080/10400435.2024.2305972] [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] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Adolescents with CP classified as Gross Motor Functional Classification System Level V attend school up to 8 h daily with limited ability to self-reposition. Despite pain reported within this population, perceived pain and self-pressure relief during prolonged classroom sitting is unknown. A case series design was used with a convenience sample of six students (13-18 years) with CP. Pain assessments were taken every 30 min for 5 h. Self-relief assessments using the SensiMATTM were recorded while students were in their wheelchairs. One student self-reported pain and three students proxy reported pain movements. All students had unrelieved pressure or did not self-relieve pressure for at least 1.5 consecutive hours. Four students increased their self-pressure relief movements after 3.5 h. This study provided preliminary data regarding perceived pain and self-pressure relief during prolonged sitting and demonstrated that the SensiMATTM can capture pressure relief movements in sitting of students with severe CP. Although there was no trend of reported pain, students may either be moving enough, as demonstrated by recorded pressure relief movements, to independently relieve pressure and pain, or current pain assessments may not be sensitive enough for those with the most severe disabilities.
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Affiliation(s)
- S Ridilla
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - H Wang
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - L Sylvester
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - S Arnold
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med 2024; 20:719-726. [PMID: 38169433 PMCID: PMC11063692 DOI: 10.5664/jcsm.10980] [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: 06/05/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Sleep quality is important during childhood and adolescence. Given the high prevalence of pain in children/youth with cerebral palsy, we aimed to measure the association between short-term pain trajectories and sleep disturbance in these individuals. METHODS We accrued the cohort between November 2019 and October 2020 and recruited children/youth who (1) were 8-18 years old; (2) had cerebral palsy with any Gross Motor Function Classification System level; and (3) could self-report pain and sleep disturbance. We collected self-reported baseline and weekly follow-up data using electronic questionnaires completed every week for 5 weeks. Sleep disturbance at 5 weeks was the primary outcome (pediatric Patient-Reported Outcomes Measurement Information System short form, v1.0-4a). We used general linear regression to assess the association between pain intensity trajectory group and sleep disturbance controlling for confounders. RESULTS A total of 190 individuals were eligible; 102 were enrolled and 89 were included in our final analysis. Pain trajectory groups had estimated crude mean sleep disturbance scores at 5 weeks ranging from 56.0 (95% confidence interval, 51.8, 60.8) to 61.8 (55.7, 67.9). Compared to those with stable, no/very mild pain, those in the stable, high-pain group had the greatest sleep disturbance (adjusted β = 5.7; 95% confidence interval, 1.2, 10.2). CONCLUSIONS Irrespective of pain trajectory, children and youth with cerebral palsy reported sleep disturbances. Those with a stable, high pain intensity in the previous 5 weeks reported the greatest sleep disturbance. The results highlight the importance of considering pain trajectories and their impact on sleep in children with cerebral palsy. CITATION Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night's sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med. 2024;20(5):719-726.
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Affiliation(s)
- Heather M. Shearer
- Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Darcy L. Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Quartermaine JR, Rose TA, Auld ML, Johnston LM. Reflections on Participation at Home, As Self-Reported by Young People with Cerebral Palsy. Dev Neurorehabil 2024; 27:69-82. [PMID: 38695307 DOI: 10.1080/17518423.2024.2347993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/23/2024] [Indexed: 07/08/2024]
Abstract
This study explored the home-based participation of young people with cerebral palsy (CP) and described factors that make participation easier or harder. Fifteen young people with CP aged 15 to 26 years provided written reflections, photographs, or videos about their home-based participation experiences. Data were analyzed using reflexive thematic analysis. Self-reported reflections were grouped inductively into 129 codes, then 20 subthemes and 5 themes which emphasized CP characteristics, thoughts, emotions, equipment, environment, supports, and inclusion as important factors influencing home-based participation. Young people with CP largely described the home environment as an inclusive place to participate.
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Affiliation(s)
- Jacinta R Quartermaine
- The University of Queensland, Brisbane, Australia
- Children's Motor Control Research Collaboration, Brisbane, Australia
- Choice, Passion, Life, Brisbane, Australia
- Queensland Cerebral Palsy Register, Brisbane, Australia
| | - Tanya A Rose
- The University of Queensland, Brisbane, Australia
| | - Megan L Auld
- The University of Queensland, Brisbane, Australia
- Children's Motor Control Research Collaboration, Brisbane, Australia
- Choice, Passion, Life, Brisbane, Australia
- Queensland Cerebral Palsy Register, Brisbane, Australia
| | - Leanne M Johnston
- The University of Queensland, Brisbane, Australia
- Children's Motor Control Research Collaboration, Brisbane, Australia
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Sorek G, Goudriaan M, Schurr I, Schless SH. Influence of musculoskeletal pain during gait on kinematics and selective motor control in individuals with spastic cerebral palsy: A pilot study. Clin Biomech (Bristol, Avon) 2024; 113:106219. [PMID: 38458003 DOI: 10.1016/j.clinbiomech.2024.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Individuals with cerebral-palsy commonly present with altered kinematics and selective-motor-control during gait, and may also experience musculoskeletal pain. This pilot study aims to investigate if the immediate experience of musculoskeletal pain during gait influences kinematics and selective-motor-control in individuals with spastic cerebral-palsy. METHODS Retrospective treadmill-based gait-analysis data for 145 individuals with spastic cerebral-palsy were screened. Participants were asked about experiencing lower-extremity musculoskeletal pain immediately during gait, with 26 individuals (18%) reporting this was the case (pain-group; mean 11.55 ± 3.15 years, Gross-Motor-Function-Classification-System levels I/II/III n = 5/13/8, Uni/bilateral involvement n = 11/15). Of the 77 individuals who did not report any pain, a no-pain group (n = 26) was individually matched. Kinematics were evaluated using the Gait-Profile-Score and spatiotemporal parameters (dimensionless-walking-speed, single-leg-support percentage and step-time). Selective-motor-control was assessed using the Walking-Dynamic-Motor-Control index. FINDINGS In the pain-group, 58% reported experiencing pain in their more-involved leg, 8% in the less-involved leg and 34% in both legs. Regarding the pain location, 38% of the pain-group reported experiencing pain in multiple locations. On a more specific level, 35%, 46% and 54% reported pain around the hip/thigh, knee/calf and ankle/ft, respectively. No significant differences were observed between the pain and no-pain groups for any of the outcome measures, in each leg or bilaterally. INTERPRETATION No significant differences in kinematics and selective-motor-control during gait were found between individuals with spastic cerebral-palsy, with and without musculoskeletal pain. This suggests that the individuals in this study may not present with obvious antalgic gait patterns, which may relate to the pre-existing altered kinematics and selective-motor-control.
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Affiliation(s)
- Gilad Sorek
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel
| | - Marije Goudriaan
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam, the Netherlands; University corporate offices, student & academic affairs office, Utrecht university, Utrecht, the Netherlands
| | - Itai Schurr
- Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel
| | - Simon-Henri Schless
- Laboratory for Pediatric Motion Analysis and Biofeedback Rehabilitation, ALYN Pediatric and Adolescent Rehabilitation Research Centre (Helmsley PARC), Jerusalem, Israel; Clinical Motion Analysis Laboratory, ALYN Pediatric and Adolescent Rehabilitation Centre, Jerusalem, Israel.
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Rinde ER, Anderzén-Carlsson A, Jahnsen RB, Andersen RD. "I have to obey my pain" - children's experiences of pain burden in cerebral palsy. Disabil Rehabil 2024; 46:1112-1120. [PMID: 36987867 DOI: 10.1080/09638288.2023.2191012] [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: 06/30/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To explore pain experiences of children with cerebral palsy, and how it influences their everyday life. METHOD Fourteen children with CP between eight and seventeen years old were included, using a purposeful sampling strategy. They had different experiences of pain, and different degrees of physical and cognitive impairments. Sixteen individual semi-structured interviews were carried out, and analyzed using inductive thematic analysis. RESULTS Data analysis resulted in the main theme "I have to obey my pain" and four themes were identified. Experiences regarding pain varied ("My pain is mine alone"). Both pain itself and the use of cognitive strategies to cope with pain involved a mental struggle ("Pain brings me down"). The children had to make adjustments to manage their pain ("I want to participate, but I have to rest"). The most important help was to be understood, but adults also provided valuable help with interventions like stretching, medication and adjustment of activity levels ("Others can help me"). CONCLUSION Pain was a determining feature in the lives of these children with CP. The wide variety of experiences and challenges emphasized the need for tailored management strategies developed together with each child and their parents.IMPLICATIONS FOR REHABILITATIONChildren with cerebral palsy had varied experiences of pain, and health professionals need to tailor their pain management approaches to the individual child.Health services should offer pain education to expand children's repertoire of pain management strategies.When a child's pain influences their daily activities, health services must ensure that the school is informed of the child's situation, and able to make necessary adjustments.Health professionals should strive to include children's own descriptions whenever possible to make sure children feel heard and believed.Even children with communicative and cognitive impairments were able to self-report when necessary adjustments in the communication situation were made.
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Affiliation(s)
- Elisabeth Rønning Rinde
- Division of Habilitation, Telemark Hospital Trust, Skien, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Agneta Anderzén-Carlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Reidun Birgitta Jahnsen
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Randi Dovland Andersen
- Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research, Telemark Hospital Trust, Skien, Norway
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Hajiyeva IE. [Morbidity rate of children's cerebral palsy in Baku city]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:143-146. [PMID: 38261297 DOI: 10.17116/jnevro2024124011143] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To study the morbidity rate of children's cerebral palsy (CP) in Baku in children born in 2006-2016. MATERIAL AND METHODS During 2006-2016, 35 891, 37 130, 37 459, 40 050, 34 726, 34 192, 33 258, 30 373, 29 722, 29 654 and 29 564 children were born in Baku. CP was diagnosed in 1162 of these children. Newborns and children with CP were divided into 3 groups by body mass (<1500; 1500- 2500; 2500 and more) and into 4 groups by the gestational age (<28, 28-32; 32-36, 36 and more weeks). The morbidity rates were detected in these groups. The statistical significance of morbidity rates was assessed by χ2 criteria. RESULTS The morbidity rate of CP changed within the interval 0.27% (95% CI 0.22-0.33%) in 2006 to 0.37% (95% CI 0.30-0.44%) in 2016. The difference between the minimum and maximum morbidity rates was not statistically significant (p>0.05). The morbidity rate of CP in newborns with body mass <1500 grams was 10.35% (95% CI 0-21.65%) and was 6.1 times higher than in the group of newborns weighing 1500-2500 grams at birth (1.72%; 95% CI 0.20-3.25%) and 30.4 times higher than in the group of newborns with body mass ≥2500 grams (0.34%; 95% CI 0.27-0.41%). The difference between morbidity rates of CP in groups depending on birth body mass was significant (p<0.0001). CONCLUSION The incidence rate of CP in a cohort of newborns during the first 60 months after birth in 2006-2016 fluctuated in the range of 0.27-0.37% and had a weak growth trend. The morbidity rate of children's CP is significantly higher in children with body mass at birth <1500 (10.34%) and 1500-2500 grams (1.72%) than in children with body mass at birth 2500 and more grams (0.34%). The gestational age of newborns affects the morbidity rate of CP, which is 5.48; 1.78 and 0.34% at gestational age <32, 32-36 and ≥36 weeks. The structure of subtypes of this pathology is close to that in other populations against the background of the comparative morbidity rate of CP in Baku, the proportion of spastic unilateral, spastic bilateral, dyskinetic and atonic CP is 35.2; 58.0; 3.9 and 1.4%, respectively.
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Hunziker S, Morosoli F, Zuercher K, Tscherter A, Grunt S. Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide-A Survey of the Swiss Cerebral Palsy Registry. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1838. [PMID: 38136040 PMCID: PMC10742030 DOI: 10.3390/children10121838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess cannabinoid prescribing practices in children with cerebral palsy, focusing on indications, types of preparations used, and tolerability. Furthermore, we investigated how physicians acquire knowledge about cannabinoid medication. We asked physicians with expertise in the care of children with cerebral palsy about their prescribing practices for cannabinoids. Data were collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, experiences regarding efficacy, and observed side effects of the therapy. Seventy physicians from Europe, North America, and Australia completed the survey. Forty-seven participants were experienced in treating of children with cerebral palsy with cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The preparations and doses prescribed varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently, drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.
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Affiliation(s)
- Sandra Hunziker
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Federico Morosoli
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
| | - Kathrin Zuercher
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, University of Bern, Freiburgstr. 15, CH-3010 Bern, Switzerland
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Smith MG, Farrar LC, Gibson RJ, Russo RN, Harvey AR. Chronic pain interference assessment tools for children and adults who are unable to self-report: A systematic review of psychometric properties. Dev Med Child Neurol 2023; 65:1029-1042. [PMID: 36740907 DOI: 10.1111/dmcn.15535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
AIM To identify and evaluate psychometric properties of assessment tools for assessing pain interference in children, adolescents, and adults with chronic pain and the inability to self-report. METHOD The protocol was registered with PROSPERO (CRD42022310102). A search was run in MEDLINE, Embase, and PsycInfo (29th March 2022) to identify articles reporting psychometric properties of pain interference assessment tools for children, adolescents, and adults with chronic pain and the inability to objectively self-report pain. Retrieved studies were reviewed by two authors (MGS, LCF) and study quality was assessed using COSMIN. RESULTS Psychometric properties of 10 pain interference tools were assessed from 33 studies. The Paediatric Pain Profile (PPP) had low-quality evidence for content validity and internal consistency with children and adolescents who are unable to self-report. No tools for adults had evidence for content validity and internal consistency. No tool had evidence for all nine psychometric properties. INTERPRETATION The PPP is recommended for pain interference assessment in children and adolescents with chronic pain and the inability to self-report. Few tools are available for adults. Three tools for children (Patient-Reported Outcome Measurement Information System Pediatric Proxy Pain Interference Scale; Bath Adolescent Pain Questionnaire for Parents; modified Brief Pain Inventory-Proxy [mBPI]) and three tools for adults (Doloplus-2; Patient-Reported Outcome Measurement Information System Pain Interference Scale-proxy; Brief Pain Inventory-proxy) are promising but require further investigation.
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Affiliation(s)
- Meredith G Smith
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Lucy C Farrar
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Rachel J Gibson
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Remo N Russo
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Paediatric Rehabilitation Department, Women's and Children's Hospital, Adelaide, Australia
| | - Adrienne R Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Sultan T, Wong C. Presence and grade of undertreatment of pain in children with cerebral palsy. Scand J Pain 2023; 23:546-552. [PMID: 37267482 DOI: 10.1515/sjpain-2022-0124] [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: 08/22/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate if chronic pain in children with cerebral palsy is undertreated with the current pharmacological/non-pharmacological interventions using a pain management index. METHODS Parents of 120 children with cerebral palsy between the ages of 2-19 years from our region in Denmark answered a questionnaire about whether their child had everyday pain. When answering in pain, we inquired about pain status and pharmacological/non-pharmacological pain coping interventions. Everyday pain was viewed as chronic pain with acute exacerbations. Pain experienced was divided into worst pain (highest moments of pain intensity) and least pain (lowest moments of pain intensity). To describe and evaluate the effectiveness of pain interventions used, a pain management index was utilized. Everyday pain was assessed using a logistical regression by adjusting for age, sex, and gross motor function classification system level. RESULTS 59/115 (0.51) of parents answering the questionnaire reported everyday pain. Of those, the median age was 10 years. For pain alleviation, massage was reported by parents as being used by 29/59 (0.49) children and paracetamol by 21/59 (0.36). Pain affected daily life in 44/59 (0.75). By our evaluation 44/59 (0.75) were inadequately treated for their pain. Our evaluation also revealed that 19/59 (0.32) of children in pain had inadequately treated pain combined with an undesirable intensity of least pain. CONCLUSIONS Half of the children with cerebral palsy experienced chronic pain according to our pain questionnaire answered by parents. Among these children three-quarters were insufficiently treated for their pain. In the same group, one-third were impacted by pain felt at both its highest and lowest moments of intensity. Massage therapy and paracetamol were the most frequently utilized pain-alleviating interventions. In our cohort, pain was undertreated and likely underdiagnose (Protocol number H-17008823).
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Affiliation(s)
- Tamo Sultan
- Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
- Kastrup, Denmark
| | - Christian Wong
- Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen, Denmark
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Alsaggaf F, Coyne I. Participation in everyday life for young people with chronic pain in Saudi Arabia: "you feel lacking in life and you feel that time is flying by". FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1099345. [PMID: 37275401 PMCID: PMC10235783 DOI: 10.3389/fresc.2023.1099345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
Introduction Chronic pain is a common health problem that can have a significant impact on children and young people's daily life. Although research on pediatric chronic pain has been a priority globally, little is known about young people's experience of chronic pain in Saudi Arabia. Thus, this article reports on young people's experience of chronic pain and the impact on their lives in Saudi Arabia which forms part of a larger study. Methods Multiple case study design following Yin's (2018) approach was used. Purposeful and theoretical sampling were used to recruit young people aged 12 to 18 who had experienced chronic pain for at least three months, their parents, and their school personnel. The young people and their parents were recruited from a tertiary hospital located on the western side of Saudi Arabia while school personnel were recruited from the schools that young people attended. Data were collected through in-depth semi-structured face-to-face (n = 15) and telephone interviews (n = 25) from 40 participants (10 young people, 10 parents, and 20 school personnel). Interviews were recorded, transcribed verbatim, and translated from Arabic to English. Data were analyzed following two phases: (1) constant comparative analysis; and (2) cross-case analysis based on the work of Charmaz (2014) and Yin (2018) respectively. Findings Young people's experiences of chronic pain were categorized into three themes: (1) experiencing chronic pain; (2) impact of pain on quality of life; and (3) everyday strategies to manage chronic pain. All young people reported that their pain was caused by a chronic condition, where the most prevalent pains were musculoskeletal/joint pain, abdominal pain, and headache/migraine. Most young people had encountered challenges with misdiagnosis or delayed diagnosis as to the cause of their chronic pain. They described how their chronic pain interfered with their physical, psychological, and social functioning. They primarily managed their pain with medications and through self-care techniques. The findings also indicated that young people's generally positive attitude to their pain reflected their beliefs in Allah's power and the belief that such suffering should be borne according to their Islamic culture. Conclusion Chronic pain is a significant health phenomenon that tends to restrict the participation of young people in everyday life. However young people used a range of strategies to normalize the pain so that they could continue with their everyday activities like their peers.
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Affiliation(s)
- Fatimah Alsaggaf
- Nursing College, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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25
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Turner A, Hayes S, Sharkey D. The Classification of Movement in Infants for the Autonomous Monitoring of Neurological Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:4800. [PMID: 37430717 DOI: 10.3390/s23104800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023]
Abstract
Neurodevelopmental delay following extremely preterm birth or birth asphyxia is common but diagnosis is often delayed as early milder signs are not recognised by parents or clinicians. Early interventions have been shown to improve outcomes. Automation of diagnosis and monitoring of neurological disorders using non-invasive, cost effective methods within a patient's home could improve accessibility to testing. Furthermore, said testing could be conducted over a longer period, enabling greater confidence in diagnoses, due to increased data availability. This work proposes a new method to assess the movements in children. Twelve parent and infant participants were recruited (children aged between 3 and 12 months). Approximately 25 min 2D video recordings of the infants organically playing with toys were captured. A combination of deep learning and 2D pose estimation algorithms were used to classify the movements in relation to the children's dexterity and position when interacting with a toy. The results demonstrate the possibility of capturing and classifying children's complexity of movements when interacting with toys as well as their posture. Such classifications and the movement features could assist practitioners to accurately diagnose impaired or delayed movement development in a timely fashion as well as facilitating treatment monitoring.
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Affiliation(s)
- Alexander Turner
- Department of Computer Science, University of Nottingham, Nottingham NG8 1BB, UK
| | - Stephen Hayes
- Department of Engineering, Nottingham Trent University, Nottingham NG4 2EA, UK
| | - Don Sharkey
- Department of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Bonouvrié LA, Haberfehlner H, Becher JG, Vles JSH, Vermeulen RJ, Buizer AI. Attainment of personal goals in the first year of intrathecal baclofen treatment in dyskinetic cerebral palsy: a prospective cohort study. Disabil Rehabil 2023; 45:1315-1322. [PMID: 35387541 DOI: 10.1080/09638288.2022.2057600] [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] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess attainment of individual treatment goals one year after intrathecal baclofen (ITB) pump implantation in individuals with dyskinetic cerebral palsy (CP). MATERIALS AND METHODS A multi-center prospective cohort study was conducted including 34 non-walking individuals with severe dyskinetic CP, classified as Gross Motor Function Classification System (GMFCS) IV/V, aged 4-24 years, 12 months after pump implantation. The main outcome measure was Goal Attainment Scaling (GAS). Predictors of GAS results were analyzed. Complications were registered systematically. RESULTS Seventy-one percent of individuals with dyskinetic CP fully achieved one or more treatment goals. One or more treatment goals were partially achieved in 97% of individuals. Two factors were found to be associated with attainment of goals: Dyskinesia Impairment Scale (DIS) score at baseline and the difference in pain score between baseline and follow-up. These two variables explain 30% of the variance in the outcome. CONCLUSIONS Intrathecal baclofen is effective in achieving individual treatment goals in children and young adults with dyskinetic CP after nine to 12 months of ITB treatment. A positive outcome on treatment goals is, for a small part, associated with higher severity of dystonia at baseline and with improvement of pain during treatment. CLINICAL TRIAL REGISTRATION NUMBER Dutch Trial Register, number NTR3642.Implications for rehabilitationIntrathecal baclofen treatment is effective in attainment of personal treatment goals, one year after pump implantation in patients with dyskinetic cerebral palsy.A positive outcome on treatment goals is, for a small part, related to higher severity of dystonia at the start and on improvement of pain during treatment.
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Affiliation(s)
- Laura A Bonouvrié
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helga Haberfehlner
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johan S H Vles
- Department Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Jeroen Vermeulen
- Department Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Child Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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Wong C. The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy. Toxins (Basel) 2023; 15:152. [PMID: 36828465 PMCID: PMC9967793 DOI: 10.3390/toxins15020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Pain and quality of life are closely interrelated in children with cerebral palsy (CCP). Even though 67% of CCP experience pain, it is overlooked and untreated. In this study, our purpose was two-fold: first, to examine the relationship between pain and spasticity by evaluating the effects of AbobotulinumtoxinA/Dysport (BoNT), and second, to describe the symptoms and location of pain in CCP. The subjects were 22 CCP in at least moderate pain. They were evaluated for spasticity by the modified Ashworth and Tardieu scale and for pain by the r-FLACC and the pediatric pain profile. After one injection of BoNT, the subjects were re-evaluated. We found a significant reduction in pain, but no significant relationship between the reduction of pain and spasticity. We found no association between the dose of BoNT and pain or spasticity. Pain in the lower extremity was located primarily in the hip region. The effect of ultrasound-guided intermuscular injections of BoNT suggests that pain in CCP has an extra-articular component. We found that pain in CCP manifests as specific tell-tale signs and problems in daily living. In conclusion, we found no relationship between pain and spasticity. Signs and manifestations of pain are described in detail. Lower extremity (hip) pain seems to have a soft tissue/extra-articular component.
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Affiliation(s)
- Christian Wong
- Department of Orthopedic Surgery, University Hospital of Copenhagen, 2650 Hvidovre, Denmark; ; Tel.: +45-35459411
- Department of Orthopedic Surgery, University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark
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Faccioli S, Sassi S, Ferrari A, Corradini E, Toni F, Kaleci S, Lombardi F, Picelli A, Benedetti MG. Prevalence and determinants of hip pain in non-ambulatory cerebral palsy children: a retrospective cohort study. Eur J Phys Rehabil Med 2023; 59:32-41. [PMID: 36507793 PMCID: PMC10035438 DOI: 10.23736/s1973-9087.22.07725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hip pain is common in cerebral palsy children, particularly at Gross-Motor Function Classification System level IV-V. It is associated to hip displacement and relates to the migration percentage. Recent literature suggested early reconstructive bone surgery, as the best approach to prevent hip luxation, then hip pain. Still, high rates of hip pain are reported. AIM To investigate prevalence and determinants of hip pain in an Italian cerebral palsy sample. DESIGN Single-center retrospective cohort study. SETTING Inpatient and outpatient. POPULATION Patients with spastic or dyskinetic cerebral palsy, Gross-Motor Function Classification System level IV or V, age 0-18. METHODS A chart review was implemented to report hip pain, as a dichotomous variable (pain/no pain), age, sex, cerebral palsy subtype, Gross-Motor Function level, lumbar scoliosis, migration percentage, previous orthopedic surgery, or botulinum injections, oral or intrathecal baclofen, drug-resistant epilepsy, assistive devices for standing or walking. Descriptive statistics and a multivariate logistic stepwise regression were performed. RESULTS A total of 504 subjects were included: 302 level V, 209 females, 432 spastics. The mean length of follow-up was 6 years. The overall prevalence of hip pain was 8.9% (6.3% were at level V) and of hip dislocation was 19% (15.9% were at level V). Just 39% of dislocated hips were painful. Children at spastic subtype and level V were predominantly affected. Botulinum and soft tissue surgery related to lower rates of hip pain, without statistical significance. Age (OR 1.19, 95%CI 1.14-1.25, P value 0.000), sex (OR 1.72, 95%CI 1.18-2.52, P value 0.005), migration percentage (OR 1.02, 95%CI 1.02-1.03, P value 0.000) and lumbar scoliosis (OR 1.32, 95%CI 0.86-2.01, P value 0.200) resulted significant independent determinants of hip pain. CONCLUSIONS Hip pain relates with the migration percentage, but not all dislocated hips become painful. Hip pain may be transient and requires a targeted and individualized approach. Children at spastic subtype and level V were predominantly affected. Age and sex are confirmed as determinants. Specific validated measures are to be implemented to assess hip pain. CLINICAL REHABILITATION IMPACT Considering severe non-ambulatory cerebral palsy patients, pain and quality of life should be considered as outcomes, in the management of hip luxation.
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Affiliation(s)
- Silvia Faccioli
- Unit of Children Rehabilitation, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy -
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy -
| | - Silvia Sassi
- Unit of Children Rehabilitation, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Adriano Ferrari
- Unit of Children Rehabilitation, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Corradini
- Unit of Children Rehabilitation, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Toni
- Unit of Physical Medicine and Rehabilitation, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Shaniko Kaleci
- Surgical Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Lombardi
- Unit of Neurorehabilitation, S. Sebastiano Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, ON, Canada
| | - Maria G Benedetti
- Unit of Physical Medicine and Rehabilitation, Rizzoli Orthopedic Institute IRCCS, Bologna, Italy
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Gilliand M, Perrenoud B, Lecerf T, Serex M, Breaud A, Larkin P. Behavioral pain indicators for adults with an intellectual disability: a scoping review protocol. JBI Evid Synth 2023; 21:254-263. [PMID: 36000781 PMCID: PMC10467817 DOI: 10.11124/jbies-21-00434] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This scoping review aims to identify and map the behavioral pain indicators observed when adults with an intellectual disability experience pain. INTRODUCTION Adults with an intellectual disability have more health problems than the general population. The likelihood that this population will experience pain is high, but intellectual disability can obstruct the verbal expression of pain. Adults with an intellectual disability express pain via behavioral pain indicators; however, because no behavioral pain scale exists for this population, observers may misinterpret the pain experienced by adults with an intellectual disability. INCLUSION CRITERIA The review will examine literature about behavioral pain indicators for adults with any type of intellectual disability who are suffering from any type of pain in any country or care setting. METHODS The review will be conducted according to the JBI recommendations for scoping reviews. A preliminary search focusing on the concepts of intellectual disability and pain measurement was conducted for PubMed and CINAHL in March 2022. Once the protocol is validated, searches will also be carried out in Embase, JBI EBP Database, the Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses, PsycINFO, Web of Science Core Collection, ERIC, Google Scholar, MedNar, and the websites of relevant professional associations. Titles and abstracts, and then full-text studies, will be selected independently by 2 researchers and assessed against the inclusion criteria. Relevant information will be imported into a data chart. Any behavioral pain indicators identified will be classified into 14 behavioral categories. REVIEW REGISTRATION NUMBER Open Science Framework osf.io/8xckf.
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Affiliation(s)
- Morgane Gilliand
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Lausanne, Switzerland
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Béatrice Perrenoud
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
- La Source, School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Thierry Lecerf
- Faculty of Psychology and Educational Sciences, Geneva University, Geneva, Switzerland
| | - Magali Serex
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Anne Breaud
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Philip Larkin
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Lausanne, Switzerland
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
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30
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Shearer HM, Verville L, Côté P, Hogg-Johnson S, Fehlings DL. Clinical course of pain intensity in individuals with cerebral palsy: A prognostic systematic review. Dev Med Child Neurol 2023; 65:24-37. [PMID: 35871758 DOI: 10.1111/dmcn.15358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions. METHOD We conducted an exploratory prognostic systematic review searching electronic databases from inception to 31st December 2021. Evidence from low and moderate risk-of-bias studies was synthesized. RESULTS We retrieved 2275 citations; 18 studies met the inclusion criteria and 10 were synthesized. The course of pain intensity in children with CP receiving usual care was stable over 15 weeks (χ2 [2] = 1.8, p = 0.5). Children who received continuous intrathecal baclofen (CITB) reported significant pain intensity reduction (visual analogue scale [VAS] = -4.2 out of 10, 95% confidence interval [CI] = -6.3 to -2.1]) 6 months postinsertion but similar children receiving usual care had no significant change over 6 months (VAS = 1.3 out of 10, 95% CI = -1.3 to 3.6). Children receiving botulinum neurotoxin A (BoNT-A) injections had significant decreases in pain after 1 month (numeric rating scale = -6.5, 95% CI = -8.0 to -5.0). Adults with chronic pain receiving usual care reported stable pain intensity over time; pain intensity improved in ambulatory adults exercising and those treated surgically for cervical myelopathy. INTERPRETATION The course of pain intensity in individuals with CP is unclear. Evidence suggests that children and adults receiving usual care had stable pain intensity over the short or long term. Interventions (CITB and BoNT-A in children and exercise and surgical treatment for cervical myelopathy in adults) had pain intensity reduction. Larger study samples are needed to confirm these results. WHAT THIS PAPER ADDS Pain intensity was stable in children with cerebral palsy (CP) receiving usual care. Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity. Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities. Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression. Limited high-quality evidence exists describing non-procedural pain changes in individuals with CP.
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Affiliation(s)
- Heather M Shearer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Leslie Verville
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Sheilah Hogg-Johnson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Darcy L Fehlings
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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31
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Marwa G, Mtawaa S, Toulgui E, Moncer R, Wannes W, Maaref K, Jemni S. Quality of life and its predicting factors for Tunisian children with cerebral palsy. Afr J Disabil 2022; 11:1046. [PMID: 36567926 PMCID: PMC9772773 DOI: 10.4102/ajod.v11i0.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background Cerebral palsy (CP) can cause motor, sensory, perceptual, cognitive, communication and behavioural disorders. The complexity of this condition justifies measuring the quality of life (QOL) of children with CP. This measurement depends on personal and socio-economic factors, hence the relevance of performing it in our cultural context of Tunisia. Objectives The objectives of this study were to assess the QOL of Tunisian children with CP and to identify predictive factors for QOL. Method A cross-sectional study using a self-administered questionnaire (the CP QOL-Child) was employed. It included 68 children with CP and their parents who consulted the outpatient clinics of Physical Medicine and Rehabilitation of the University Hospital of Sahloul Sousse. Results The QOL of children with CP was altered, and the mean total score for the CP QOL-Child was 59.3 (± 14). All domains were affected by this alteration. Six predictive factors for lowered QOL in children with CP were identified, namely age older than 6 years, swallowing disorders, more intense chronic pain, greater level of motor impairment, the use of botulinum toxin injection and the absence of verbal communication. Conclusion Intervention with children with CP must be mindful of their altered QOL. Five out of the six predictive factors of QOL are modifiable through a multidisciplinary approach within the framework of the International Classification of Functioning, Disability and Health (ICF). Contribution The multiplicity of the factors associated with QOL revealed by this study incites clinicians to adopt the ICF approach by displaying its practical implications on the efficiency of the medical intervention.
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Affiliation(s)
- Ghanmi Marwa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Monastir, University Hospital Sahlou, Sousse, Tunisia
| | - Sahbi Mtawaa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Kairouan, Kairouan, Tunisia
| | - Emna Toulgui
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Sahloul, Sousse, Tunisia
| | - Rihab Moncer
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Sahloul, Sousse, Tunisia
| | - Walid Wannes
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Sahloul, Sousse, Tunisia
| | - Khaled Maaref
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Sahloul, Sousse, Tunisia
| | - Sonia Jemni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine of Sousse, University Hospital of Sahloul, Sousse, Tunisia
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Larsen SM, Eide TB, Brunborg C, Ramstad K. Daytime contacts and general practitioner consultations, and pain as a reason for encounter in children with cerebral palsy; a Norwegian national registry linkage study. Scand J Prim Health Care 2022; 40:474-480. [PMID: 36633354 PMCID: PMC9848342 DOI: 10.1080/02813432.2022.2144992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIM The aim of this study was to compare the prevalence of daytime contacts and consultations, and pain as a reason for encounter (RFE) with a general practitioner (GP), in children with cerebral palsy (CP) (cases) to that of the general paediatric population (controls). METHODS The study linked the Norwegian Directorate of Health's database for the control and reimbursement of health expenses, and the Norwegian Quality and Surveillance Registry for Cerebral Palsy, including children born from 1996 to 2012 in the period 2006 to 2018. All daytime contacts were included. International Classification for Primary Care was applied for RFE. RESULTS Cases accounted for 0.46% of all daytime contacts and 0.27% of all daytime consultations, the latter corresponding with the estimated national prevalence of CP. GPs registered more administrative contact and coded pain as an RFE less frequently in consultations with cases (6%) than with controls (12%). INTERPRETATION Children with CP did not consult GPs more than the general paediatric population did. In consultations, GPs should ask for pain even if the child with CP or parent does not address pain. The local multidisciplinary team should encourage the family to consider consulting a GP if the child is in pain.KEY MESSAGESPrevalence of GP consultations in children with CP is similar to that of children in the general population.GPs perform more administrative work for children with CP than for their other paediatric patients.GPs code pain as an RFE less frequently in consultations with children with CP than in consultations with children in the general population.
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Affiliation(s)
- Selma Mujezinović Larsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo and Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- CONTACT Selma Mujezinović Larsen Oslo universitetssykehus HF, Rikshospitalet, Barne- og ungdomsklinikken, Postboks 4950 Nydalen, OsloN-0424, Norway
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Center for Statistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Ramstad
- Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Perioperative Care of Children with Severe Neurological Impairment and Neuromuscular Scoliosis- A Practical Pathway to Optimize Peri-Operative Health and Guide Decision Making. J Clin Med 2022; 11:jcm11226769. [PMID: 36431246 PMCID: PMC9696380 DOI: 10.3390/jcm11226769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Neuromuscular scoliosis is a common feature in children with severe neurological impairment (SNI), including those with severe cerebral palsy. Surgical correction of scoliosis is the mainstay of treatment. This group of patients also have associated medical complexity. The complication rates post-surgery are high, although, for many, they are worth the risk. There are currently no published practice guidelines or care pathways for children with SNI who are undergoing scoliosis corrective surgery. In response to the high uptake of this surgery, coupled with the expected complication rates, our hospital established a perioperative clinic. The purpose of this paper is to describe our perioperative approach. This clinic has developed into a service beyond perioperative care and, with the collaborative meeting, enables shared decision-making to identify the right candidate for surgery. The process involves surgical expertise, understanding the family and child at the centre, and optimisation of medical care pre- and post-surgery. In this paper, we describe the process in a step-by-step manner. We provide clinical vignettes, as well as the proformas that we use, and we highlight the benefits of the team-based process.
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Harvey AR, McKinnon CT, Smith N, Ostojic K, Paget SP, Smith S, Shepherd DA, Lewis J, Morrow A. Establishing consensus for the assessment of chronic pain in children and young people with cerebral palsy: a Delphi study. Disabil Rehabil 2022; 44:7161-7166. [PMID: 34613866 DOI: 10.1080/09638288.2021.1985632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Inconsistent and inadequate pain assessment practices in cerebral palsy (CP) have resulted from a lack of standardisation of pain assessment, limited use of appropriate tools and failure to integrate disability and biopsychosocial models. To assist with improving consistency, this study aimed to establish consensus from key stakeholders regarding domains considered essential for measuring chronic pain in children and young people with CP. METHOD A modified electronic Delphi study was conducted on 83 stakeholders, including clinicians, researchers, people with CP and parents of children with CP. Participants rated 18 domains sourced from existing literature as either "core", "recommended", "exploratory" or "not required". RESULTS After two rounds of surveys, 12 domains were considered core: pain location, pain frequency, pain intensity, changeable factors, impact on emotional wellbeing, impact on participation, pain communication, influence on quality of life, physical impacts, sleep, pain duration and pain expression. CONCLUSION These domains reflect the complexity of pain in a heterogeneous population where medical comorbidities are common and communication and intellectual limitations impact significantly on the ability of many to self-report. The domains will be utilised to build a framework of pain assessment specific to children and young people with CP guided by the biopsychosocial model.Implications for rehabilitationChronic pain is under-identified and poorly assessed in the cerebral palsy (CP) population.The perspectives of clinicians, researchers and consumers are vital for developing a framework for chronic pain assessment in CP.Consensus of key stakeholders found 12 domains considered essential to incorporate into a chronic pain assessment model in CP.
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Affiliation(s)
- Adrienne R Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Clare T McKinnon
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Australia
| | - Nadine Smith
- Kids Rehab, Perth Children's Hospital, Nedlands, Australia
| | - Katarina Ostojic
- Faculty of Medicine & Health, Specialty of Child & Adolescent Health, Sydney Medical School, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Smith
- Victorian Paediatric Rehabilitation Service, Bendigo, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Jenny Lewis
- Kids Rehab, The Children's Hospital at Westmead, Westmead, Australia
| | - Angie Morrow
- Discipline of Paediatrics and Child Health, Kids Rehab, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
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Shearer HM, Côté P, Hogg‐Johnson S, Mckeever P, Fehlings DL. Pain trajectories and well-being in children and young people with cerebral palsy: A cohort study. Dev Med Child Neurol 2022; 64:1416-1424. [PMID: 35489074 PMCID: PMC9790202 DOI: 10.1111/dmcn.15252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
AIM To identify 5-week pain intensity trajectories and their association with physical and psychological well-being in children/young people with cerebral palsy (CP). METHOD A cohort study was conducted with 101 Canadian children/young people with CP, of whom 49 were female, with an overall mean age of 12 years 11 months (SD 3 years 1 month), range of 8 to 18 years, and classified in any Gross Motor Function Classification System level. Self-reported pain intensity (Faces Pain Scale - Revised) was collected weekly for 5 weeks and physical and psychological well-being (KIDSCREEN-27) at baseline and 5 weeks. Statistical analyses included latent class growth and general linear models. RESULTS All Gross Motor Function Classification System levels were represented (I = 40.6%; II = 15.8%; III = 20.8%; IV = 13.9%; V = 8.9%). Five pain intensity trajectories were identified. Three trajectories had very low (35.4%), low (32.4%), or high (4.9%) mean stable pain. Two trajectories had moderate changing pain (16.8%) and high pain decreasing to moderate levels (10.5%) respectively. Trajectory participants with stable high pain had the lowest physical well-being (adjusted β = -10.01; 95% confidence interval [CI] = -19.37 to -0.66). Those in the three trajectories with the highest mean baseline pain intensity (>3 out of 10) had the lowest psychological well-being (adjusted β = -8.27, 95% CI = -14.84 to -1.70; β = -6.74, 95% CI = -12.43 to -1.05; β = -5.82, 95% CI = -15.34 to 3.71). INTERPRETATION Almost one-third of participants had moderate-to-high pain intensity trajectories. Membership in the higher pain intensity trajectories was associated with lower physical and psychological well-being. WHAT THIS PAPER ADDS Five distinct 5-week pain intensity trajectories were identified in children/young people with cerebral palsy. Thirty-two per cent of participants had moderate-to-high pain intensity trajectories. Participants in the trajectories with higher pain intensity reported lower physical and psychological well-being.
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Affiliation(s)
- Heather M. Shearer
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Holland Bloorview Kids Rehabilitation HospitalTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada
| | - Pierre Côté
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Sheilah Hogg‐Johnson
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada,Research and InnovationCanadian Memorial Chiropractic CollegeTorontoONCanada
| | | | - Darcy L. Fehlings
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Holland Bloorview Kids Rehabilitation HospitalTorontoONCanada,Department of PaediatricsUniversity of TorontoTorontoONCanada
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Reedich EJ, Genry LT, Singer MA, Cavarsan CF, Mena Avila E, Boudreau DM, Brennan MC, Garrett AM, Dowaliby L, Detloff MR, Quinlan KA. Enhanced nociceptive behavior and expansion of associated primary afferents in a rabbit model of cerebral palsy. J Neurosci Res 2022; 100:1951-1966. [PMID: 35839339 PMCID: PMC9388620 DOI: 10.1002/jnr.25108] [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: 01/03/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/07/2022]
Abstract
Spastic cerebral palsy (CP) is a movement disorder marked by hypertonia and hyperreflexia; the most prevalent comorbidity is pain. Since spinal nociceptive afferents contribute to both the sensation of painful stimuli as well as reflex circuits involved in movement, we investigated the relationship between prenatal hypoxia-ischemia (HI) injury which can cause CP, and possible changes in spinal nociceptive circuitry. To do this, we examined nociceptive afferents and mechanical and thermal sensitivity of New Zealand White rabbit kits after prenatal HI or a sham surgical procedure. As described previously, a range of motor deficits similar to spastic CP was observed in kits born naturally after HI (40 min at ~70%-80% gestation). We found that HI caused an expansion of peptidergic afferents (marked by expression of calcitonin gene-related peptide) in both the superficial and deep dorsal horn at postnatal day (P)5. Non-peptidergic nociceptive afferent arborization (labeled by isolectin B4) was unaltered in HI kits, but overlap of the two populations (peptidergic and non-peptidergic nociceptors) was increased by HI. Density of glial fibrillary acidic protein was unchanged within spinal cord white matter regions important in nociceptive transmission at P5. We found that mechanical and thermal nociception was enhanced in HI kits even in the absence of motor deficits. These findings suggest that prenatal HI injury impacts spinal sensory pathways in addition to the more well-established disruptions to descending motor circuits. In conclusion, changes to spinal nociceptive circuitry could disrupt spinal reflexes and contribute to pain experienced by individuals with CP.
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Affiliation(s)
- Emily J Reedich
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Landon T Genry
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Meredith A Singer
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Clarissa Fantin Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elvia Mena Avila
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Daphne M Boudreau
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Michael C Brennan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alyssa M Garrett
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Rhode Island Institutional Development Award (IDeA) Network for Biomedical Research Excellence (INBRE) Summer Undergraduate Research Fellowship (SURF) Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lisa Dowaliby
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Megan R Detloff
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Katharina A Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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Chronic Pain in Young People With Cerebral Palsy: Activity Limitations and Coping Strategies. Pediatr Phys Ther 2022; 34:489-495. [PMID: 35943391 DOI: 10.1097/pep.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the effect of chronic pain on the activities of children and adolescents with cerebral palsy, to describe coping strategies, and to examine associations between effect of pain on activities, coping strategies, and level of pain. METHODS Using an online survey, 27, 8- to 18-year-olds with cerebral palsy and chronic pain or their parents reported pain intensity, distribution, activity limitations (using the Child Activity Limitations Interview-21), and coping strategies (using the Pediatric Pain Coping Inventory). RESULTS Pain intensity ranged from 3 to 10, and 89% reported pain in multiple areas, principally the lower limbs. Individuals reporting higher pain intensity had more activity limitations and were more likely to use catastrophizing coping strategies. CONCLUSIONS Coping strategies may be an important mediator between pain and its effect on activities in children with cerebral palsy. Individualized pain management should be based on routine pain assessment.
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Sierra-Núñez D, Zuriguel-Pérez E, Bosch-Alcaraz A. Postsurgical pain assessment in children and adolescents with cerebral palsy: A scoping review. Dev Med Child Neurol 2022; 64:1085-1095. [PMID: 35490248 DOI: 10.1111/dmcn.15259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/20/2022] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
AIM To investigate factors that influence the assessment of postoperative pain in children and adolescents with cerebral palsy (CP) and the tools available to determine pain intensity. METHOD The search was performed in January 2022 using six databases. Articles focused on paediatric patients with CP; we included instruments for postsurgical pain assessment in this population published in the last 11 years. RESULTS Eight of 441 studies were included. Males and females behave differently; their families can be called on to describe their pain responses. Seven instruments for pain assessment were identified: the Non-Communicating Children's Pain Checklist and its Postoperative Version; the Paediatric Pain Profile; the revised Face, Legs, Activity, Cry and Consolability (FLACC) pain scale; the Douleur Enfant San Salvador scale; the Pain Indicator for Communicatively Impaired Children; the University of Wisconsin Children's Hospital Pain Scale; and the Individualized Numeric Rating Scale. INTERPRETATION The revised FLACC pain scale is suited to postsurgical units because of its ease of use and the fact that parental collaboration is not required. More studies are needed to demonstrate the clinical utility of these scales in postsurgical units and the factors that influence pain assessment. WHAT THIS PAPER ADDS Families should be asked to collaborate when assessing pain in children and adolescents whenever possible. Larger studies that focus on the factors influencing pain assessment in this population are required.
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Affiliation(s)
- Débora Sierra-Núñez
- Paediatric Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Department of Knowledge Management and Evaluation, Vall d'Hebron University Hospital, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Gorter JW, Fehlings D, Ferro MA, Gonzalez A, Green AD, Hopmans SN, McCauley D, Palisano RJ, Rosenbaum P, Speller B. Correlates of Mental Health in Adolescents and Young Adults with Cerebral Palsy: A Cross-Sectional Analysis of the MyStory Project. J Clin Med 2022; 11:jcm11113060. [PMID: 35683448 PMCID: PMC9181041 DOI: 10.3390/jcm11113060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.
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Affiliation(s)
- Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Correspondence:
| | - Darcy Fehlings
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON M4G 1R8, Canada
| | - Mark A. Ferro
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - Amanda D. Green
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Sarah N. Hopmans
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Dayle McCauley
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Robert J. Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
| | - Brittany Speller
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada; (A.D.G.); (S.N.H.); (P.R.); (B.S.)
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON L8S 1C7, Canada; (D.F.); (M.A.F.); (D.M.); (R.J.P.)
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The effect of an ankle-foot orthosis on tibiofemoral motion during step-up and step-down in healthy adults. Prosthet Orthot Int 2022; 46:148-154. [PMID: 35412522 DOI: 10.1097/pxr.0000000000000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Solid ankle-foot orthoses (SAFOs) are frequently prescribed in conditions such as cerebral palsy and stroke. Although gait is improved in the short term, long-term effects of limiting ankle and foot motion during functional activities on joints such as the knee have not been investigated. Our study purpose was to compare tibiofemoral (TF) motion in shoe and SAFO conditions in healthy adults to inform future studies in clinical populations. METHODS A custom-made device using electromagnetic sensors was used to collect three-dimensional TF rotation data while 29 healthy adult participants (female participants = 19, age = 24.4 ± 4.5 years) performed step-up/step-down in shoe and SAFO conditions. RESULTS In the SAFO condition during step-up, extent of motion was greater in frontal and transverse planes and less in the sagittal plane. Discrete values at 0%-10% of the cycle in sagittal, 50%-100% in frontal, and 40%-100% in transverse planes were statistically different, producing more abduction and external rotation. In the SAFO condition during step-down, extent of motion was significantly greater in the frontal and transverse planes. Discrete values were statistically different in 40%-60% of the cycle in sagittal, 0%-30% and 70%-90% in frontal, and 0%-30% and 70%-90% in transverse planes, producing more abduction and external rotation in the first half of the cycle and more adduction and internal rotation in the second half of the cycle. CONCLUSIONS An SAFO affects triplanar TF kinematics in healthy adults during step-up/step-down. Future investigations into ankle-foot orthosis prescription and TF motion in clinical populations will facilitate optimal ankle-foot orthosis prescription and knee function in the long term.
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Larsen SM, Terjesen T, Jahnsen RB, Ramstad K. Recurrent pain in adolescents with cerebral palsy: a longitudinal population-based study. Dev Med Child Neurol 2022; 64:357-363. [PMID: 34448501 DOI: 10.1111/dmcn.15040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate the pain characteristics, pain interference with activities of daily living, and use of analgesics in adolescents with cerebral palsy (CP) and compare the results with previous findings. METHOD Sixty-seven adolescents (median age 14y 4mo, range 12y 2mo-17y, 28 females, 39 males) classified in Gross Motor Function Classification System (GMFCS) levels III to V, who participated in a CP surveillance programme, were assessed on pain measures twice, 5 years apart. Primary caregivers marked recurrent pain sites and graded pain interference with activities of daily living and sleep. Information on pain severity was obtained through two questions from the Child Health Questionnaire (CHQ) and were transformed into a pain score scaled from 0 to 100, where 100 represented no pain. The use of short-acting analgesics was recorded. RESULTS Over 5 years, the prevalence of recurrent pain, number of pain sites, pain intensity, and pain frequency all increased significantly. The most frequent pain sites were the hip/thigh in GMFCS level V and knee in GMFCS level III. The median CHQ pain score decreased from 60 to 40 (p<0.001). Pain interference with activities of daily living increased (p=0.011) but not for sleep. Twenty-eight of 54 participants with moderate or severe pain (CHQ pain score ≤60) received no short-acting analgesics. INTERPRETATION In adolescents with CP, pain increased over 5 years despite follow-up in a surveillance programme. For enhanced management of pain, we propose that an algorithm on pain should be included in surveillance programmes.
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Affiliation(s)
- Selma Mujezinović Larsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Terjesen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Reidun B Jahnsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Research Centre of Habilitation and Rehabilitation Models and Services, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjersti Ramstad
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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42
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Andersen RD, Genik L, Alriksson‐Schmidt AI, Anderzen‐Carlsson A, Burkitt C, Bruflot SK, Chambers CT, Jahnsen RB, Jeglinsky‐Kankainen I, Kildal OA, Ramstad K, Sheriko J, Symons FJ, Wallin L, Andersen GL. Pain burden in children with cerebral palsy (CPPain) survey: Study protocol. PAEDIATRIC AND NEONATAL PAIN 2022; 4:12-22. [PMID: 35546915 PMCID: PMC8975236 DOI: 10.1002/pne2.12049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
Pain is a significant health concern for children living with cerebral palsy (CP). There are no population‐level or large‐scale multi‐national datasets using common measures characterizing pain experience and interference (ie, pain burden) and management practices for children with CP. The aim of the CPPain survey is to generate a comprehensive understanding of pain burden and current management of pain to change clinical practice in CP. The CPPain survey is a comprehensive cross‐sectional study. Researchers plan to recruit approximately 1400 children with CP (primary participants) across several countries over 6‐12 months using multimodal recruitment strategies. Data will be collected from parents or guardians of children with CP (0‐17 years) and from children with CP (8‐17 years) who are able to self‐report. Siblings (12‐17 years) will be invited to participate as controls. The CPPain survey consists of previously validated and study‐specific questionnaires addressing demographic and diagnostic information, pain experience, pain management, pain interference, pain coping, activity and participation in everyday life, nutritional status, mental health, health‐related quality of life, and the effect of the COVID‐19 pandemic on pain and access to pain care. The survey will be distributed primarily online. Data will be analyzed using appropriate statistical methods for comparing groups. Stratification will be used to investigate subgroups, and analyses will be adjusted for appropriate sociodemographic variables. The Norwegian Regional Committee for Medical and Health Research Ethics and the Research Ethics Board at the University of Minnesota in USA have approved the study. Ethics approval in Canada, Sweden, and Finland is pending. In addition to dissemination through peer‐reviewed journals and conferences, findings will be communicated through the CPPain Web site (www.sthf.no/cppain), Web sites directed toward users or clinicians, social media, special interest groups, stakeholder engagement activities, articles in user organization journals, and presentations in public media.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Research Telemark Hospital Skien Norway
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
| | - Lara Genik
- Department of Psychology University of Guelph Guelph ON Canada
| | - Ann I. Alriksson‐Schmidt
- Department of Clinical Sciences Lund Skåne University Hospital Orthopedics Lund University Lund Sweden
| | - Agneta Anderzen‐Carlsson
- University Health Care Research Center and Swedish Institute for Disability Research Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Chantel Burkitt
- Gillette Children's Specialty Healthcare Saint Paul MN USA
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Sindre K. Bruflot
- Telemark Chapter of the Norwegian Cerebral Palsy Association Skien Norway
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics Dalhousie University Halifax NS Canada
- Centre for Pediatric Pain Research IWK Health Centre Nova Scotia Canada
| | - Reidun B. Jahnsen
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
- Department of Clinical Neurosciences for Children Oslo University Hospital Oslo Norway
| | | | - Olav Aga Kildal
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM) Institute of Health and Society University of Oslo Oslo Norway
- Department of Child and Adolescent Health Services Telemark Hospital Trust Skien Norway
| | - Kjersti Ramstad
- Department of Paediatric Neurology Oslo University Hospital Oslo Norway
| | - Jordan Sheriko
- Department of Pediatrics Dalhousie University Halifax NS Canada
- Rehabilitation Services IWK Health Halifax NS Canada
| | - Frank J. Symons
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Lars Wallin
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Guro L. Andersen
- The Cerebral Palsy Registry of Norway Vestfold Hospital Trust Tønsberg Norway
- Department of Clinical and Molecular Medicine Faculty of Medicine and Health Sciences Norwegian University of Science and Technology Trondheim Norway
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Ostojic K, Sharp NL, Paget SP, Morrow AM. Lived experiences of pain in children and young people with cerebral palsy. Dev Med Child Neurol 2022; 64:364-371. [PMID: 34553772 DOI: 10.1111/dmcn.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore the lived experiences of pain in children and young people with cerebral palsy (CP). METHOD Participants were recruited from the Sydney Children's Hospitals Network and the New South Wales/Australian Capital Territory CP Registers. Inclusion criteria were as follows: CP; aged 9 to 17 years; current/past experience of pain; fluent in English; no greater than mild intellectual disability. Purposive sampling ensured representation across age, motor subtypes, and Gross Motor Function Classification System (GMFCS) levels. Semi-structured face-to-face interviews were conducted. Data were analysed following an interpretative phenomenological approach. RESULTS Ten participants (three male) were included (mean age 14y 5mo, SD 2y), GMFCS levels I (n=4), II (n=3), III (n=2), and IV (n=1). Analysis led to three superordinate themes: (1) Everybody's experience of pain is different; (2) When the pain is winning; (3) 'I know how to deal with it'. Pain contributors and locations varied between children. Pain intruded on school, physical activity, and psychosocial functioning. Children described personalized strategies used to deal with pain. INTERPRETATION In this study, children self-reported highly individualized pain experiences which interfered with their daily life and psychosocial well-being. There is a need for improvement in pain assessment and a personalized approach to pain management.
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Affiliation(s)
- Katarina Ostojic
- Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole L Sharp
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon P Paget
- Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Angela M Morrow
- Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Byiers BJ, Roberts CL, Burkitt CC, Merbler AM, Craig KD, Symons FJ. Parental Pain Catastrophizing, Communication Ability, and Post-surgical Pain Outcomes Following Intrathecal Baclofen Implant Surgery for Patients With Cerebral Palsy. FRONTIERS IN PAIN RESEARCH 2022; 2:809351. [PMID: 35295472 PMCID: PMC8915662 DOI: 10.3389/fpain.2021.809351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
There is strong evidence that psychosocial variables, including pain catastrophizing, influence parental and child ratings of pain, pain expression, and long-term outcomes among children with chronic pain. The role of these factors among children who have communication deficits due to cerebral palsy (CP) and other intellectual and developmental disabilities is currently unclear. In this study, parental pain catastrophizing was assessed before intrathecal baclofen (ITB) pump implantation for spasticity management in 40 children and adolescents with CP, aged 4 to 24 years. Pain was assessed before and after surgery with two methods: a parent-reported pain interference scale, and behavioral pain signs during a standardized range of motion exam. Linear mixed models with clinical/demographic factors and scores from the Pain Catastrophizing Scale for Parents (PCS-P), and child spoken language ability as predictors and the pain variables as the outcomes were implemented. On average, both pain outcomes improved after surgery. Only child spoken language ability predicted change in behavioral reactivity scores, with children with phrase speech showing an increase in reactivity at follow-up compared to pre-surgery levels, on average. A significant interaction between PCS-P scores and spoken language ability on change in pain interference scores over time showed that dyads with children with phrase speech whose parents reported high PCS-P scores reported the least improvement in pain interference at follow-up. Due to the preliminary nature of the study, future work is needed to investigate the parental behaviors that mediate the relationships between parental catastrophizing and pain outcomes in this population.
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Affiliation(s)
- Breanne J. Byiers
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Breanne J. Byiers
| | - Caroline L. Roberts
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Chantel C. Burkitt
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
- Gillette Children's Specialty Healthcare, Saint Paul, MN, United States
| | - Alyssa M. Merbler
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Kenneth D. Craig
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Frank J. Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
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45
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Debelle G, Morris H, Shaw N, Oates A. Fifteen-minute consultation: Fractures in non-ambulant children with cerebral palsy. Arch Dis Child Educ Pract Ed 2022; 107:15-20. [PMID: 33361095 DOI: 10.1136/archdischild-2020-319882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe a safeguarding decision pathway for the assessment of osteopenic fractures in non-ambulant children with cerebral palsy. METHOD Literature review and consensus practice of a child safeguarding team, including clinicians and social workers. CONCLUSION Low-energy fractures of the lower limb in non-ambulant children with cerebral palsy are relatively common and explained by the presence of reduced bone strength, in the absence of any other unexplained injuries or safeguarding concerns.
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Affiliation(s)
- Geoff Debelle
- Safeguarding Team, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helen Morris
- Department of General Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Nick Shaw
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Department of Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Department of Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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46
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Flyckt N, Wong C, Michelsen JS. Non-pharmacological and non-surgical treatment of pain in children and adolescents with cerebral palsy: A scoping review. J Pediatr Rehabil Med 2022; 15:49-67. [PMID: 35275574 DOI: 10.3233/prm-210046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore the existing literature on non-pharmacological and non-surgical pain management in children and adolescents with cerebral palsy (CP). METHODS Databases (Cochrane Library, PubMed MEDLINE, Ovid Embase, and PsycINFO) were systematically searched to identify literature on non-pharmacological and non-surgical interventions for relieving pain in children with CP or similar conditions. RESULTS Thirteen publications met the inclusion criteria. Based on study designs, the overall level of evidence of the included studies was low, justifying the use of a scoping review. Only three were randomized controlled trials. Pain reduction was reported in 8 of the 13 studies from following interventions: physiotherapy/rehabilitation, massage, cranial osteopathy, swimming and aquatics, and assistive devices. These complementary strategies should not omit conventional treatment, and a multidisciplinary approach using multifaceted treatment of pharmacological and non-pharmacological therapy is recommended to increase the pain-relieving effect. CONCLUSION The results indicate that physiotherapy, massage, swimming exercise, and various assistive devices can have pain-relieving effects. We found limited evidence on the topic of non-pharmacological and non-surgical treatment of pain in children with CP. Due to the lack of power in the included studies, no true evidence-based recommendations can be made from the collected articles; thus, further studies with larger cohorts and more power are needed to substantiate evidence-based treatment of pain in children and adolescents with CP.
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Affiliation(s)
- Natasja Flyckt
- Department of Orthopedic Surgery, Hvidovre Hospital, Hvidovre, Denmark
| | - Christian Wong
- Department of Orthopedic Surgery, Hvidovre Hospital, Hvidovre, Denmark
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47
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Ni ZH, Ding S, Wu JH, Zhang S, Liu CY. Family Caregivers’ Experiences of Caring for Children With Cerebral Palsy in China: A Qualitative Descriptive Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221121510. [PMID: 36062607 PMCID: PMC9449510 DOI: 10.1177/00469580221121510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate family caregivers’ experiences of caring for
children with cerebral palsy in China. This study used a descriptive qualitative
design. We selected 18 family caregivers from 3 children’s hospitals in Jiangsu
Province, China, using a purposive sampling method. The following 5 themes
emerged as needs of family caregivers’ experiences of caring for children with
cerebral palsy: overall responsibility, being alone, exhaustion from caring,
being a prisoner of life, and uncertainty regarding the future. The findings of
our research contribute to a better understanding of the life situation of
family caregivers of children with cerebral palsy as we identify the
difficulties they experience as well as their specific needs.
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Affiliation(s)
- Zhi Hong Ni
- Children’s Hospital of Soochow University, Suzhou, China
| | - Sheng Ding
- Children’s Hospital of Soochow University, Suzhou, China
| | - Jin Hua Wu
- Children’s Hospital of Soochow University, Suzhou, China
| | - Shuo Zhang
- Children’s Hospital of Soochow University, Suzhou, China
| | - Chun Yan Liu
- Children’s Hospital of Soochow University, Suzhou, China
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48
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Heinen F, Bonfert M, Kaňovský P, Schroeder AS, Chambers HG, Dabrowski E, Geister TL, Hanschmann A, Althaus M, Banach M, Gaebler-Spira D. Spasticity-related pain in children/adolescents with cerebral palsy. Part 1: Prevalence and clinical characteristics from a pooled analysis. J Pediatr Rehabil Med 2022; 15:129-143. [PMID: 35342060 PMCID: PMC9277671 DOI: 10.3233/prm-220011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE A large prospective database from three Phase 3 studies allowed the study of spasticity-related pain (SRP) in pediatric cerebral palsy (CP). METHODS Baseline (pretreatment) SRP data occurring during different activities in children/adolescents (aged 2-17 years, ambulant/nonambulant) with uni-/bilateral spastic CP was obtained using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to spasticity level [lower limb (LL) or upper limb (UL)] and type of respondent [child/adolescent, interviewer, or parent/caregiver]). RESULTS At baseline, 331 children/adolescents with LL- and 155 with UL-spasticity completed at least one key item of their modules; LL/UL QPS modules of parent/caregivers were at least partially completed (key items) by 841/444 parents/caregivers. SRP with at least one activity at baseline was self-reported in 81.9% /69.7% (LLs/ULs) of children/adolescents with spasticity. Parents/caregivers observed LL/UL SRP behaviors in 85.9% /77.7% of their children, with multiple body regions affected. SRP negatively affected the great majority of the children in various ways. Child/adolescent-reported mean SRP intensity and parent/caregiver-observed mean SRP behavior frequencies were higher for LLs than ULs, and the level of SRP increased with more physically demanding activities. CONCLUSION These data suggest SRP is more common and intense in pediatric CP than generally thought, emphasizing the need for effective, long-term pain management.
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Affiliation(s)
- Florian Heinen
- Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Michaela Bonfert
- Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, Olomouc, Czech Republic
| | - A Sebastian Schroeder
- Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Edward Dabrowski
- Beaumont Pediatric Physical Medicine & Rehabilitation - Royal Oak, Royal Oak, MI, USA
| | | | | | | | - Marta Banach
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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49
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Jersak T, Noritz G. Evaluation of Pain in Adults With Childhood-Onset Disabilities and Communication Difficulties. Front Neurol 2021; 12:722971. [PMID: 34675866 PMCID: PMC8523837 DOI: 10.3389/fneur.2021.722971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
Adults with childhood-onset disabilities, particularly those with central nervous system impairment, commonly experience pain. Because many such individuals have difficulties in communication, caregivers and medical professionals must identify and interpret non-verbal behaviors as indicators of pain. This process is challenging and can lead to poor outcomes through delayed or incorrect diagnosis and treatment. Most research in the evaluation of pain in individuals with neurologic impairment has focused on the pediatric population, and evidence-based guidelines do not exist for adults. The purpose of this paper is to review current recommendations for pain assessment in adults with communication impairment. This approach includes guidance for history-taking, pharmacologic review, physical examination, and the judicious use of laboratory and imaging tests. Finally, we discuss adult-specific diagnoses to consider when evaluating pain in adults with childhood-onset disabilities and communication difficulties.
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Affiliation(s)
- Taylor Jersak
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
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50
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Shearer HM, Côté P, Hogg-Johnson S, McKeever P, Fehlings DL. Identifying pain trajectories in children and youth with cerebral palsy: a pilot study. BMC Pediatr 2021; 21:428. [PMID: 34587937 PMCID: PMC8480103 DOI: 10.1186/s12887-021-02861-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Although chronic pain is common in children with cerebral palsy (CP), little is known about short-term pain fluctuations and their impact on children’s well-being. High-quality cohort studies are needed to understand the clinical course of pain in this population. We aimed to determine the feasibility of conducting a multicentre cohort study. In this pilot study we assessed: 1) study processes, 2) resource and 3) management indicators including recruitment and follow-up rates, data completeness, participant characteristics, and successes and barriers in the study conduct. Methods A multi-centre pilot cohort study was conducted with 10 Canadian children/youth with CP attending one of two children’s rehabilitation centers. We collected self-reported pain intensity (Faces Pain Scale-Revised [FPS-R], Numeric Rating Scale [NRS]); pain interference (PROMIS PI); pain location (pain diagram); physical and psychological well-being (KIDSCREEN-27), sleep characteristics, preceding months’ interventions, and some clinical characteristics at baseline. Average pain intensity was reported weekly for five weeks. Well-being, sleep and interventions were measured at baseline and again at five weeks. We used feasibility indicators to evaluate:1) study processes (e.g. recruitment, attrition rates); 2) resources (e.g. data completion, budgetary challenges); and 3) management (e.g. data optimization, variability of participants and pain scores). Results Between March and May 2019, 24 children and their parents/guardians were contacted and 20 met eligibility criteria. Of those, 10 agreed to in-person screening (50%) and were subsequently enrolled. The follow-up rate was 90% and self-reported missing data was minimal. Ninety percent of participants chose e-questionnaire follow-ups versus mailed paper questionnaires. Sixty percent required reminders to complete e-follow-ups. Participants were aged 8-17 years, five were female, GMFCS levels I-IV (none with level V), 90% had spastic CP and 80% reported having pain in the preceding week. Pain intensity (FPS-R) between participants ranged from 0-8/10 at baseline and 0-6/10 across all four weekly follow-ups. Conclusions This pilot study demonstrates the feasibility of conducting a multicentre cohort study to identify short-term pain trajectories and measure their association with well-being in children and youth with CP. Additional strategies to improve recruitment and accessibility for those with GMFCS levels V should be implemented in future studies.
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Affiliation(s)
- Heather M Shearer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd., Toronto, ON, M4G 1R8, Canada. .,Institute for Disability and Rehabilitation Research, Oshawa, Ontario, Canada.
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Disability and Rehabilitation Research, Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Disability and Rehabilitation Research, Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Patricia McKeever
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Darcy L Fehlings
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd., Toronto, ON, M4G 1R8, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
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