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Miah MAA, Chandna J, Gurung R, Masoud NS, Paul P, Ameen S, Basnet O, Miraji M, Tann C, Mili IA, Hossain AKMT, Chowdhury AI, Alam A, Milner KM, Arifeen SE, Kc A, Manji K, Lynch P, Lawn JE, Hamadani JD. Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)- a parent group intervention for school readiness in Bangladesh, Nepal, and Tanzania: study protocol for a cluster randomized controlled trial. Trials 2024; 25:556. [PMID: 39180108 PMCID: PMC11342614 DOI: 10.1186/s13063-024-08381-6] [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: 04/29/2024] [Accepted: 08/06/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn-Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility. METHODS EN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent-child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is "school readiness", assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders' perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. DISCUSSION: This protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities. TRIAL REGISTRATION The trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627).
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Affiliation(s)
- Mohammad Abdul Awal Miah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Rejina Gurung
- Golden Community, Research Division, Lalitpur, Nepal
| | - Nahya Salim Masoud
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Proma Paul
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Omkar Basnet
- Golden Community, Research Division, Lalitpur, Nepal
| | - Mustafa Miraji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Temeke Regional Referral Hospital, Dar es Salaam, Tanzania
| | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Ismat Ara Mili
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - A K M Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Atique Iqbal Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Asraful Alam
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kate Mackinnon Milner
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashish Kc
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Lynch
- School of Education, University of Glasgow, Glasgow, Scotland
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Jena Derakhshani Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Lanza M, Incagli F, Ceccato C, Reffo ME, Mercuriali E, Parmeggiani F, Pagliano E, Saletti V, Leonardi M, Suppiej A, Dollfus H, LeBreton D, Finger RP, Leroy BP, Zemaitiene R, Nowomiejska K, Guastafierro E. Quality of life, functioning and participation of children and adolescents with visual impairment: A scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104772. [PMID: 38870675 DOI: 10.1016/j.ridd.2024.104772] [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: 03/15/2024] [Revised: 04/24/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Vision has a key role in children's neuromotor, cognitive and social development. Children with visual impairment attain developmental milestones at later stages and are at higher risk of developing psychological disorders and social withdrawn. AIMS We performed a scoping review to summarize the mostly used instruments assessing the impact of visual impairment on quality of life, functioning and participation of children and adolescents. In addition, the main findings of the included studies are discussed. METHODS AND PROCEDURES We searched for papers assessing quality of life, functioning and participation of children and adolescents with visual impairment from 0 to 18 years old conducted between 2000 and 2023. OUTCOMES AND RESULTS In total, 69 studies met the inclusion criteria and were included in the review. Child self-report, caregivers-proxy and self-report questionnaires as well as interviews were used. The results showed that quality of life, functioning and participation are significantly reduced in children and adolescents with visual impairment, and that the impact depends on different factors (e.g., severity of the impairment, age). CONCLUSIONS AND IMPLICATIONS Considering the significant impact of visual impairment on quality of life, functioning and participation on this population, it is fundamental to develop integrated and multi-dimensional assessment programs that evaluate the impact of visual impairment on those dimensions considering different contexts of life (e.g., family, school, leisure time). WHAT THIS PAPER ADDS?: The present review aims to give an overview of what is known about the impact of visual impairment on quality of life, functioning and participation of children and adolescents. We assumed a biopsychosocial perspective which, in line with the definition of health by the International Classification of Functioning, Disability and Health (WHO, 2001), considered how body functions and structures, functioning, participation and environmental factors dynamically interact to define the health, or the disease, status of a person at a certain moment of life. We reported the most used instruments for the assessment of quality of life, participation, and functioning, with a specific interest on Patient-Reported Outcome Measures and self-report measures. By reporting the different instruments used, we gave a broad overview about the available tools that can be used in clinical as well as in research field to assess quality of life, functioning and participation in this population. Additionally, the review of the existing literature allowed us to demonstrate that those dimensions are negatively impacted by visual impairment and thus they should be considered in the assessment programs. Specifically, there is the need to provide more integrated assessment programs that investigate the impact of visual impairment on children and adolescents' social and emotional wellbeing, everyday functioning and social relationship, considering their subjective experience together with the one of caregivers, teachers, health care professionals, and other relevant adults involved in their life. Additionally, it is essential to plan and implement multidimensional assessment programs that consider how all areas of life are differently impacted by visual impairment.
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Affiliation(s)
- Martina Lanza
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesca Incagli
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Chiara Ceccato
- Robert Hollman Foundation, Padova, Italy; Pediatric Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Francesco Parmeggiani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Emanuela Pagliano
- Department of Pediatric Neurosciences Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Saletti
- Department of Pediatric Neurosciences Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Agnese Suppiej
- Robert Hollman Foundation, Padova, Italy; Pediatric Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Hélène Dollfus
- Centre de référence pour les affections rares ophtalmologiques CARGO, FSMR SENSGENE, ERN-EYE, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, Strasbourg, France
| | - David LeBreton
- Institute for Advanced study (USIAS), University of Strasburg, France
| | - Robert P Finger
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bart Peter Leroy
- Department of Ophthalmology and Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Reda Zemaitiene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Erika Guastafierro
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Bradley SS, de Holanda LJ, Chau T, Wright FV. Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments. Front Neurosci 2024; 18:1398459. [PMID: 39145294 PMCID: PMC11322617 DOI: 10.3389/fnins.2024.1398459] [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: 03/09/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Background Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm. Methods This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents. Discussion This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention. Clinical trial registration https://clinicaltrials.gov, identifier NCT05463211.
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Affiliation(s)
- Stefanie S. Bradley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Schwartz A, Guerrero Calle F, Barbour E, Persch A, Pfeiffer B, Davies DK, Mugele EJ, Kramer J. Interpretability and Clinical Utility of the Pediatric Evaluation of Disability Inventory - Patient Reported Outcome (PEDI-PRO) Score Report. Phys Occup Ther Pediatr 2024:1-19. [PMID: 39039971 DOI: 10.1080/01942638.2024.2378064] [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: 03/20/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
AIMS Well-designed score reports can support therapists to accurately interpret assessments. We piloted a score report for the Pediatric Evaluation Disability Inventory-Patient Reported Outcome (PEDI-PRO) and evaluated: 1) To what extent can occupational and physical therapists (OT, PT) accurately interpret item-response theory (IRT)-based PEDI-PRO assessment results? 2) What is the perceived clinical utility of the pilot score report? METHODS Exploratory, sequential mixed methods design. Focus groups with OT and PTs (n = 20) informed the development of the final score report; revisions were made in response to feedback. Next, OTs and PTs (n = 33) reviewed score reports from two fictional clients and answered survey questions about the interpretation of the PEDI-PRO results. Additional questions evaluated clinical utility. RESULTS Focus groups: Visual cues supported score interpretation, but therapists requested additional explanations for advanced IRT measurement concepts. Survey: Therapists accurately interpreted foundational IRT concepts (e.g. identifying most/least difficult items, highest scores), but were less accurate when interpreting advanced concepts (e.g. fit, unexpected responses). Therapists anticipated sharing different components of the score report with family members, clinicians, and payers to support their clinical practice. CONCLUSIONS The pilot PEDI-PRO score report was highly endorsed by therapists, but therapists may need additional training to interpret advanced IRT concepts.
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Affiliation(s)
- Ariel Schwartz
- Institute on Disability, University of New Hampshire, Durham, New Hampshire, USA
| | | | - Elizabeth Barbour
- Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA
| | - Andrew Persch
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
| | - Beth Pfeiffer
- Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Daniel K Davies
- AbleLink Smart Living Technologies, LLC, Colorado Springs, Colorado, USA
| | - Erik J Mugele
- AbleLink Smart Living Technologies, LLC, Colorado Springs, Colorado, USA
| | - Jessica Kramer
- Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA
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Devine TM, Alter KE, Damiano DL, Bulea TC. A randomized cross-over study protocol to evaluate long-term gait training with a pediatric robotic exoskeleton outside the clinical setting in children with movement disorders. PLoS One 2024; 19:e0304087. [PMID: 38976710 PMCID: PMC11230531 DOI: 10.1371/journal.pone.0304087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/02/2024] [Indexed: 07/10/2024] Open
Abstract
Individuals with neuromuscular disorders display a combination of motor control deficits and lower limb weakness contributing to knee extension deficiency characterized by exaggerated stance phase knee flexion. There is a lack of evidence for long-term improvement of knee extension deficiency with currently available clinical treatment programs. Our previous work testing a wearable robotic exoskeleton with precisely timed assistive torque applied at the knee showed immediate increases in knee extension during walking for children with cerebral palsy, which continued to improve over an acute practice period. When we applied interleaved assistance and resistance to knee extension, we observed improvements in knee extension and increased muscle activation indicating the potential for muscle strengthening when used over time. There is a need for additional, high-quality trials to assess the impact of dosage, intensity and volume of training necessary to see persistent improvement in lower limb function for these patient populations. This randomized crossover study (ClinicalTrials.gov: NCT05726591) was designed to determine whether 12 weeks of overground gait training with a robotic exoskeleton outside of the clinical setting, following an initial in clinic accommodation period, has a beneficial effect on walking ability, muscle activity and overall motor function. Participants will be randomized to either complete the exoskeleton intervention or continue their standard therapy for 12 weeks first, followed by a crossover to the other study component. The primary outcome measure is change in peak knee extension angle during walking; secondary outcome measures include gait speed, strength, and validated clinical scales of motor function and mobility. Assessments will be completed before and after the intervention and at 6 weeks post-intervention, and safety and compliance will be monitored throughout. We hypothesize that the 12-week exoskeleton intervention outside the clinical setting will show greater improvements in study outcome measures than the standard therapy.
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Affiliation(s)
- Taylor M. Devine
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Katharine E. Alter
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Diane L. Damiano
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Thomas C. Bulea
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
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Levy S, Wynd AHD, Motee A. "Crafting a 'TransitionOmeter': A Proposed Framework for Developing and Honing Capabilities of Young People Transitioning to Adult Healthcare Services.". Compr Child Adolesc Nurs 2024; 47:86-97. [PMID: 38713540 DOI: 10.1080/24694193.2024.2348830] [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: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
This paper focuses on an innovative approach to preparing children and young people, with Spina Bifida, to move from child-centered to adult-oriented healthcare systems. Reflecting on our role in delivering a national nurse led service, we set to identify and critique international transition tools in use for this population. Specifically, we aimed to identify the core capabilities and indicators of progression to successful transition, so that holistic interventions could be planned to match the needs of individuals and their carers. There were two phases to the study, initially focusing on a systematic literature review on transition tools and the specific items that these tools captured, including skills, abilities and behaviors. Phase two culminated in the articulation of a segmented and incremental "road map", aligned with facets deemed essential for a successful healthcare transition. The reporting of the literature review (phase one) followed the PRISMA guidelines and shaped the qualitative element of the study (phase two) through the use of semi-structured interviews and thematic analysis. The search strategy yielded 11 studies, which were then manually searched for other relevant literature, adding a further 14 articles. The review analyzed 7 specific tools for spina bifida and 8 generic tools, which were deemed appropriate for this group of patients. A comprehensive list of core capabilities was then articulated and framed to fit a progression timeline. Specific interventions were formulated to explore ways to co-produce resources that could enhance and support a planned transition to adult-focused services. Our proposed mapping of capabilities and progression could shape other transition programs, where nurses work collaboratively with young people, carers and other members of a team. More work is needed to further explore and embed the framework that, as we did, could be digitized and shared with all stakeholders involved in the transition process.
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Affiliation(s)
- Sharon Levy
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Hwang Y, Kwon JY. Identifying the most representative actigraphy variables reflecting standardized hand function assessments for remote monitoring in children with unilateral cerebral palsy. BMC Pediatr 2024; 24:273. [PMID: 38664706 PMCID: PMC11044557 DOI: 10.1186/s12887-024-04724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Accurate assessment of physical activity and motor function in children with cerebral palsy is crucial for determining the effectiveness of interventions. This study aimed to investigate the correlation between real-world activity monitoring outcomes and in-laboratory standardized hand function assessments in children with unilateral cerebral palsy. METHODS Actigraphy data were collected over 3 days from children aged 4-12 years with unilateral cerebral palsy before in-laboratory assessments. To tackle the high dimensionality and collinearity of actigraphy variables, we first applied hierarchical clustering using the Pearson correlation coefficient as the distance metric and then performed a principal component analysis (PCA) to reduce the dimensionality of our data. RESULTS Both hierarchical clustering and PCAs revealed a consistent pattern in which magnitude ratio variables (ln[affected side magnitude/less-affected side magnitude]) were more strongly associated with standardized assessments of hand function than with activity time and distance domain variables. Hierarchical clustering analysis identified two distinct clusters of actigraphy variables, with the second cluster primarily consisting of magnitude ratio variables that exhibited the strongest correlation with Melbourne Assessment 2, Pediatric Motor Activity Log, Assisting Hand Assessment, and Manual Ability Classification System level. Principal component 2, primarily representing the magnitude ratio domain, was positively associated with a meaningful portion of subcategories of standardized measures, whereas principal component 1, representing the activity time and distance component, showed limited associations. CONCLUSIONS The magnitude ratio of actigraphy can provide additional objective information that complements in-laboratory hand function assessment outcomes in future studies of children with unilateral cerebral palsy. TRIAL REGISTRATION IN CLINICALTRIALS.GOV: NCT04904796 (registered prospectively; date of registration: 23/05/2021).
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Hyer LC, Shull ER, Wagner LV, Westberry DE. Functional Independence of Children With Arthrogryposis. J Pediatr Orthop 2024; 44:197-201. [PMID: 38053409 DOI: 10.1097/bpo.0000000000002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Arthrogryposis (AMC) is a descriptive term to characterize a child born with multiple joint contractures. Treatment aims to improve functional independence, yet the literature objectively describing functional independence in this population is scarce. This study aimed to describe the functional independence of children with AMC through the lens of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) and observational activities of daily living (ADL) tasks. METHODS Patients with AMC between the ages of 3 and 12 years participated in this prospective study. Parents completed the PEDI-CAT while a trained occupational therapist observed children as they completed a checklist of functional ADL tasks. Patients were grouped according to developmental age groups: "preschoolers" (3 to 5 y), "early school-age" (6 to 9 y), and "late school-age" (10 to 12 y). Patient's PEDI-CAT normative scores were described, comparing the study population to typically developing children, and differences in each domain were examined between developmental age groups. The observed ADL tasks completed were also described, and differences in scores were examined between developmental age groups. RESULTS Forty-four patients (mean age of 7±2.86 y) were enrolled. The distribution between age groups was nearly even. Mean daily activities T -score for patients with AMC was 25.80±11.98 and the mean mobility T -score was 17.39±9.77. Late school-age children scored significantly lower than preschool-age children in both of these domains ( P <0.01). Observed ADL tasks demonstrated a high level of required assistance for patients (range: 27.3% to 61.4%), although older school-age children did show greater independence with tested activities than preschool-age children ( P =0.05). CONCLUSION Children with AMC are significantly limited in functional independence, particularly regarding age-appropriate daily activities and mobility. Outcomes from this study provide a reference to help gauge the results of nonoperative and surgical treatment toward improving functional independence in this population. LEVEL OF EVIDENCE Level III: prognostic study.
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Graham FP, Williman JA, Desha LN, Snell D, Jones B, Ingham TR, Latu A, Maggo JK, Ranta A, Ziviani J. Occupational Performance Coaching for Children With Neurodisability: A Randomized Controlled Trial Protocol. Can J Occup Ther 2024; 91:4-16. [PMID: 36919383 PMCID: PMC10903119 DOI: 10.1177/00084174231160976] [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] [Indexed: 03/16/2023]
Abstract
Background. Occupational Performance Coaching (OPC) is a goal-oriented approach in which client agency takes precedence in goal selection, analysis, choice of action, and evaluation of success. The intended outcomes of OPC are improved occupational performance and participation in clients' life situations. Randomized clinical trials are needed to determine the effectiveness of OPC. Purpose. This study protocol outlines a randomized controlled trial (RCT) of OPC compared to usual care with caregivers of children with neurodisability in improving child, caregiver, and family occupational performance. Method. A single-blind, 2-arm parallel-group, cluster RCT of OPC compared to usual care is planned. Therapists delivering the intervention (N = 14) are randomized to "OPC training" or "usual care" groups. The primary outcome is occupational performance improvement in caregiver (N = 84) identified goals. Implications. Findings will provide translational evidence of the effectiveness of OPC and clarify intervention processes. Areas of future OPC research and development will be indicated.
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Affiliation(s)
- Fiona P. Graham
- Fiona P. Graham, Rehabilitation Teaching and Research Unit, University of Otago Wellington, 23A Mein Street, Newtown, Wellington 6242, New Zealand. Phone: ++64 364 3620.
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Mulkey SB, Corn E, Williams ME, Peyton C, Andringa-Seed R, Arroyave-Wessel M, Vezina G, Bulas DI, Podolsky RH, Msall ME, Cure C. Neurodevelopmental Outcomes of Normocephalic Colombian Children with Antenatal Zika Virus Exposure at School Entry. Pathogens 2024; 13:170. [PMID: 38392908 PMCID: PMC10892822 DOI: 10.3390/pathogens13020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been examined to the age of school entry level. A total of 51 Colombian children with antenatal ZIKV exposure without CZS and 70 unexposed controls were evaluated at 4-5 years of age using the Behavior Rating Inventory of Executive Function (BRIEF), the Pediatric Evaluation of Disability Inventory (PEDI-CAT), the Bracken School Readiness Assessment (BSRA), and the Movement Assessment Battery for Children (MABC). The mean ages at evaluation were 5.3 and 5.2 years for cases and controls, respectively. Elevated BRIEF scores in Shift and Emotional Control may suggest lower emotional regulation in cases. A greater number of cases were reported by parents to have behavior and mood problems. BSRA and PEDI-CAT activity scores were unexpectedly higher in cases, most likely related to the COVID-19 pandemic and a delayed school entry among the controls. Although PEDI-CAT mobility scores were lower in cases, there were no differences in motor scores on the MABC. Of 40 cases with neonatal neuroimaging, neurodevelopment in 17 with mild non-specific findings was no different from 23 cases with normal neuroimaging. Normocephalic children with ZIKV exposure have positive developmental trajectories at 4-5 years of age but differ from controls in measures of emotional regulation and adaptive mobility, necessitating continued follow-up.
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Affiliation(s)
- Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
- Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Elizabeth Corn
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Meagan E. Williams
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Regan Andringa-Seed
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Margarita Arroyave-Wessel
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Gilbert Vezina
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Dorothy I. Bulas
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Robert H. Podolsky
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC 20010, USA;
| | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Carlos Cure
- BIOMELab, Atlántico, Barranquilla 080001, Colombia;
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Kanner CH, Uher D, Zreibe K, Beard G, Patterson M, Harris M, Doerger J, Calamia S, Chung WK, Montes J. Validation of a modified version of the gross motor function measure in PPPR5D related neurodevelopmental disorder. Orphanet J Rare Dis 2024; 19:45. [PMID: 38326877 PMCID: PMC10848481 DOI: 10.1186/s13023-024-03067-3] [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: 09/19/2023] [Accepted: 02/03/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Protein phosphatase 2 regulatory subunit B' Delta (PPP2R5D)-related neurodevelopmental disorder is a rare genetic condition caused by pathogenic variants in the PPP2R5D gene. Clinical signs include hypotonia, gross motor delay, intellectual disability (ID), epilepsy, speech delays, and abnormal gait among other impairments. As this disorder was recognized within the last decade, there are only 103 people published diagnoses to date. A thorough understanding of the motor manifestations of this disorder has not yet been established. Knowledge of the natural history of PPP2R5D related neurodevelopmental disorder will lead to improved standard of care treatments as well as serve as a baseline foundation for future clinical trials. Appropriate outcome measures are necessary for use in clinical trials to uniformly measure function and monitor potential for change. The aim of this study was to validate the gross motor function measure (GMFM) in children and adults with PPP2R5D-related neurodevelopmental disorder in order to better characterize the disorder. RESULTS Thirty-eight individuals with PPP2R5D pathogenic variants, median age 8.0 years (range 1-27) were evaluated. Gross motor, upper limb and ambulatory function were assessed using the GMFM-66, six-minute walk test (6MWT), 10-meter walk run (10MWR), timed up and go (TUG), and revised upper limb module (RULM). The pediatric disability inventory computer adapted test (PEDI-CAT) captured caregiver reported assessment. Median GMFM-66 score was 60.6 (SD = 17.3, range 21.1-96.0). There were strong associations between the GMFM-66 and related mobility measures, 10MWR (rs = -0.733; p < 0.001), TUG (rs= -0.747; p = 0.003), 6MWT (r = 0.633; p = 0.006), RULM (r = 0.763; p < 0.001), PEDICAT-mobility (r = 0.855; p < 0.001), and daily activities (r = 0.822; p < 0.001) domains. CONCLUSIONS The GMFM is a valid measure for characterizing motor function in individuals with PPP2R5D related neurodevelopmental disorder. The GMFM-66 had strong associations with the RULM and timed function tests which characterized gross motor, upper limb and ambulatory function demonstrating concurrent validity. The GMFM-66 was also able to differentiate between functional levels in PPP2R5D related neurodevelopmental disorder demonstrating discriminant validity. Future studies should examine its sensitivity to change over time, ability to identify sub-phenotypes, and suitability as an outcome measure in future clinical trials in individuals with PPP2R5D variants.
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Affiliation(s)
- Cara H Kanner
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA.
| | - David Uher
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Kyle Zreibe
- Department of Rehabilitation, UHealth-Jackson Holtz Children's Hospital, Miami, FL, USA
| | - Gabriella Beard
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA
| | - Madison Patterson
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA
| | - Matthew Harris
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA
| | - Jerome Doerger
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Sean Calamia
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, New York, NY, 10032, USA
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Msall ME, Lagatta JM, Bora S. Optimizing trajectories of social adaptive competencies after extreme prematurity during the first 1000 days. Semin Fetal Neonatal Med 2024; 29:101531. [PMID: 38632009 PMCID: PMC11156543 DOI: 10.1016/j.siny.2024.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Over 75% of surviving extremely preterm infants do not have major neurodevelopmental disabilities; however, more than half face difficulties with communication, coordination, attention, learning, social, and executive function abilities. These "minor" challenges can have a negative impact on educational and social outcomes, resulting in physical, behavioral, and social health problems in adulthood. We will review assessment tools for social-emotional and adaptive functional skills in early childhood as these determine family and early childhood supports. We highlight bronchopulmonary dysplasia as an example of the critical intersections of parental wellbeing, medical and developmental adaptive trajectories in infancy and early childhood, and partnerships between child neurologists and community medical and developmental professionals. We examine studies of engaging parents to promote developmental trajectories, with a focus on supporting parent-child interactions that underlie communication, social-adaptive behaviors, and learning in the first 1000 days of life. Recommendations for neurodevelopmental surveillance and screening of extremely preterm infants can also be applied to infants with other risk factors for altered neurodevelopment.
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Affiliation(s)
- Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Medicine, Chicago, IL, USA.
| | - Joanne M Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Samudragupta Bora
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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13
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Brugnaro BH, Kraus de Camargo O, Pfeifer LI, Pavão SL, Hlyva O, Rocha NACF. Association between participation at home and functional skills in children and adolescents with Down syndrome: A cross-sectional study. Child Care Health Dev 2024; 50:e13197. [PMID: 37955102 DOI: 10.1111/cch.13197] [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: 07/24/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions. OBJECTIVE This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility. METHODS This was an observational study. Forty-eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM-CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI-CAT-SV) (continuous score). RESULTS Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI-CAT-SV Mobility, no significant correlation was found. CONCLUSIONS Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation-focused intervention.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Department of Physical Therapy, Child Development Analysis Laboratory (LADI), Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | - Luzia Iara Pfeifer
- Department of Occupational Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | - Silvia Letícia Pavão
- Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná, Curitiba, Brazil
| | - Oksana Hlyva
- CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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14
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Botchway-Commey E, Muscara F, Greenham M, D'Cruz K, Bonyhady B, Anderson V, Scheinberg A, Knight S. Rehabilitation models of care for children and youth with traumatic brain and/or spinal cord injuries: A focus on service structure, service organization, and the barriers and facilitators of rehabilitation service provision. Neuropsychol Rehabil 2023; 33:1697-1727. [PMID: 36423210 DOI: 10.1080/09602011.2022.2147196] [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: 06/14/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022]
Abstract
To understand the systems underlying current rehabilitation models of care used with children and youth (0-21years) who sustain traumatic brain and/or spinal cord injuries. This study gathered qualitative data on service structures, service organization, and the barriers and facilitators of service provision in selected medical rehabilitation service(s) (MRS) and community-based rehabilitation service(s) (CBRS). Informants from 11 rehabilitation services were interviewed using a semi-structured interview guide. Interviews were analysed in NVivo using content analysis method. Experiences shared by the service representatives indicated that most services supported children and youth with brain injury, with a limited number also specializing in spinal cord injuries. MRS often delivered care in inpatient or outpatient settings, while CBRS offered home/community-based services. Care planning often started either prior to or shortly after admission from acute care settings, using either multidisciplinary or interdisciplinary teamwork models. Strengths of the services included innovation and provision of family-centred care; while challenges experienced included difficulty translating evidence into practice and poor team communication. Models of care were similar across services, with a focus on providing family-centred care. Several shared challenges were described, and service representatives expressed interest in forming partnerships and collaborations to address these challenges through innovative initiatives.
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Affiliation(s)
- Edith Botchway-Commey
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
| | - Frank Muscara
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Mardee Greenham
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
| | - Kate D'Cruz
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Bruce Bonyhady
- Melbourne Disability Institute, University of Melbourne, Melbourne, Australia
| | - Vicki Anderson
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Adam Scheinberg
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Parkville, Australia
| | - Sarah Knight
- Brain and Mind, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- The Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Parkville, Australia
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15
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Hwang Y, Kwon JY, Na Y. An Exploration of Tri-Axial Accelerometers in Assessing the Therapeutic Efficacy of Constraint-Induced Movement Therapy in Children with Unilateral Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 23:9393. [PMID: 38067766 PMCID: PMC10708848 DOI: 10.3390/s23239393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to elucidate the role of tri-axial accelerometers in assessing therapeutic interventions, specifically constraint-induced movement therapy (CIMT), in children with unilateral cerebral palsy (UCP). The primary focus was understanding the correlation between the actigraphy metrics recorded during CIMT sessions and the resultant therapeutic outcomes. Children with UCP, aged between 4 and 12 years, participated in this study from July 2021 to December 2022. In conjunction with in-clinic sessions, during which participants wore tri-axial accelerometers on both limbs, we analyzed actigraphy data over three days of routine activities pre- and post-CIMT. While not all metrics derived from the accelerometers indicated significant improvements post-intervention, there was a clear trend towards a more balanced usage of both limbs, particularly evident in Axis 3, associated with vertical movement (p = 0.017). Additionally, a discernible correlation was observed between changes in the magnitude ratio derived from actigraphy data during CIMT (Δweek3-week1) and variations in traditional assessments pre- and post-intervention (ΔT0-T1), specifically the Assisting Hand Assessment grasp and release. Using tri-axial accelerometers has helped clarify the potential impacts of CIMT on children with UCP. The preliminary results suggest a possible link between actigraphy metrics taken during CIMT and the subsequent therapeutic outcomes determined by standardized tests.
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonju Na
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Fernandes AC, Souto DO, de Sousa Junior RR, Clutterbuck GL, Wright FV, de Souza MG, Ferreira LFB, Cardoso Rodrigues AA, Camargos ACR, Leite HR. Sports Stars Brazil in children with autism spectrum disorder: A feasibility randomized controlled trial protocol. PLoS One 2023; 18:e0291488. [PMID: 37939077 PMCID: PMC10631688 DOI: 10.1371/journal.pone.0291488] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/23/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) children have lower levels of participation in recreational and sporting activities when compared to their peers. Participation has been defined based on the Family of Participation-Related Constructs (fPRC) which defines participation as including both attendance and involvement, with sense of self, preferences and activity competence related to a child's participation. Modified sports interventions such as Sports Stars can act on physical literacy and some of the fPRCs components. This study aims to assess the feasibility of the Sports Stars Brazil intervention for children with ASD. METHODS This study will be conducted with 36 participants with ASD aged 6 to 12 years old following the CONSORT for pilot and feasibility recommendation. Participants will be randomly allocated into two groups. Intervention group will receive eight, weekly Sports Stars sessions. Each session will include of sports-focused gross motor activity training, confidence building, sports-education and teamwork development. Study assessments will occur at baseline, immediately post-intervention and 20-weeks post-randomization. First, we will assess process feasibility measures: recruitment, assessment completion, adherence, adverse events and satisfaction. Second, we will investigate the scientific feasibility of the intervention by estimating the effect size and variance at the level of achievement sports-related activity and physical activity participation goals (Goal Attainment Scaling), activity competence (Ignite Challenge, Test of Gross Motor Development-second edition, Physical Literacy Profile Questionnaire, Pediatric Disability Assessment Inventory-Computer Adaptive Test-PEDI-CAT-mobility, 10×5 Sprint Test and Muscle Power Sprint Test), sense of self (PEDI-CAT-responsibility), and overall participation at home, school and community, (Participation and Environment Measure for children and young people, PEM-CY). DISCUSSION The results of this feasibility study will inform which components are critical to planning and preparing a future RCT study, aiming to ensure that the RCT will be feasible, rigorous and justifiable. TRIAL REGISTRATION The trial was registered with the Brazilian Registry of Clinical Trials database (ID: RBR-9d5kyq4) on June 15, 2022.
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Affiliation(s)
- Amanda Cristina Fernandes
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deisiane Oliveira Souto
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo R. de Sousa Junior
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Georgina L. Clutterbuck
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - F. Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, and Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Mariane Gonçalves de Souza
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lidiane Francisca Borges Ferreira
- Graduate Program in Occupation Studies, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Amélia Cardoso Rodrigues
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina R. Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hércules R. Leite
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Girshin K, Sachdeva R, Cohn R, Gad P, Krassioukov AV, Edgerton VR. sPinal cOrd neUromodulatioN to treat Cerebral palsy in pEdiatrics: POUNCE Multisite Randomized Clinical Trial. Front Neurosci 2023; 17:1221809. [PMID: 37564370 PMCID: PMC10411340 DOI: 10.3389/fnins.2023.1221809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Cerebral palsy (CP) affects up to 4 children in 1,000 live births, making it the most common motor disorder in children. It impairs the child's ability to move voluntarily and maintain balance and posture, and results in a wide range of other functional disorders during early development impairments in various sensory modalities, e.g., vision, hearing ability and proprioception. Current standard of care therapy focuses on symptom management and does not mitigate the progression of many of these underlying neurological impairments. The goal of this trial is to conduct a prospective multicenter, double-blinded, sham-controlled, crossover, randomized control trial to demonstrate the safety and efficacy of noninvasive spinal cord neuromodulation (SCiP™, SpineX Inc.) in conjunction with activity-based neurorehabilitation therapy (ABNT) to improve voluntary sensorimotor function in children with cerebral palsy. Methods and analysis Sixty participants (aged 2-13 years) diagnosed with CP classified as Gross Motor Function Classification Scale Levels I-V will be recruited and divided equally into two groups (G1 and G2). Both groups will receive identical ABNT 2 days/wk. G1 will initially receive sham stimulation, whereas G2 will receive therapeutic SCiP™ therapy for 8 weeks. After 8 weeks, G1 will cross over and receive therapeutic SCiP™ therapy for 8 weeks, whereas G2 will continue to receive SCiP™ therapy for another 8 weeks, for a total of 16 weeks. Primary and secondary outcome measures will include Gross Motor Function Measure-88 and Modified Ashworth Scale, respectively. Frequency and severity of adverse events will be established by safety analyses. Ethics and dissemination The trial is registered on clinicaltrials.gov (NCT05720208). The results from this trial will be reported on clinicaltrials.gov, published in peer-reviewed journals and presented at scientific and clinical conferences.
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Affiliation(s)
- Kristin Girshin
- GirshinPT, Rancho Cucamonga, CA, United States
- SpineX Inc., Los Angeles, CA, United States
| | - Rahul Sachdeva
- SpineX Inc., Los Angeles, CA, United States
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Cohn
- Independent Consultant, Chapel Hill, NC, United States
| | - Parag Gad
- SpineX Inc., Los Angeles, CA, United States
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, BC, Canada
| | - V. Reggie Edgerton
- SpineX Inc., Los Angeles, CA, United States
- Rancho Research Institute, Downey, CA, United States
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain
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18
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Hwang Y, Kwon JY, Cho J, Choi J. Individualized Goal Setting for Pediatric Intensive Care Unit-Based Rehabilitation Using the Canadian Occupational Performance Measure. CHILDREN (BASEL, SWITZERLAND) 2023; 10:985. [PMID: 37371217 DOI: 10.3390/children10060985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
The Canadian Occupational Performance Measure (COPM) is a client-centered outcome measure that facilitates the prioritization of individualized interventions. Given the rising emphasis on individualized intervention in pediatric intensive care units (PICUs), this cross-sectional study aimed to explore caregivers' perspectives on their children's functional goals within PICUs. From 1 September 2020 to 26 June 2022, caregivers of 41 children aged 1-18 years completed the COPM within 48 h of PICU admission. The study also explored the clinical variables predicting a high number of occupational performance goals (≥4/5). Out of 190 goals proposed by caregivers, 87 (45.8%) pertained to occupational performance, while 103 (54.2%) were related to personal factors. Among the occupational performance goals, the majority were associated with functional mobility (55; 28.9%), followed by personal care (29; 15.2%) and quiet recreation (3; 1.6%). Among personal goals, physiological factors (68; 35.8%) were most common, followed by physical factors (35; 18.4%). We found caregiver anxiety, measured by the State-Trait Anxiety Inventory-State, to be a significant predictor of the number of occupational performance goals. These findings underscore the importance of caregiver psychological assessment in the PICU to facilitate personalized goal setting and improve rehabilitation outcomes.
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Jaeyoung Choi
- Department of Critical Care Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
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Oliver H, Seccurro D, Dorich J, Rice M, Schwartz T, Harpster K. "Even though a lot of kids have it, not a lot of people have knowledge of it": A qualitative study exploring the perspectives of parents of children with cerebral/cortical visual impairment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104443. [PMID: 36753819 DOI: 10.1016/j.ridd.2023.104443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Cerebral/Cortical Visual Impairment (CVI) is the leading cause of visual impairment in children and can negatively impact participation in daily activities. METHODS AND PROCEDURE This qualitative study used virtual focus groups and an online questionnaire to understand the perspectives of families with children who have CVI. Constant comparison analysis was used to analyze focus group transcripts and extract themes. The PEDI-CAT and an online questionnaire were administered to characterize the study population. OUTCOMES AND RESULTS Four themes were identified: (1) Awareness of CVI and its effect on the child and family, (2) Parent experiences, (3) Child factors and functional implications, and (4) Supports that enhance child development/vision. CONCLUSIONS AND IMPLICATIONS Findings from this study highlight the substantial impact that lack of CVI awareness had on parent experiences. Lack of awareness led to late diagnosis, missed intervention opportunities, and caregiver burden. Due to insufficient resources, parents had to educate themselves and service providers about CVI and advocate for their child's needs. Healthcare and educational providers who work with pediatric neurodevelopmental populations must be knowledgeable about clinical features of CVI, task and environmental adaptations to support vision and implementation of family-centered care.
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Affiliation(s)
- Haley Oliver
- Division of Occupational Therapy, The Ohio State University, 453 West 10th Avenue, Columbus, OH 43210, United States.
| | - Daria Seccurro
- University of Indianapolis, School of Occupational Therapy, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States
| | - Jenny Dorich
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3430 Burnet Avenue, MLC 4007, Cincinnati, OH 45229, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, United States
| | - Melissa Rice
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States; Department Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0527, Cincinnati, OH 45267-0527, United States
| | - Terry Schwartz
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States; Department Ophthalmology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0527, Cincinnati, OH 45267-0527, United States
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, 3430 Burnet Avenue, MLC 4007, Cincinnati, OH 45229, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, United States
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20
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Benfer K, Boyd RN, Roe Y, Fagan R, Luke C, Mick-Ramsamy L, Whittingham K, Novak I, Bosanquet M, McNamara L, Khandaker G, Fogarty L, Cadet-James Y, Ruben A, Comans T, Smith A, Ware RS. Study protocol: peer delivered early intervention (Learning through Everyday Activities with Parents for Infants at risk of Cerebral Palsy: LEAP-CP) for First Nation Australian infants at high risk of cerebral palsy - an RCT study. BMJ Open 2023; 13:e059531. [PMID: 36914182 PMCID: PMC10016288 DOI: 10.1136/bmjopen-2021-059531] [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] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). METHODS AND ANALYSIS This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP ('absent fidgety' on General Movements Assessment, and/or 'suboptimal score' on the Hammersmith Infant Neurological Examination) aged 12-52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. SAMPLE SIZE total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition). ETHICS AND DISSEMINATION Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167p.
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Affiliation(s)
- Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Yvette Roe
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Ruth Fagan
- Research, Gurriny Yealamucka Health Service, Yarrabah, Queensland, Australia
| | - Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Gulam Khandaker
- Public Health Unit, Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Queensland, Australia
| | - Lucy Fogarty
- Department of Physiotherapy, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Research, Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Alan Ruben
- Child, Youth, and Family Health, Cape and Torres Strait Hospital and Health Service, Cairns, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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21
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Boyd RN, Novak I, Morgan C, Bora S, Sakzewski L, Ware RS, Comans T, Fahey MC, Whittingham K, Trost S, Pannek K, Pagnozzi A, Mcintyre S, Badawi N, Smithers Sheedy H, Palmer KR, Burgess A, Keramat A, Bell K, Hines A, Benfer K, Gascoigne-Pees L, Leishman S, Oftedal S. School readiness of children at high risk of cerebral palsy randomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials. BMJ Open 2023; 13:e068675. [PMID: 36849209 PMCID: PMC9972445 DOI: 10.1136/bmjopen-2022-068675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION School readiness includes cognitive, socio-emotional, language and physical growth and development domains which share strong associations with life-course opportunities. Children with cerebral palsy (CP) are at increased risk of poor school readiness compared with their typically developing peers. Recently, earlier diagnosis of CP has allowed interventions to commence sooner, harnessing neuroplasticity. First, we hypothesise that early referral to intervention for children at-risk of CP will lead to improved school readiness at 4-6 years relative to placebo or care as usual. Second, we hypothesise that receipt of early diagnosis and early intervention will lead to cost-savings in the form of reduced healthcare utilisation. METHODS AND ANALYSIS Infants identified as at-risk of CP ≤6 months corrected age (n=425) recruited to four randomised trials of neuroprotectants (n=1), early neurorehabilitation (n=2) or early parenting support (n=1) will be re-recruited to one overarching follow-up study at age 4-6 years 3 months. A comprehensive battery of standardised assessments and questionnaires will be administered to assess all domains of school readiness and associated risk factors. Participants will be compared with a historical control group of children (n=245) who were diagnosed with CP in their second year of life. Mixed-effects regression models will be used to compare school readiness outcomes between those referred for early intervention versus placebo/care-as-usual. We will also compare health-resource use associated with early diagnosis and intervention versus later diagnosis and intervention. ETHICS AND DISSEMINATION The Children's Health Queensland Hospital and Health Service, The University of Queensland, University of Sydney, Monash University and Curtin University Human Research Ethics Committees have approved this study. Informed consent will be sought from the parent or legal guardian of every child invited to participate. Results will be disseminated in peer-reviewed journals, scientific conferences and professional organisations, and to people with lived experience of CP and their families. TRIAL REGISTRATION NUMBER ACTRN12621001253897.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samudragupta Bora
- Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
- Faculty of Medicine, Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Collingwood Fahey
- Paediatric Neurology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stewart Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Alex Pagnozzi
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Sarah Mcintyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Rebecca Palmer
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Afroz Keramat
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - Ashleigh Hines
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Laura Gascoigne-Pees
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
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22
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Masaki M, Isobe H, Uchikawa Y, Okamoto M, Chiyoda Y, Katsuhara Y, Mino K, Aoyama K, Nishi T, Ando Y. Association of gross motor function and activities of daily living with muscle mass of the trunk and lower extremity muscles, range of motion, and spasticity in children and adults with cerebral palsy. Dev Neurorehabil 2023; 26:115-122. [PMID: 36717387 DOI: 10.1080/17518423.2023.2171149] [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: 02/01/2023]
Abstract
PURPOSE We examined the association of gross motor function and activities of daily living (ADL) with muscle mass of the trunk and lower extremity muscles in children and adults with cerebral palsy (CP). METHODS The subjects were 32 children and adults with CP. Muscle thickness of the trunk and lower extremity muscles was measured using an ultrasound imaging device. RESULTS Stepwise regression analysis revealed that the thoracic erector spinae muscle thickness was a significant and independent factor of gross motor function. Stepwise regression analysis also showed that the thickness of the rectus abdominis and vastus lateralis muscles were significant and independent factors of ADL. CONCLUSIONS Our findings suggest that declined gross motor function is associated with decreased thoracic erector spinae muscle mass in children and adults with CP. The results also indicate that declined ADL is associated with decreased muscle mass of the rectus abdominis and vastus lateralis muscles.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Honoka Isobe
- Department of Rehabilitation, Ibaraki Seinan Medical Center Hospital, Sashimagun, Japan
| | - Yuki Uchikawa
- Department of Rehabilitation, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Mami Okamoto
- Midori-no Kodomokan, Musashino City Development Support Center for Children, Musashino, Japan
| | - Yoshie Chiyoda
- Department of Rehabilitation, Gunma Seishi Ryougoen, Takasaki, Japan
| | - Yuki Katsuhara
- Department of Rehabilitation, Nikoniko-house Medical Welfare Center, Kobe, Japan
| | - Kunio Mino
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Kaori Aoyama
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Tatsuya Nishi
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
| | - Yasushi Ando
- Department of Rehabilitation, Asahigawasou Rehabilitation & Medical Center, Kita-ku, Japan
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23
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Ryan JL, Beal DS, Levac DE, Fehlings DL, Wright FV. Integrating Transcranial Direct Current Stimulation into an Existing Inpatient Physiotherapy Program to Enhance Motor Learning in an Adolescent with Traumatic Brain Injury: A Case Report. Phys Occup Ther Pediatr 2023:1-19. [PMID: 36624962 DOI: 10.1080/01942638.2022.2163214] [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: 01/11/2023]
Abstract
PURPOSE Describe how transcranial direct current stimulation (tDCS) was incorporated into an inpatient physiotherapy program for an adolescent with severe traumatic brain injury (TBI), detail the motor learning focus of the physiotherapy sessions, and summarize gross motor progress. METHOD This case report describes an adolescent who received 20 minutes of anodal tDCS immediately prior to 16 physiotherapy sessions over four weeks. Potential side effects were tracked pre/post tDCS. Gross motor outcomes were measured pre-intervention, post-intervention, and three months post-intervention. Physiotherapy session content was analyzed using therapist documentation and the Motor Learning Strategies Rating Instrument. RESULTS The youth tolerated tDCS well. The primary side effect was itchiness under the electrodes during tDCS sessions. His mobility progressed from wheelchair use pre- 'tDCS + physiotherapy' to ambulation with a walker post-intervention. His Gross Motor Function Measure score increased 33.1% points pre/post intervention. Session tasks often had several foci (e.g., skill acquisition, strength, and balance) with task focus changing as the youth progressed. Various motor learning strategies were layered within tasks to support performance and learning. CONCLUSIONS tDCS was successfully integrated into an existing inpatient physiotherapy program for an adolescent with TBI. This protocol provides a structure for implementing, monitoring, and measuring tDCS + physiotherapy in pediatric rehabilitation.
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Affiliation(s)
- Jennifer L Ryan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Danielle E Levac
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | - Darcy L Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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24
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de Koning L, Warnink-Kavelaars J, van Rossum M, Limmen S, Van der Looven R, Muiño-Mosquera L, van der Hulst A, Oosterlaan J, Rombaut L, Engelbert R. Physical activity and physical fitness in children with heritable connective tissue disorders. Front Pediatr 2023; 11:1057070. [PMID: 37009265 PMCID: PMC10065825 DOI: 10.3389/fped.2023.1057070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/21/2023] [Indexed: 04/04/2023] Open
Abstract
Objectives Health problems in patients with heritable connective tissue disorders (HCTD) are diverse and complex and might lead to lower physical activity (PA) and physical fitness (PF). This study aimed to investigate the PA and PF of children with heritable connective tissue disorders (HCTD). Methods PA was assessed using an accelerometer-based activity monitor (ActivPAL) and the mobility subscale of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). PF was measured in terms of cardiovascular endurance using the Fitkids Treadmill Test (FTT); maximal hand grip strength, using hand grip dynamometry (HGD) as an indicator of muscle strength; and motor proficiency, using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOTMP-2). Results A total of 56 children, with a median age of 11.6 (interquartile range [IQR], 8.8-15.8) years, diagnosed with Marfan syndrome (MFS), n = 37, Loeys-Dietz syndrome (LDS), n = 6, and genetically confirmed Ehlers-Danlos (EDS) syndromes, n = 13 (including classical EDS n = 10, vascular EDS n = 1, dermatosparaxis EDS n = 1, arthrochalasia EDS n = 1), participated. Regarding PA, children with HCTD were active for 4.5 (IQR 3.5-5.2) hours/day, spent 9.2 (IQR 7.6-10.4) hours/day sedentary, slept 11.2 (IQR 9.5-11.5) hours/day, and performed 8,351.7 (IQR 6,456.9-1,0484.6) steps/day. They scored below average (mean (standard deviation [SD]) z-score -1.4 (1.6)) on the PEDI-CAT mobility subscale. Regarding PF, children with HCTD scored well below average on the FFT (mean (SD) z-score -3.3 (3.2)) and below average on the HGD (mean (SD) z-score -1.1 (1.2)) compared to normative data. Contradictory, the BOTMP-2 score was classified as average (mean (SD) z-score.02 (.98)). Moderate positive correlations were found between PA and PF (r(39) = .378, p < .001). Moderately sized negative correlations were found between pain intensity and fatigue and time spent actively (r(35) = .408, p < .001 and r(24) = .395 p < .001, respectively). Conclusion This study is the first to demonstrate reduced PA and PF in children with HCTD. PF was moderately positively correlated with PA and negatively correlated with pain intensity and fatigue. Reduced cardiovascular endurance, muscle strength, and deconditioning, combined with disorder-specific cardiovascular and musculoskeletal features, are hypothesized to be causal. Identifying the limitations in PA and PF provides a starting point for tailor-made interventions.
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Affiliation(s)
- Lisanne de Koning
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Correspondence: Lisanne de Koning
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Marion van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Selina Limmen
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | - Ruth Van der Looven
- Department of Physical and Rehabilitation Medicine, Child Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Laura Muiño-Mosquera
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Annelies van der Hulst
- Department of Pediatric Cardiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Raoul Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
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25
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Munsell EGS, Orsmond GI, Fulford D, Coster WJ. Self-management of daily life tasks in diploma-track youth with disabilities. Disabil Rehabil 2022; 44:8011-8021. [PMID: 34877919 DOI: 10.1080/09638288.2021.2008524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Youth with disabilities who graduate with a regular high school diploma often continue to have difficulties in their daily functioning that ultimately impact adulthood outcomes. To better understand these functional difficulties and determine how best to address them, it is important to distinguish deficits in discrete skills from difficulty organizing skills to self-manage complex tasks associated with adult roles. The purpose of this study was to explore the extent to which challenges in social, executive function and behavior management factors relate to these two aspects of daily functioning. METHODS This is a secondary analysis of the National Longitudinal Transition Study 2 funded by the United States Department of Education. The direct and indirect associations between youth underlying factors and self-management of daily life tasks (SMDLT) versus discrete functional skills were modelled using structural equation modelling. RESULTS A model incorporating social skills, communication, and behavior regulation explained 55% of the variance in SMDLT. In contrast, the model predicting discrete functional skills had fewer significant associations and described less variance (37%) in the outcome. CONCLUSIONS Findings suggest that using measures of SMDLT and designing targeted interventions for SMDLT might help improve participation in independent living and productivity for diploma-track youth with disabilities.Implications for rehabilitationSuccessful transition from high school to adult roles requires the ability to self-manage the daily life tasks required for those roles, such as employment, post-secondary education, and independent living.The ability to self-manage daily tasks is distinct from mastery of discrete functional skills and should be assessed with measures that uniquely examine this domain.Social and communication skills, executive functioning, and behavioral regulation, are important contributors to the ability to self-manage life tasks for diploma-track youth with disabilities and should be incorporated into multifaceted interventions.Interventions to improve self-management of tasks should include teaching strategies and practice coordinating underlying skills in flexible ways that meet the varying demands of tasks and diverse environments.
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Affiliation(s)
- Elizabeth G S Munsell
- Occupational Therapy Department, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Gael I Orsmond
- Occupational Therapy Department, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Daniel Fulford
- Occupational Therapy Department, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.,Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Wendy J Coster
- Occupational Therapy Department, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
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26
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Preschool neurodevelopment in Zika virus-exposed children without congenital Zika syndrome. Pediatr Res 2022:10.1038/s41390-022-02373-5. [PMID: 36446920 PMCID: PMC10227180 DOI: 10.1038/s41390-022-02373-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Children with in utero Zika virus (ZIKV) exposure without congenital Zika syndrome (CZS) are at risk for abnormal neurodevelopment. Preschool-age outcomes for children with antenatal ZIKV exposure have not yet been established. METHODS Children with in utero ZIKV exposure and non-exposed controls had neurodevelopmental evaluations at age 3-5 years in Sabanalarga, Colombia. Cases did not have CZS and were previously evaluated prenatally through age 18 months. Controls were born before ZIKV arrival to Colombia. Neurodevelopmental assessments included Pediatric Evaluation of Disability Inventory (PEDI-CAT), Behavior Rating Inventory of Executive Function (BRIEF-P), Bracken School Readiness Assessment (BSRA), and Movement Assessment Battery for Children (MABC). Family demographics and child medical history were recorded. RESULTS Fifty-five ZIKV-exposed children were evaluated at mean age 3.6 years and 70 controls were evaluated at 5.2 years. Family demographics were similar between groups. BRIEF-P t-scores were higher for cases than controls in shift and flexibility domains. Cases had lower PEDI-CAT mobility t-scores compared to controls. There was no difference in MABC between groups. In 11% of cases and 1% of controls, parents reported child mood problems. CONCLUSIONS Children with in utero ZIKV exposure without CZS may demonstrate emerging differences in executive function, mood, and adaptive mobility that require continued evaluation. IMPACT Preschool neurodevelopmental outcome in children with in utero Zika virus exposure is not yet known, since the Zika virus epidemic occurred in 2015-2017 and these children are only now entering school age. This study finds that Colombian children with in utero Zika virus exposure without congenital Zika syndrome are overall developing well but may have emerging differences in executive function, behavior and mood, and adaptive mobility compared to children without in utero Zika virus exposure. Children with in utero Zika virus exposure require continued multi-domain longitudinal neurodevelopmental evaluation through school age.
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Forst H, Sylvanus T. Impact of Occupational Therapy on Self-Care After Selective Dorsal Rhizotomy Among Children With Cerebral Palsy. Am J Occup Ther 2022; 76:23958. [PMID: 36255304 DOI: 10.5014/ajot.2022.049267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Selective dorsal rhizotomy (SDR) is an established treatment for spastic cerebral palsy (CP). The effects and predictors of occupational therapy's benefit for self-care after SDR in children with CP have not been thoroughly investigated. OBJECTIVE To identify changes in self-care after occupational therapy post-SDR and determine whether changes were affected by age, Gross Motor Function Classification System (GMFCS) level, and number of occupational therapy dressing sessions. DESIGN In this retrospective cohort study, we collected outcomes pre-SDR, at discharge, and at 1-yr follow-up. Paired t tests and regression analysis were performed. SETTING Commission on Accreditation of Rehabilitation Facilities-accredited pediatric inpatient rehabilitation facility. PARTICIPANTS Seventy-three children (GMFCS Levels I-III, ages 4-17 yr) diagnosed with spastic CP who underwent SDR from 2014 to 2018. INTERVENTION After having SDR, each child received an average of twice daily occupational therapy for an average of 37.3 days. OUTCOMES AND MEASURES The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and Functional Independence Measure for Children® (WeeFIM) were used to assess self-care performance. RESULTS The mean WeeFIM dressing (upper and lower body) and mean PEDI-CAT daily activities scores from baseline to discharge and mean WeeFIM lower body dressing at 1-yr follow-up improved significantly. The improvement in lower body dressing correlated with GMFCS level and the number of occupational therapy dressing sessions. CONCLUSIONS AND RELEVANCE The improvement in upper and lower extremity dressing and PEDI-CAT daily activities scores suggests that inpatient occupational therapy post-SDR may provide benefits. What This Article Adds: Children diagnosed with CP may undergo surgical interventions to improve their ability to walk. This article demonstrates the benefit of occupational therapy services after SDR to improve upper and lower body dressing skills.
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Affiliation(s)
- Heather Forst
- Heather Forst, MA, OTR/L, BCP, is Occupational Therapist, Rehabilitation Therapies Department, Gillette Children's Specialty Healthcare, Saint Paul, MN;
| | - Tonye Sylvanus
- Tonye Sylvanus, MD, MPH, is Clinical Research Specialist, Neurosciences and Rehabilitation Research Program, Gillette Children's Specialty Healthcare, Saint Paul, MN
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Pinto NP, Maddux AB, Dervan LA, Woodruff AG, Jarvis JM, Nett S, Killien EY, Graham RJ, Choong K, Luckett PM, Heneghan JA, Biagas K, Carlton EF, Hartman ME, Yagiela L, Michelson KN, Manning JC, Long DA, Lee JH, Slomine BS, Beers SR, Hall T, Morrow BM, Meert K, del Pilar Arias Lopez M, Knoester H, Houtrow A, Olson L, Steele L, Schlapbach LJ, Burd RS, Grosskreuz R, Butt W, Fink EL, Watson RS. A Core Outcome Measurement Set for Pediatric Critical Care. Pediatr Crit Care Med 2022; 23:893-907. [PMID: 36040097 PMCID: PMC9633391 DOI: 10.1097/pcc.0000000000003055] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To identify a PICU Core Outcome Measurement Set (PICU COMS), a set of measures that can be used to evaluate the PICU Core Outcome Set (PICU COS) domains in PICU patients and their families. DESIGN A modified Delphi consensus process. SETTING Four webinars attended by PICU physicians and nurses, pediatric surgeons, rehabilitation physicians, and scientists with expertise in PICU clinical care or research ( n = 35). Attendees were from eight countries and convened from the Pediatric Acute Lung Injury and Sepsis Investigators Pediatric Outcomes STudies after PICU Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network PICU COS Investigators. SUBJECTS Measures to assess outcome domains of the PICU COS are as follows: cognitive, emotional, overall (including health-related quality of life), physical, and family health. Measures evaluating social health were also considered. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Measures were classified as general or additional based on generalizability across PICU populations, feasibility, and relevance to specific COS domains. Measures with high consensus, defined as 80% agreement for inclusion, were selected for the PICU COMS. Among 140 candidate measures, 24 were delineated as general (broadly applicable) and, of these, 10 achieved consensus for inclusion in the COMS (7 patient-oriented and 3 family-oriented). Six of the seven patient measures were applicable to the broadest range of patients, diagnoses, and developmental abilities. All were validated in pediatric populations and have normative pediatric data. Twenty additional measures focusing on specific populations or in-depth evaluation of a COS subdomain also met consensus for inclusion as COMS additional measures. CONCLUSIONS The PICU COMS delineates measures to evaluate domains in the PICU COS and facilitates comparability across future research studies to characterize PICU survivorship and enable interventional studies to target long-term outcomes after critical illness.
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Affiliation(s)
- Neethi P. Pinto
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine and Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aline B. Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Leslie A. Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington and Seattle Children’s, Seattle, WA, USA
| | - Alan G. Woodruff
- Department of Anesthesiology, Section of Pediatric Critical Care Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jessica M. Jarvis
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sholeen Nett
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Elizabeth Y. Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington and Seattle Children’s, Seattle, WA, USA
| | - Robert J. Graham
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Karen Choong
- Departments of Pediatrics, Critical Care, Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Peter M. Luckett
- Department of Pediatrics, UT Southwestern Medical Center and Division of Pediatric Critical Care Medicine, Children’s Health, Dallas, TX, USA
| | - Julia A. Heneghan
- Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
| | - Katherine Biagas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, The Renaissance School of Medicine at Stony Brook University and the Stony Brook Children’s Hospital, Stony Brook, NY, USA
| | - Erin F. Carlton
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan; Susan B. Meister Child Health Evaluation and Research Center; Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Mary E. Hartman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren Yagiela
- Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI; Department of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA
| | - Kelly N. Michelson
- Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph C. Manning
- Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK; Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | - Beth S. Slomine
- Department of Neuropsychology, Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Trevor Hall
- Department of Pediatrics, Division of Pediatric Psychology, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, USA
| | - Brenda M. Morrow
- Department of Paediatrics and Child Health; University of Cape Town; Cape Town; South Africa
| | - Kathleen Meert
- Division of Critical Care, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI; Department of Pediatrics, Central Michigan University, Mount Pleasant, MI, USA
| | - Maria del Pilar Arias Lopez
- Department of Pediatric Critical Care, Hospital de Niños Ricardo Gutierrez. SATI-Q Program. Argentine Society of Intensive Care, Buenos Aires. Argentina
| | - Hennie Knoester
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Amy Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lenora Olson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Lisa Steele
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland; and Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Center for Surgical Care, Children’s National Hospital, Washington, DC, USA
| | | | - Warwick Butt
- Intensive Care Unit, Royal Children’s Hospital Melbourne, Australia
| | - Ericka L. Fink
- Department of Critical Care Medicine, Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - R. Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington and Seattle Children’s, Seattle, WA, USA
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Hayden-Evans M, Milbourn B, D’Arcy E, Chamberlain A, Afsharnejad B, Evans K, Whitehouse AJO, Bölte S, Girdler S. An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14114. [PMID: 36360993 PMCID: PMC9659140 DOI: 10.3390/ijerph192114114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.
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Affiliation(s)
- Maya Hayden-Evans
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Benjamin Milbourn
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Emily D’Arcy
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Angela Chamberlain
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Bahareh Afsharnejad
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
| | - Kiah Evans
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Allied Health, University of Western Australia, Perth 6009, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Psychological Science, University of Western Australia, Perth 6009, Australia
| | - Sven Bölte
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
| | - Sonya Girdler
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Allied Health, University of Western Australia, Perth 6009, Australia
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
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Moraes JMD, Costa MADD, Rodrigues ISDO, Fontes DE, Camargos ACR. Comparação entre as versões rápida e conteúdo-balanceada do Inventário de Avaliação Pediátrica de Incapacidade - Testagem Computadorizada Adaptativa (PEDI-CAT) em crianças com paralisia cerebral. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22008629042022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
RESUMO O objetivo deste estudo foi comparar as versões rápida e conteúdo-balanceada do Inventário de Avaliação Pediátrica de Incapacidade - Testagem Computadorizada Adaptativa (PEDI-CAT) em seus quatro domínios. Para tanto, foi realizado um estudo observacional transversal com crianças com paralisia cerebral (PC). As duas versões do PEDI-CAT foram aplicadas em cada criança com um intervalo de sete dias, no formato remoto, por meio de entrevistas com os responsáveis. Foi utilizada a correlação de Pearson para verificar a associação entre os escores contínuos das duas versões do PEDI-CAT. Participaram do estudo 11 crianças com PC, entre 2 e 12 anos de idade. Foi verificada forte associação significativa entre valores médios do escore contínuo da versão rápida e conteúdo-balanceada em todos os domínios (p<0,0001). Duas crianças (18,2%) foram classificadas de forma diferente em relação ao escore normativo no domínio social-cognitivo. As versões do PEDI-CAT mostraram resultados concordantes em relação ao escore contínuo quando aplicadas em crianças com PC. No entanto, é necessário ter cautela na interpretação do escore normativo dependendo da versão utilizada no domínio social-cognitivo.
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Moraes JMD, Costa MADD, Rodrigues ISDO, Fontes DE, Camargos ACR. Comparison between speedy and content-balanced versions of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in children with cerebral palsy. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22008629042022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
ABSTRACT This study aimed to compare the speedy and content-balanced versions of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in its four domains. A cross-sectional observational study was conducted with children with cerebral palsy (CP). The two versions of PEDI-CAT were administered to each child with a 7-days interval, remotely, in interview format with caregivers. Pearson’s correlation was used to evaluate the association among scaled scores in the two versions of PEDI-CAT. In total, 11 children with CP, aged 2 to 12 years, participated in the study. A strong significant association between mean values of the scaled score of the speedy and content-balanced versions in all domains (p<0.0001) was observed. Two children (18.2%) were classified differently regarding normative standard score in the Social/Cognitive domain. Both versions of PEDI-CAT showed concordant results in relation to the scaled score when applied to children with CP. However, one must cautiously interpret the normative standard score depending on the version used in the Social/Cognitive domain.
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Moraes BLC, Barbosa VM, Cardoso AA, Rihtman T, de Castro Magalhães L. Cross-cultural validation of the Brazilian Little Developmental Coordination Disorder Questionnaire (LDCDQ-BR) for preschool children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 129:104297. [PMID: 35858509 DOI: 10.1016/j.ridd.2022.104297] [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: 08/26/2021] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Motor difficulties associated with Developmental Coordination Disorder (DCD) are frequently apparent before the accepted diagnostic age of 5. Tools to support identification of DCD markers would allow provision of early intervention to reduce negative sequelae. OBJECTIVE Establish psychometric properties and define preliminary cut-off scores for the Brazilian Little Developmental Coordination Disorder Questionnaire - Brazil (LDCDQ-BR). METHODS AND PROCEDURES Parents of 3- and 4-year-old children (n = 312; 154 girls) from Belo Horizonte/MG, Brazil, completed the LDCDQ-BR, the Brazil Economic Classification Criterion and a demographic questionnaire. One sub-set of children (n = 119) was assessed with the Movement Assessment Battery for Children-2nd Edition; another sub-set (n = 77) completed the LDCDQ-BR a second time. RESULTS Rasch analysis indicated good item functioning with only one erratic item, suggesting unidimensionality. Item calibration reliability was excellent (0.97), children's measures reliability was low (0.72), but implying separation of 2.46 motor ability levels. Significant, low correlations were found between the LDCDQ-BR and MABC-2 (r = 0.30, p < 0.01). Test-retest reliability was 0.77 (total score) and 0.44-0.78 (individual items). ROC curve analysis revealed sensitivity of 68% at a cut-off score of 64. CONCLUSION The LDCDQ-BR shows promising psychometric properties to support early identification of DCD.
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Affiliation(s)
- Barbara L C Moraes
- Federal University of Minas Gerais, Department of Rehabilitation Science Program, 6627 Antonio Carlos Avenue, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Maziero Barbosa
- University of Illinois at Chicago, UI Health, Occupational and Physical Therapy Department, 1740 W. Taylor Street, Suite C-100, Chicago, IL 60602, USA
| | - Ana Amélia Cardoso
- Federal University of Minas Gerais, Department of Rehabilitation Science Program, 6627 Antonio Carlos Avenue, Belo Horizonte, Minas Gerais, Brazil
| | - Tanya Rihtman
- Oxford Brookes University, Department of Sport, Health Sciences and Social Work, Faculty of Health and Life Sciences, Jack Straws Lane, Marston, Oxford OX3 0FL, United Kingdom
| | - Lívia de Castro Magalhães
- Federal University of Minas Gerais, Department of Rehabilitation Science Program, 6627 Antonio Carlos Avenue, Belo Horizonte, Minas Gerais, Brazil.
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Maintenance of Functional Gains Following a Goal-Directed and FES-Assisted Cycling Program for Children With Cerebral Palsy. Pediatr Phys Ther 2022; 34:480-487. [PMID: 36067381 DOI: 10.1097/pep.0000000000000942] [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 This study investigated whether the functional improvements associated with functional electrical stimulation-assisted cycling, goal-directed training, and adapted cycling in children with cerebral palsy were maintained 8 weeks after the intervention ceased. METHODS The intervention (2 × 1-hour supervised sessions and 1-hour home program/week) ran for 8 weeks. Primary outcomes were the Gross Motor Function Measure (GMFM-88) and the Canadian Occupational Performance Measure (COPM). Secondary outcomes included the GMFM-66 and goal scores, 5 times sit-to-stand test (FTSTS), Participation and Environment Measure-Children and Youth (PEM-CY), Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT), and cycling power output (PO). Outcomes were assessed at baseline, 8 and 16 weeks. RESULTS Twenty children participated (mean age = 10 years 3 months; SD = 2 years 11 months; Gross Motor Function Classification System II = 5, III = 6, and IV = 9). Improvements were retained above baseline at 16 weeks on the GMFM and COPM. Improvements in cycling PO, PEDI-CAT scores, PEM-CY environmental barriers and FTSTS were also retained. CONCLUSION Functional improvements in children with cerebral palsy were retained 8 weeks post-intervention.
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Imms C, Wallen M, Elliott C, Hoare B, Greaves S, Randall M, Orsini F. Implications of providing wrist-hand orthoses for children with cerebral palsy: evidence from a randomised controlled trial. Disabil Rehabil 2022:1-11. [PMID: 35649128 DOI: 10.1080/09638288.2022.2079734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy. METHODS A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5-15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles. RESULTS The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81-25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20-33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings. CONCLUSION The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population. Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572 IMPLICATIONS FOR REHABILITATIONThere may be incremental benefit, for children with cerebral palsy, at 6 and 12 months on passive wrist range from wearing a rigid wrist-hand orthosis designed according to this protocol.The rigid-wrist-hand orthosis evaluated in this study, which allowed for some tailoring for individual children's presentations, differed in design from past recommendations for "resting hand" positioning.Longitudinal follow up of children with cerebral palsy prescribed a rigid wrist-hand orthosis is essential to monitor any benefit.Minor adverse events were commonly experienced when wearing the orthosis and should be discussed prior to prescription of a rigid wrist-hand orthosis.
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Affiliation(s)
- Christine Imms
- Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, Parkville, Australia
| | - Margaret Wallen
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
| | - Catherine Elliott
- Telethon Kids Institute, Nedlands, Australia.,Perth Children's Hospital, Nedlands, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - Brian Hoare
- School of Occupational Therapy, La Trobe University, Bundoora, Australia
| | - Susan Greaves
- Murdoch Children's Research Institute, and The Royal Children's Hospital, Parkville, Australia
| | - Melinda Randall
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia
| | - Francesca Orsini
- Murdoch Children's Research Institute, Melbourne Children's Trials Centre, Parkville, Australia
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Burgess A, Reedman S, Chatfield MD, Ware RS, Sakzewski L, Boyd RN. Development of gross motor capacity and mobility performance in children with cerebral palsy: a longitudinal study. Dev Med Child Neurol 2022; 64:578-585. [PMID: 34800033 DOI: 10.1111/dmcn.15112] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe development of gross motor capacity and mobility performance in children with cerebral palsy. METHOD This longitudinal cohort study measured gross motor capacity with the Gross Motor Function Measure and mobility performance with the Pediatric Evaluation of Disability Inventory (PEDI) between 18 months and 5 years, and the PEDI - Computer Adaptive Test (PEDI-CAT) between 8 years and 12 years. Longitudinal analyses used mixed-effects regression modelling with interaction between age and Gross Motor Function Classification System (GMFCS). Stability of GMFCS levels over time was measured using agreement. RESULTS Two hundred and twenty-two children provided 871 observations (median 4 observations, range 1-7). Children classified in GMFCS level I improved in both capacity and performance until 8 to 12 years. Children classified in GMFCS levels II and III continued to develop mobility performance after gross motor capacity had plateaued at 5 years. Children classified in GMFCS level IV plateaued at 5 years in capacity and performance. Children classified in GMFCS level V showed no changes in capacity or performance between 18 months and 8 to 12 years. Stability of GMFCS levels was 73%. INTERPRETATION Change in mobility performance over time somewhat reflected gross motor capacity trajectories. Continued improvement in mobility performance after plateau of gross motor capacity for children classified in GMFCS levels II and III suggests importance of other personal or environmental factors.
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Affiliation(s)
- Andrea Burgess
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Reedman
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Luke CR, Benfer K, Mick-Ramsamy L, Ware RS, Reid N, Bos AF, Bosanquet M, Boyd RN. Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol. BMJ Open 2022; 12:e053646. [PMID: 34996793 PMCID: PMC8744123 DOI: 10.1136/bmjopen-2021-053646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are 'at risk' of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for identifying infants 'at risk' of a later diagnosis of adverse NDO or NDD will be determined. METHODS AND ANALYSIS Aboriginal and/or Torres Strait Islander infants born in Queensland, Australia (birth years 2020-2022) will be invited to participate. Infants aged <9 months corrected age (CA) will undergo screening using the (1) General Movements Assessment (GMA); (2) Hammersmith Infant Neurological Examination (HINE); (3) Rapid Neurodevelopmental Assessment (RNDA) and (4) Ages and Stages Questionnaire-Aboriginal adaptation (ASQ-TRAK). Developmental outcomes at 12 months CA will be determined for: (1) neurological (HINE); (2) motor (Peabody Developmental Motor Scales 2); (3) cognitive and communication (Bayley Scales of Infant Development III); (4) functional capabilities (Paediatric Evaluation of Disability Inventory-Computer Adaptive Test) and (5) behaviour (Infant Toddler Social and Emotional Assessment). Infants will be classified as typically developing or 'at risk' of an adverse NDO and/or specific NDD based on symptomology using developmental and diagnostic outcomes for (1) CP (2) ASD and (3) FASD. The effects of perinatal, social and environmental factors, caregiver mental health and clinical neuroimaging on NDOs will be investigated. ETHICS AND DISSEMINATION Ethics approval has been granted by appropriate Queensland ethics committees; Far North Queensland Health Research Ethics Committee (HREC/2019/QCH/50533 (Sep ver 2)-1370), the Townsville HHS Human Research Ethics Committee (HREC/QTHS/56008), the University of Queensland Medical Research Ethics Committee (2020000185/HREC/2019/QCH/50533) and the Children's Health Queensland HHS Human Research Ethics Committee (HREC/20/QCHQ/63906) with governance and support from local First Nations communities. Findings from this study will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167.
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Affiliation(s)
- Carly R Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Arend F Bos
- Department of Neonatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Margot Bosanquet
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Levy TJ, Tyner CE, Amaral S, Lefkowitz DS, Kessler SK, Levin LS. 5-Year Activity and Participation Outcomes of the First Successful Pediatric Bilateral Hand Transplantation: A Case Report. Phys Occup Ther Pediatr 2022; 42:663-679. [PMID: 35379065 DOI: 10.1080/01942638.2022.2057210] [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: 10/18/2022]
Abstract
AIMS Describe the 5-year outcomes of the first successful pediatric bilateral hand transplantation. METHODS The child underwent quadrimembral amputation at age two and received bilateral hand allografts at age eight. Rehabilitation included biomechanical, neurorehabilitation, and occupational approaches in acute and outpatient settings. Therapist observed outcomes, patient-reported measures, and parent-reported measures were repeated over a 5-year period. RESULTS Observation assessments revealed functional dexterity skills and modified independence to full independence with self-care activities. The parent reported the child had moderate difficulty with upper extremity functioning 25-, 41-, and 48-months post-transplantation, and mild difficulty at 60-months; the child reported no difficulties in this domain at 41 months. Five years post-transplantation the child reported enjoying many age-appropriate activities, and high-quality peer relations were endorsed by both parent and child. CONCLUSION The child developed hand movements for daily activities and was completing daily activities with improved efficiency. Health-related quality of life outcomes were favorable.
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Affiliation(s)
- Todd J Levy
- Center for Rehabilitation, Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Sandra Amaral
- Departments of Pediatrics and Epidemiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Debra S Lefkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sudha K Kessler
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - L Scott Levin
- Paul B Magnusson Professor and Chairman of Orthopedic Surgery, Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA.,Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Resnik LJ, Borgia ML, Clark MA, Graczyk E, Segil J, Ni P. Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users. PLoS One 2021; 16:e0261865. [PMID: 34962943 PMCID: PMC8714100 DOI: 10.1371/journal.pone.0261865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Recent advances in upper limb prosthetics include sensory restoration techniques and osseointegration technology that introduce additional risks, higher costs, and longer periods of rehabilitation. To inform regulatory and clinical decision making, validated patient reported outcome measures are required to understand the relative benefits of these interventions. The Patient Experience Measure (PEM) was developed to quantify psychosocial outcomes for research studies on sensory-enabled upper limb prostheses. While the PEM was responsive to changes in prosthesis experience in prior studies, its psychometric properties had not been assessed. Here, the PEM was examined for structural validity and reliability across a large sample of people with upper limb loss (n = 677). The PEM was modified and tested in three phases: initial refinement and cognitive testing, pilot testing, and field testing. Exploratory factor analysis (EFA) was used to discover the underlying factor structure of the PEM items and confirmatory factor analysis (CFA) verified the structure. Rasch partial credit modeling evaluated monotonicity, fit, and magnitude of differential item functioning by age, sex, and prosthesis use for all scales. EFA resulted in a seven-factor solution that was reduced to the following six scales after CFA: social interaction, self-efficacy, embodiment, intuitiveness, wellbeing, and self-consciousness. After removal of two items during Rasch analyses, the overall model fit was acceptable (CFI = 0.973, TLI = 0.979, RMSEA = 0.038). The social interaction, self-efficacy and embodiment scales had strong person reliability (0.81, 0.80 and 0.77), Cronbach's alpha (0.90, 0.80 and 0.71), and intraclass correlation coefficients (0.82, 0.85 and 0.74), respectively. The large sample size and use of contemporary measurement methods enabled identification of unidimensional constructs, differential item functioning by participant characteristics, and the rank ordering of the difficulty of each item in the scales. The PEM enables quantification of critical psychosocial impacts of advanced prosthetic technologies and provides a rigorous foundation for future studies of clinical and prosthetic interventions.
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Affiliation(s)
- Linda J. Resnik
- Research Department, Providence VA Medical Center, Providence, RI, United States of America
- Health Services, Policy and Practice, Brown University, Providence, RI, United States of America
| | - Mathew L. Borgia
- Research Department, Providence VA Medical Center, Providence, RI, United States of America
| | - Melissa A. Clark
- Health Services, Policy and Practice, Brown University, Providence, RI, United States of America
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Emily Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Research Department, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
| | - Jacob Segil
- Research Department, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America
| | - Pengsheng Ni
- Boston University, Boston, Massachusetts, United States of America
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Ramey SL, DeLuca SC, Stevenson RD, Conaway M, Darragh AR, Lo W. Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial. Pediatrics 2021; 148:peds.2020-033878. [PMID: 34649982 DOI: 10.1542/peds.2020-033878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT). METHODS CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures. RESULTS Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment). CONCLUSIONS CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.
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Affiliation(s)
| | - Stephanie C DeLuca
- Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, Virginia
| | - Richard D Stevenson
- Department of Pediatrics and Division of Neurodevelopmental Behavioral Pediatrics, UVA Children's, Charlottesville, Virginia
| | - Mark Conaway
- Department of Pediatrics and Division of Neurodevelopmental Behavioral Pediatrics, UVA Children's, Charlottesville, Virginia
| | - Amy R Darragh
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Warren Lo
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.,Departments of Neurology and Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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Park H, Choi JY, Yi SH, Park ES, Shim D, Choi TY, Rha DW. Relationship between the more-affected upper limb function and daily activity performance in children with cerebral palsy: a cross-sectional study. BMC Pediatr 2021; 21:459. [PMID: 34666730 PMCID: PMC8524797 DOI: 10.1186/s12887-021-02927-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are differences in roles between the more-affected and less-affected upper limb of children with cerebral palsy (CP). However, there is a lack of studies of the relationship between the more-affected limb function and activities of daily living (ADL) in children with CP. Thus, the aim of this prospective cross-sectional study was to investigate the relationship between more-affected upper limb function and ADL in children with CP. Methods Children with spastic CP (unilateral CP n = 28, bilateral CP n = 31; 34 males, 25 females; mean age ± SD, 6.8 ± 3.1y [range, 3-14y]) participated in this study. Function of the more-affected upper limb was measured using the Melbourne Assessment of Unilateral Upper limb Function, version 2 (MA2) and the Upper Limb Physician’s Rating Scale (ULPRS). Performance of daily living activities was measured using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). Results The range, accuracy and fluency dimension of MA2 and ULPRS total scores were moderately correlated with the daily activity domain (r = 0.47, 0.47, 0.56 for MA2 and r = 0.50 for ULPRS, respectively; P < 0.001) rather than the mobility, social/cognitive, and responsibility domains of the PEDI-CAT. ULPRS scores for elbow extension, supination in extension, supination in flexion, and two-handed function were moderately correlated with the PEDI-CAT daily activity domain (r = 0.44, 0.43, 0.41, and 0.49, respectively; P < 0.01). Finger opening and thumb-in-palm deformity of the ULPRS did not correlate with any PEDI-CAT domain. Conclusions The MA2 range, accuracy, and fluency domains (rather than dexterity) had the strongest correlations with the PEDI-CAT daily activity domain. Elbow extension, forearm supination, and two-handed function (rather than wrist and finger movements) of the ULPRS had the strongest correlations with the PEDI-CAT daily activity domain. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02927-2.
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Affiliation(s)
- Hyerin Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1, Yonsei‑ro, Seodaemun‑gu, Seoul, Republic of Korea
| | - Ja Young Choi
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Sook-Hee Yi
- Department of Rehabilitation Medicine, Seoul Rehabilitation Hospital, 30, Galhyeon-ro 11-gil, Eunpyeong-gu, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1, Yonsei‑ro, Seodaemun‑gu, Seoul, Republic of Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1, Yonsei‑ro, Seodaemun‑gu, Seoul, Republic of Korea
| | - Tae Young Choi
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1, Yonsei‑ro, Seodaemun‑gu, Seoul, Republic of Korea
| | - Dong-Wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1, Yonsei‑ro, Seodaemun‑gu, Seoul, Republic of Korea.
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Logan LR, Sawin KJ, Bellin MH, Brei T, Woodward J. Self-management and independence guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:583-600. [PMID: 33252094 PMCID: PMC7838981 DOI: 10.3233/prm-200734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Self-management and independence behaviors are associated with improved health conditions common to spina bifida such as skin integrity and bowel and bladder management. While most children with spina bifida ultimately achieve basic self-care behaviors, (e.g., dressing appropriately, planning activities with peers, or cooking pre-planned meals), they often lag 2-5 years behind their typically-developing peers in these activities [1]. Valid and reliable condition-specific assessments of self-management and independence are critical to optimizing outcomes for this population. Partnerships among parents, clinicians, and youths with spina bifida are essential to implementing tailored interventions based on these assessments. The guidelines delineated in this article are informed by current self-management research for people with spina bifida and offer recommendations to promote self-management and independence across the lifespan.
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Affiliation(s)
- Lynne Romeiser Logan
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, Syracuse, NY, USA
| | - Kathleen J. Sawin
- Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Timothy Brei
- Division of Developmental Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
| | - Jason Woodward
- University of Cincinnati College of Medicine, Division of Developmental and Behavioral Pediatrics Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Munsell EGS, Orsmond GI, Fulford D, Coster WJ. Metacognition Mediates the Effect of Social Communication and Internalizing Behaviors on Self-management of Daily Life Tasks for Diploma-Track Autistic Youth. J Autism Dev Disord 2021; 52:4274-4285. [PMID: 34611837 DOI: 10.1007/s10803-021-05306-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Social communication and executive functioning challenges as well as co-occurring anxiety/depression may make acquiring the skills needed to manage daily life tasks difficult for diploma-track autistic youth, thus limiting their participation in adult roles. This study describes the associations between executive function, social communication skills, and internalizing behaviors on task management in academically capable autistic adolescents (n = 46) using multiple regression with mediator analysis. The three predictors and youth age explained a moderate amount of variance in task management. Metacognition mediated the effect of social communication skills and internalizing behaviors on task management. Relations between underlying factors that influence self-management of daily life tasks are complex, supporting the need for multifaceted assessment and intervention approaches for academically capable autistic youth.
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Affiliation(s)
- Elizabeth G S Munsell
- Occupational Therapy Department, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Gael I Orsmond
- Occupational Therapy Department, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Daniel Fulford
- Occupational Therapy Department, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA.,Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Wendy J Coster
- Occupational Therapy Department, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
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Krasovsky T, Shammah C, Addes A, Brezner A, Barak S. The Development and Evaluation of the Powered Mobility Function Scale (PMFS) for Children and Adolescents with Cerebral Palsy. Dev Neurorehabil 2021; 24:338-347. [PMID: 33703993 DOI: 10.1080/17518423.2021.1898057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: To describe the development and evaluation of a novel task-based measure of powered mobility function: the Powered Mobility Function Scale (PMFS).Methods: PMFS was developed in Hebrew in four phases, with feedback from clinicians and clients. Psychometric properties (inter-rater, test-retest reliability, concurrent, convergent and known-groups validity) were evaluated for N = 49 children and adolescents with Cerebral Palsy (11.1 ± 4.8y) using Powered Mobility Program (PMP), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)Results: PMFS development involved 3 versions over three years. Inter-rater reliability was κ=0.75-0.95 (video/observation). Test-retest reliability was κ=0.93-0.96. Concurrent validity (PMP) was ρ=-0.84-to-0.96. Convergent validity (PEDI-CAT) was ρ=-0.47-to-0.70. Known-groups validity (GMFCS/MACS) demonstrated medium effect sizes (r = 0.33-0.46)Conclusions: PMFS is valid and reliable for measuring powered mobility function in children and adolescents with CP. Future validation of the English version of PMFS is warranted.
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Affiliation(s)
- Tal Krasovsky
- University of Haifa, Haifa, Israel.,The Edmond & Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Chana Shammah
- Merkaz Shikum Yeladim (MESHI) Kindergarten and School, Jerusalem, Israel
| | - Anat Addes
- Merkaz Shikum Yeladim (MESHI) Kindergarten and School, Jerusalem, Israel
| | - Amichai Brezner
- The Edmond & Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Sharon Barak
- The Edmond & Lily Safra Children's Hospital, Ramat-Gan, Israel.,Kaye Academic College of Education, Be'er Sheba, Israel
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Gimeno H, Polatajko HJ, Cornelius V, Lin JP, Brown RG. Rehabilitation in childhood-onset hyperkinetic movement disorders including dystonia: Treatment change in outcomes across the ICF and feasibility of outcomes for full trial evaluation. Eur J Paediatr Neurol 2021; 33:159-167. [PMID: 34052114 DOI: 10.1016/j.ejpn.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Childhood-onset hyperkinetic movement disorders (HMD), including dystonia are notoriously difficult to treat and there are limited studies showing successful medical, surgical or non-pharmacological interventions. METHODS This prospective study used grouped data (n = 22) from two studies of the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach for patient-selected goals. Eligibility included aged 6-21 years, deep brain stimulation in place, with manual ability classification system level I-IV. Outcome was assessed on a range of patient-reported and clinician-rated measures across the International Classification of Function at end-treatment (10 weekly sessions) (series 1 and 2) and 3-month follow-up (series 1). Feasibility of outcomes to be used in a full trial were explored. FINDINGS Nineteen participants completed the intervention and were included in the analysis. Of the primary outcome measures, the self-reported Canadian Occupational Performance Measure showed improvement in goal performance (mean change 4.08, 95% CI [3.37,4.79] post-; 4.18 [5.10,5.26] follow-up), and satisfaction (4.03 [3.04,5.03) post-; 4.44 [3.07,5.82] follow-up]. The Assessment of Motor and Process Skills showed improved motor score (0.52 [0.01,1.03] at follow-up only, while the process score did not change. Objective blind-rated pooled data using the Performance Quality Rating Scale-individualized indicated significant change for trained goals (3.79 [3.37,4.21] post-; (4.01,5.10) follow-up] and untrained goals (1.90 [1.24,2.55] post 1.91 [0.23,3.60] follow-up]. Motor impairment assessed by the Burke-Fahn Motor Disability Rating Scale was unchanged (-3.26 [-6.62,0.09] post-; -1.11 [-8.05,5.82] follow-up). Improvement was also observed in self-efficacy (0.97 [0.47,1.47] post-; 1.37 [1.91-0.83] follow-up) and Quality of Life (0.12 [0.03-0.22] follow-up). Goal improvement; self-efficacy and quality of life captured significant change post-intervention. This improvement was shown despite no change on impairment-related measures and were shown to be feasible measures to use in a larger study of CO-OP for this population.
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Affiliation(s)
- Hortensia Gimeno
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
| | - Helene J Polatajko
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Richard G Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Bain JM, Ardalan A, Goldman S. Deliberate paradigm shift in research in rare neurodevelopmental disorders. Orphanet J Rare Dis 2021; 16:263. [PMID: 34107995 PMCID: PMC8188744 DOI: 10.1186/s13023-021-01885-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
Diagnosis and management of children with rare neurodevelopmental disorders (RNDDs) are complex. The COVID-19 pandemic has forced us to rethink the research activities critical to improve our understanding and treatment of RNDDs, such as creating large international registries and developing natural history studies. In this communication, we reflect on our latest effort in conducting research remotely while providing support, education and feedback to families affected by a specific RNDD. Specifically, we advocate for a deliberate paradigm shift towards virtual family meetings as ecological platforms to enroll and assess individuals with rare disorders. Herein, we demonstrate that such a shift is crucial to substantially increasing geographical and age range coverage, which are essential for capturing the phenotypic variations in RNDDs. Finally, we call on the community to invest in building integrated technological platforms necessary for effective remote research activities, through standardization, collaboration and training.
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Affiliation(s)
- Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, 180 Fort Washington Avenue, 5th Floor, New York, NY 10032 USA
| | - Adel Ardalan
- Zuckerman Mind Brain Behavior Institute, Columbia University, 3227 Broadway, New York, NY 10027 USA
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, 180 Fort Washington Avenue, 5th Floor, New York, NY 10032 USA
- Department of Neurology, Division of Cognitive Neuroscience, Columbia University Irving Medical Center, 622 West 168th Street, PH18-331, New York, NY 10032 USA
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Camden C, Zwicker JG, Morin M, Schuster T, Couture M, Poder TG, Maltais DB, Battista MC, Baillargeon JP, Goyette M, Pratte G, Hurtubise K, Phoenix M, Nguyen T, Berbari J, Tousignant M. Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families. BMJ Open 2021. [PMCID: PMC8039274 DOI: 10.1136/bmjopen-2020-046561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation. Methods and analysis A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation. Ethics and dissemination The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities. Trial registration number NCT04254302.
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Affiliation(s)
- Chantal Camden
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Jill G Zwicker
- Occupational Science & Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Melanie Morin
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Melanie Couture
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Thomas G Poder
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montreal, Québec, Canada
| | - Desiree B Maltais
- Département de réadaptation, Universite Laval, Québec City, Québec, Canada
| | - Marie-Claude Battista
- Department of Medicine, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
- Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Mathieu Goyette
- Département de sexologie, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Gabrielle Pratte
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Karen Hurtubise
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tram Nguyen
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jade Berbari
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Michel Tousignant
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
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Garbellini S, Randall M, Steele M, Elliott C, Imms C. The Neurological Hand Deformity Classification: Construct validity, test-retest, and inter-rater reliability. J Hand Ther 2021; 35:581-589. [PMID: 34011469 DOI: 10.1016/j.jht.2021.03.005] [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: 03/12/2020] [Revised: 02/04/2021] [Accepted: 03/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Neurological Hand Deformity Classification (NHDC) is an impairment-based tool that classifies hand deformity into one of two ordinal scales: flexion or extension deformities. Classification is made from live observation or from recorded video footage. Differentiation between the levels is determined by wrist position and wrist and finger movement. PURPOSE To examine aspects of validity and reliability of the NHDC. STUDY DESIGN A measurement study design. METHODS Data from a convenience sample of 127 children with cerebral palsy, 66 males: 61 females, ranging in age from 8 months to 15 years, across all Manual Ability Classification System levels I to V, were analyzed. Construct validity was assessed by testing predetermined hypotheses of relationships between the NHDC and measures of body function and activity measures with observed performance using the Chi Squared Test of Independence and Spearman Correlation Coefficient. Test-retest and inter-rater reliability were assessed by calculating agreement between repeated measures and paired raters using weighted kappa and Cohen's kappa with 95% confidence intervals. RESULTS Predicted hypotheses for the NHDC were met in nine of 10 Spearman's rho correlations with body structure measures and in 2 of 7 correlations with activity measures. Test-retest for flexion deformities: κw = 0.84; 95% CI 0.70-0.98; and extension deformities: κ = 1.0; 95% CI 1.0-1.0 was good to excellent; inter-rater reliability for flexion deformities: κw = 0.76; 95% CI 0.67-0.85; and extension deformities κ = 0.75; 95% CI 0.43-1.0 was moderate to excellent. CONCLUSION Expected relationships between the NHDC and other measures, stability between repeated measures and acceptable between-rater agreement supports confidence classifying hand deformity in children with cerebral palsy with the NHDC.
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Affiliation(s)
- Simon Garbellini
- School of Allied Health, Australian Catholic University, Melbourne, VIC, Australia; Department of Pediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia.
| | | | - Michael Steele
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Catherine Elliott
- Department of Pediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia; School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Christine Imms
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
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48
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Kao YC, Coster W, Cohn ES, Orsmond GI. Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children. Am J Occup Ther 2021; 75:7502205050p1-7502205050p11. [PMID: 33657347 PMCID: PMC7929602 DOI: 10.5014/ajot.2020.041723] [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] [Indexed: 11/19/2022] Open
Abstract
Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood. Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child. Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests. Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr. Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task). Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15. Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood. What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.
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Affiliation(s)
- Ying-Chia Kao
- Ying-Chia Kao, ScD, OTR, is Assistant Professor, Department of Occupational Therapy, Asia University, Taichung, Taiwan;
| | - Wendy Coster
- Wendy Coster, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
| | - Ellen S Cohn
- Ellen S. Cohn, ScD, OTR, FAOTA, is Clinical Professor Emerita, Department of Occupational Therapy, Boston University, Boston, MA
| | - Gael I Orsmond
- Gael I. Orsmond, PhD, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
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Sakzewski L, Reedman S, McLeod K, Thorley M, Burgess A, Trost S, Ahmadi M, Rowell D, Chatfield M, Bleyenheuft Y, Boyd RN. Preschool HABIT-ILE: study protocol for a randomised controlled trial to determine efficacy of intensive rehabilitation compared with usual care to improve motor skills of children, aged 2-5 years, with bilateral cerebral palsy. BMJ Open 2021; 11:e041542. [PMID: 33653745 PMCID: PMC7929797 DOI: 10.1136/bmjopen-2020-041542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial. METHODS AND ANALYSIS 60 children with BCP aged 2-5 years, Gross Motor Function Classification System (GMFCS) II-IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales-Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function-Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. ETHICS AND DISSEMINATION Ethics approval has been granted by the Medical Research Ethics Committee Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/59444) and The University of Queensland (2020000336/HREC/19/QCHQ/59444). TRIAL REGISTRATION NUMBER ACTRN126200000719.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Kate McLeod
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Matthew Ahmadi
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - David Rowell
- Faculty of Business, Economics and Law, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Mark Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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50
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Hildenbrand H, Wickstrom J, Parks R, Zampieri C, Nguyen TT, Thurm A, Jenkins K, Alter KE, Matsubara J, Hammond D, Soldatos A, Porter FD, Dang Do AN. Characterizing upper limb function in the context of activities of daily living in CLN3 disease. Am J Med Genet A 2021; 185:1399-1413. [PMID: 33559393 DOI: 10.1002/ajmg.a.62114] [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: 10/23/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/06/2022]
Abstract
In CLN3 disease, impairments in motor function are frequently reported to have later onset compared to visual and cognitive decline, but upper limb motor function has yet to be explored in this population. In a cohort of 22 individuals with CLN3, we used a novel application of multiple measures to (1) characterize motor function, particularly of the upper limbs, in activities of daily living (ADLs), and (2) explore associations between motor function and age as well as visual ability, disease severity, and cognitive function, as evaluated by the Unified Batten Disease Rating Scale (UBDRS), a validated CLN3 disease measure. ADLs that required coordination, speed, and fine motor control were particularly challenging for children with CLN3 based on item-level performance across direct assessments (Jebsen-Taylor Hand Function Test [JTHFT] and MyoSet Tools) and caregiver reports (Pediatric Evaluation of Disability Inventory-Computer Adaptive Testing [PEDI-CAT] and Patient-Reported Outcomes Measurement Information System [PROMIS] Pediatric Upper Extremity). Poorer visual ability, disease severity, and cognitive function were associated with worse performance on these measures, whereas age had limited impact. These findings support the need for children with CLN3 to receive skilled clinical evaluation and treatment tailored to their individual needs, particularly in the context of ADLs, as their symptom profile progresses.
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Affiliation(s)
- Hanna Hildenbrand
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jordan Wickstrom
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca Parks
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Cris Zampieri
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Thuy-Tien Nguyen
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institutes of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Kisha Jenkins
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Katharine E Alter
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jesse Matsubara
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Dylan Hammond
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Ariane Soldatos
- Pediatric Neurology Consultation Service, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Forbes D Porter
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - An N Dang Do
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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