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Martins EJ, Franco CSB, Siqueira MBDS, Mattiello-Sverzut AC. A deficit to reach the isokinetic velocity in youth wheelchair users with spina bifida. J Spinal Cord Med 2024:1-10. [PMID: 39037328 DOI: 10.1080/10790268.2024.2355745] [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: 07/23/2024] Open
Abstract
INTRODUCTION The self-paced adopted by wheelchair users in their postural transfers and locomotion may require sufficient levels of speed-strength in the upper limbs. In clinical practice, we observed limited functional independence and social participation. OBJECTIVES This study aimed to investigate and compare the speed-strength relationship between wheelchair users with spina bifida (SB) and typically developing youth. In particular, to analyze if SB wheelchair users reached the preset velocities in the isokinetic evaluation of shoulder and elbow. DESIGN Cross-sectional observational study. SETTING Ribeirão Preto Medical School of the University of São Paulo. PARTICIPANTS AND PROCEDURES SB (SB; n = 11) and controls (CT; n = 22) performed the isokinetic assessment of shoulder abductors (SAB), adductors (SAD), flexors (SFL), extensors (SEX), and elbow flexors (EFL) and extensors (EEX) at velocities of 60 and 120degree.s-1. The analysis of covariance was used to identify the intergroup differences in muscle performance. OUTCOME MEASURES The values of peak torque (PT), power (Pow), time to peak torque (tPT) and the percentage to reach the isokinetic velocity. RESULTS The percentage to reach 120degree.s-1 was moderate-to-low for both groups (26-75.9%). CT presented a significantly greater relative risk of reaching the preset velocities than SB. SB presented higher PT and Pow for SAB and SFL at 60degree.s-1, higher PT for SFL and EEX at 120degree.s-1, and lower tPT for SFL at 120degree.s-1 compared to CT. CONCLUSION SB had difficulty reaching 120degree.s-1, probably related to neuromuscular differences. However, arm movements in their daily tasks seem to maintain the ability to produce PT and Pow.
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Affiliation(s)
- Emanuela Juvenal Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Martins EJ, Serrão P, Leonardi-Figueiredo MM, Ravanelli LS, Serenza FS, Mattiello S, Aagaard P, Mattiello-Sverzut A. Isokinetic arm and shoulder muscle torque-velocity characteristics in mobility limited children and adolescents with spina bifida. Physiother Theory Pract 2024; 40:962-972. [PMID: 36482746 DOI: 10.1080/09593985.2022.2150529] [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: 11/26/2020] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Propulsive wheelchair capacity may be influenced by arm muscle performance.Objectives: To determine whether children and adolescent wheelchair-users with spina bifida show reduced arm muscle strength compared to their typically developing peers and to compare muscle strength data obtained by isokinetic and handheld dynamometry (HHD). METHODS Participants (mean age 12.5 ± 2.5 years) were assigned to spina bifida (SB; n = 11) or control (n = 22) groups. Isokinetic dynamometry was used to measure peak torque (PT) during dynamic (60°s-1 and 120°s-1) and isometric strength testing (MVIC) for shoulder and elbow flexors and extensors. HHD was used to measure MVIC of the same muscle groups. RESULTS SB showed reduced isokinetic PT for shoulder extensors at 60°s-1 and 120°s-1, shoulder flexor MVIC, and elbow flexors at 60°s-1 and MVIC; higher PT for shoulder flexors and elbow flexors at 120°s-1; and decreased MVIC for elbow flexors but not extensors compared to controls when assessed by HHD. The SB and control groups showed strong positive correlations between MVIC data obtained by the two devices for all muscle groups (r ≥ 0.81; p < .01), except for shoulder flexor MVIC in controls (r = 0.68; p < .01). CONCLUSION SB presented reduced levels of dynamic slow-speed and isometric shoulder and elbow muscle strength and greater dynamic high-speed shoulder and elbow flexor strength than controls possibly due to the exposure to self-sustained wheelchair ambulation. Exercise-based intervention protocols to increase slow-speed arm muscle strength should be considered in youth with SB. Strong positive correlations observed between muscle strength assessed by isokinetic dynamometry and HHD support the use of HHD in this clinical population.
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Affiliation(s)
- Emanuela J Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula Serrão
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Letícia S Ravanelli
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Felipe S Serenza
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Stela Mattiello
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark
| | - Ana Mattiello-Sverzut
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Martins EJ, Mattiello-Sverzut AC, Franco CSB, de Lemos TW, Aagaard P. Muscle strength, rate of torque development and neuromuscular activation of the upper arm muscles in children and adolescents with spina bifida. Clin Biomech (Bristol, Avon) 2023; 102:105861. [PMID: 36623326 DOI: 10.1016/j.clinbiomech.2022.105861] [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: 07/09/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of locomotive devices requires sufficient levels of upper limb strength. Therefore, it is important to evaluate the maximal isometric torque, rate of torque development and neuromuscular activation in youth with spina bifida. The objective was to investigate these parameters in the elbow muscles of youth with spina bifida versus healthy age-matched peers. METHODS Forty-eight participants (8-17 years) were recruited: Spina Bifida (n = 23) and non-affected Controls (n = 25). Maximal isometric elbow flexor/extensor contractions were performed to assess maximal muscle strength (peak torque) and rate of torque development, along with synchronized electromyography recording in the biceps and triceps brachii muscles. FINDINGS During elbow flexor contractions, Spina Bifida showed reduced rate of torque development in the early contraction phase (0-50 ms) along with lowered relative rate of torque development in the later rate of torque development phase (0-100/200/300 ms) compared to controls. Spina Bifida showed reduced rate of torque development for the elbow extensors in the later phase of rising muscle force (0-200/300 ms) compared to controls. Lower isometric peak torque and smaller triceps brachii electromyography amplitudes (0-200/300 ms) were observed during elbow extensor contractions in Ambulatory spina bifida participants vs. controls. INTERPRETATION Although a majority of peak torque and rate of torque development parameters did not differ, significant impairments in maximal and rapid elbow muscle force characteristics were noted in Spina Bifida compared to non-affected Controls. Ambulatory and Non-ambulatory spina bifida participants demonstrated similar rate of torque development in their upper arm muscles.
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Affiliation(s)
- Emanuela Juvenal Martins
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | | | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern Denmark, Odense, Denmark.
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Gour-Provençal G, Costa C. Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature. Top Spinal Cord Inj Rehabil 2022; 28:15-40. [PMID: 36017122 DOI: 10.46292/sci21-00032] [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: 11/19/2022]
Abstract
Objectives The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies. Methods A literature review of articles published in English and French between 1990 and April 2020 was conducted. Results Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases. Conclusion Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.
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Affiliation(s)
| | - Camille Costa
- Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
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Houtrow AJ, MacPherson C, Jackson-Coty J, Rivera M, Flynn L, Burrows PK, Adzick NS, Fletcher J, Gupta N, Howell LJ, Brock JW, Lee H, Walker WO, Thom EA. Prenatal Repair and Physical Functioning Among Children With Myelomeningocele: A Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr 2021; 175:e205674. [PMID: 33555337 PMCID: PMC7871205 DOI: 10.1001/jamapediatrics.2020.5674] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The Management of Myelomeningocele Study (MOMS), a randomized clinical trial of prenatal vs standard postnatal repair for myelomeningocele, found that prenatal repair reduced hydrocephalus and hindbrain herniation and improved motor function in children aged 12 to 30 months. The Management of Myelomeningocele Study Follow-up (MOMS2) was conducted in children at ages 5 to 10 years. The primary (neurocognitive) outcome has already been reported. OBJECTIVE To determine whether MOMS2 participants who had prenatal repair have better physical functioning than those with postnatal repair. DESIGN, SETTING, AND PARTICIPANTS Participants from MOMS were recruited for participation in the follow-up study, MOMS2, conducted from April 9, 2012, to April 15, 2017. For this secondary analysis of the randomized clinical trial, trained examiners without knowledge of the treatment group evaluated the physical characteristics, self-care skills, neurologic function, and mobility of the children. Physical functioning outcomes were compared between the prenatal and postnatal repair groups. MOMS2 was conducted at the same 3 clinical sites as MOMS. Home visits were conducted for families who were unable to travel to one of the clinical sites. Of the 161 children with myelomeningocele aged 5 to 10 years old enrolled in MOMS2, 154 had a physical examination and were included in the analyses. EXPOSURES Prenatal repair of myelomeningocele. MAIN OUTCOMES AND MEASURES Prespecified secondary trial outcomes of self-care skills, functional mobility, walking skills, and motor level. RESULTS This analysis included 78 children with postnatal repair (mean [SD] age, 7.4 [2.1] years; 50 girls [64.1%]; 69 White children [88.5%]) and 76 with prenatal repair (mean [SD] age, 7.5 [1.2] years; 43 boys [56.6%]; 70 White children [92.1%]). Children in the prenatal repair group were more competent with self-care skills (mean [SD] percentage of maximum FRESNO Scale score, 90.8% [9.6%] vs 85.5% [17.6%]) and were commonly community ambulators per the Modified Hoffer Classification (51.3% prenatal vs 23.1% postnatal; adjusted relative risk [aRR] for sex, 1.70; 95% CI, 1.23-2.34). Children with prenatal repair also performed the 10-m walk test 1 second faster (difference in medians, 1.0; 95% CI, 0.3-1.7), had better gait quality (adjusted mean difference for home distances of 5 m, 1.71; 95% CI, 1.14-2.54), and could perform higher-level mobility skills (adjusted mean difference for motor total, 5.70; 95% CI, 1.97-11.18). Children in the prenatal repair group were less likely to have a motor function level worse than their anatomic lesion level (aRR, 0.44; 95% CI, 0.25-0.77). CONCLUSIONS AND RELEVANCE This secondary analysis of a randomized clinical trial found that the physical functioning benefits of prenatal repair for myelomeningocele reported at age 30 months persisted into school age. These findings indicate the benefit of prenatal repair of myelomeningocele for school-aged children. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00060606.
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Affiliation(s)
- Amy J. Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania,Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Cora MacPherson
- The Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC
| | - Janet Jackson-Coty
- Department of Physical Therapy, Jefferson University, Philadelphia, Pennsylvania
| | - Monica Rivera
- Department of Physical Therapy, Fresno State University, Fresno, California
| | - Laura Flynn
- Department of Physical Therapy, Vanderbilt University, Nashville, Tennessee
| | - Pamela K. Burrows
- The Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC
| | - N. Scott Adzick
- Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jack Fletcher
- Department of Psychology, University of Houston, Houston, Texas
| | - Nalin Gupta
- Department of Neurosurgery, University of California, San Francisco, San Francisco
| | - Lori J. Howell
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John W. Brock
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Hanmin Lee
- Department of Surgery, University of California, San Francisco, San Francisco
| | | | - Elizabeth A. Thom
- The Biostatistics Center, Milken Institute of Public Health, George Washington University, Washington, DC
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Bartonek Å, Guariglia C, Piccardi L. Locomotion and Topographical Working Memory in Children With Myelomeningocele and Arthrogryposis Multiplex Congenita. Front Psychiatry 2021; 12:729859. [PMID: 34867521 PMCID: PMC8632943 DOI: 10.3389/fpsyt.2021.729859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In children with myelomeningocele (MMC) and arthrogryposis multiplex congenital (AMC), adequate rehabilitation measures are accessible with the goal of attaining the utmost motor development. However, there is a lack of knowledge as to how children develop navigation utilizing their locomotion abilities. The aim of the present study was to explore topographic working memory in children with MMC and AMC. Methods: For this purpose, we assessed 41 children with MMC and AMC, assigned an ambulation group, and 120 typical developing (TD) children, with mean ages of 11.9, 10.6, and 9.9 years, respectively. All groups performed a topographic working memory test while moving in a walking space and a visuospatial working memory test in a reaching space. Children with MMC and AMC also performed a test to measure their ability to reason on visuospatial material, Raven's Coloured Progressive Matrices. Results: The topographic working memory span was shorter in the MMC group than in the TD group. In general, all ambulation groups had a shorter topographic working memory span than the TD group. The visuospatial working memory span was shorter in the non-ambulation group than in the TD group. Scores from the visuospatial reasoning test were lower in the non-ambulation group than in the community ambulation group. Conclusions: Even though a higher cognitive score was found in the community ambulation group than in the non-ambulation group, topographic working memory was affected similarly in both groups. Including children who develop community ambulation in therapy programs containing aspects of navigation may gain even children with low levels of MMC and AMC. These results evidenced the importance of motor development and navigational experience gained through direct exploration of the environment on topographic memory.
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Affiliation(s)
- Åsa Bartonek
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Guariglia
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, University Sapienza of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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Steinhart S, Kornitzer E, Weiss PL, Katz-Leurer M. Exploring hand dexterity in children with myelomeningocele. J Pediatr Rehabil Med 2021; 14:613-619. [PMID: 33935118 DOI: 10.3233/prm-200713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess hand dexterity in children with myelomeningocele (MMC) and to explore factors related to hand dexterity in these children. METHODS Ninety-four children with myelomeningocele, aged 4 to 18 years, were assessed. Demographic characteristics, disease factors, visual perception (Beery test of Visual Motor Integration), cognition (WeeFunctional Independence Measure), and self-care (Pediatric Evaluation of Disability Inventory) were assessed in relation to the Nine-Hole Peg Test (9HPT) for hand dexterity using Spearmen correlations and linear regressions. RESULTS The children's performance on the 9HPT in both hands was significantly slower than the norms for their age groups. Children without a shunt showed significantly better function in both hands (p = .005) than those with a shunt. Factors most related to hand dexterity were neurological spinal level of MMC, presence of shunt, age, cognitive ability, and years of mother's education. CONCLUSION Children with MMC appear to have poorer hand skills than typically developed children, which was related to pathology as well as functional and environmental factors. When addressing hand dexterity in children with MMC, it is important that rehabilitation professionals continue to work with these children as they get older, and put greater emphasis on parent education using materials that are adapted to varying educational levels.
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Affiliation(s)
- Shoshana Steinhart
- Rehabilitation Department, ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Emmanuel Kornitzer
- Rehabilitation Department, ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - Patrice L Weiss
- Rehabilitation Department, ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel.,Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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8
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Bartonek Å, Guariglia C, Piccardi L. Topographical working memory in children and adolescents with motor disabilities. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1757855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Åsa Bartonek
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Guariglia
- Department of Psychology, Sapienza Universityof Rome, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Laura Piccardi
- Department of Psychology, Sapienza Universityof Rome, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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Houtrow AJ, Thom EA, Fletcher JM, Burrows PK, Adzick NS, Thomas NH, Brock JW, Cooper T, Lee H, Bilaniuk L, Glenn OA, Pruthi S, MacPherson C, Farmer DL, Johnson MP, Howell LJ, Gupta N, Walker WO. Prenatal Repair of Myelomeningocele and School-age Functional Outcomes. Pediatrics 2020; 145:peds.2019-1544. [PMID: 31980545 PMCID: PMC6993457 DOI: 10.1542/peds.2019-1544] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Management of Myelomeningocele Study (MOMS), a randomized trial of prenatal versus postnatal repair for myelomeningocele, found that prenatal surgery resulted in reduced hindbrain herniation and need for shunt diversion at 12 months of age and better motor function at 30 months. In this study, we compared adaptive behavior and other outcomes at school age (5.9-10.3 years) between prenatal versus postnatal surgery groups. METHODS Follow-up cohort study of 161 children enrolled in MOMS. Assessments included neuropsychological and physical evaluations. Children were evaluated at a MOMS center or at a home visit by trained blinded examiners. RESULTS The Vineland composite score was not different between surgery groups (89.0 ± 9.6 in the prenatal group versus 87.5 ± 12.0 in the postnatal group; P = .35). Children in the prenatal group walked without orthotics or assistive devices more often (29% vs 11%; P = .06), had higher mean percentage scores on the Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes (92 ± 9 vs 85 ± 18; P < .001), lower rates of hindbrain herniation (60% vs 87%; P < .001), had fewer shunts placed for hydrocephalus (49% vs 85%; P < .001) and, among those with shunts, fewer shunt revisions (47% vs 70%; P = .02) than those in the postnatal group. Parents of children repaired prenatally reported higher mean quality of life z scores (0.15 ± 0.67 vs 0.11 ± 0.73; P = .008) and lower mean family impact scores (32.5 ± 7.8 vs 37.0 ± 8.9; P = .002). CONCLUSIONS There was no significant difference between surgery groups in overall adaptive behavior. Long-term benefits of prenatal surgery included improved mobility and independent functioning and fewer surgeries for shunt placement and revision, with no strong evidence of improved cognitive functioning.
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Affiliation(s)
- Amy J. Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth A. Thom
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Pamela K. Burrows
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - N. Scott Adzick
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nina H. Thomas
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John W. Brock
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Timothy Cooper
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Hanmin Lee
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Orit A. Glenn
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Sumit Pruthi
- Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Cora MacPherson
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Diana L. Farmer
- Departments of Neurological Surgery and Pediatrics, University of California, Davis, Davis, California; and
| | - Mark P. Johnson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori J. Howell
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nalin Gupta
- Department of Surgery, University of California, San Francisco, San Francisco, California
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Joyeux L, Danzer E, Flake AW, Deprest J. Fetal surgery for spina bifida aperta. Arch Dis Child Fetal Neonatal Ed 2018; 103:F589-F595. [PMID: 30006470 DOI: 10.1136/archdischild-2018-315143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022]
Abstract
Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.
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Affiliation(s)
- Luc Joyeux
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jan Deprest
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, London, UK
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Ferreira FR, Bexiga FP, Martins VVDM, Favero FM, Sartor CD, Artilheiro MC, Voos MC. Independência funcional de crianças de um a quatro anos com mielomeningocele. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17006325022018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A mielomeningocele é causada por defeito no fechamento do tubo neural. A doença representa a segunda causa de deficiência crônica no aparelho locomotor em crianças. A independência funcional depende do nível da lesão medular e sua avaliação é importante para a determinação de abordagens terapêuticas adequadas. O objetivo foi descrever a independência funcional e o nível de lesão de 15 crianças de seis meses a quatro anos com lesão medular completa causada por mielomeningocele. Foi realizado um estudo observacional do tipo transversal nas Universidades Ibirapuera e Santa Cecília. O Inventário de Avaliação Pediátrica de Incapacidade (Pediatric Evaluation of Disability Inventory - PEDI) foi aplicado com os pais, para avaliação da independência funcional nas atividades de vida diária das crianças. A escala de Padrões Internacionais para Classificação Neurológica de Lesão da Medula Espinhal da Associação Americana de Lesão Medular (International Standards for Neurological Classification of Spinal Cord Injury of the American Spinal Injury Association) foi utilizada para determinar o nível motor e sensitivo da lesão. Foram avaliados seis meninos e nove meninas (27,0±11,8 meses de idade). Três crianças apresentaram lesão torácica, nove apresentaram lesão lombar alta, duas apresentaram lesão lombar baixa e uma apresentou lesão sacral. As pontuações na PEDI variaram de 15 a 60% no domínio autocuidado, de 10 a 15% no domínio mobilidade e de 19 a 58% no domínio função social. Houve grande variabilidade no desempenho funcional de crianças com mielomeningocele, detectada pelos domínios autocuidado e função social da PEDI. As crianças apresentaram grande prejuízo no domínio mobilidade.
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Persson M, Janeslätt G, Peny-Dahlstrand M. Daily time management in children with spina bifida. J Pediatr Rehabil Med 2017; 10:295-302. [PMID: 29125520 DOI: 10.3233/prm-170459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Spina bifida (SB) often results in a complex disability and can also cause cognitive dysfunction. No previous study has investigated the ability to adapt to time in children with SB. This ability is crucial for an individual's possibility to develop autonomy in life. The purpose of this study was to investigate whether children aged 10-17 with SB have lower time-processing abilities than typically-developing children, and to describe the profile of time-processing in children with SB. METHOD Participants comprised a consecutive sample of 21 children (drawn from a geographical cohort of 45) aged 10-17 years (mean: 14 years, SD: 2 years); 13 were boys. The instruments used were KaTid-Y, Time-S, and Time-P. RESULTS The children with SB had lower time-processing abilities than typically-developing children (52.4% under -2SD), particularly difficulties to orient to and to estimate objective time, to understand time perspectives and with time planning. They also self-rated low use of strategies to adapt to time. The parents rated their children as having extensive difficulties in daily time management. CONCLUSIONS The low time-processing ability found in children with SB is likely to be an important contributing factor to low autonomy and independence.
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Affiliation(s)
- Marika Persson
- Regional Rehabilitation Centre, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Marie Peny-Dahlstrand
- Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Luz CL, Moura MCDSD, Becker KK, Teixeira RAA, Voos MC, Hasue RH. The relationship between motor function, cognition, independence and quality of life in myelomeningocele patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:509-514. [DOI: 10.1590/0004-282x20170088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Motor function, cognition, functional independence and quality of life have been described in myelomeningocele patients, but no study has investigated their relationships. We aimed to investigate the relationships between motor function, cognition, functional independence, quality of life, age, and lesion level in myelomeningocele patients, and investigate the influence of hydrocephalus on these variables. We assessed 47 patients with the Gross Motor Function Measure (motor function), Raven’s Colored Progressive Matrices (cognition), Pediatric Evaluation of Disability Inventory (functional independence) and the Autoquestionnaire Qualité de vie Enfant Imagé (quality of life). Spearman’s correlation tests determined relationships between the variables. The Friedman ANOVAs determined the influence of hydrocephalus. Motor function was strongly related to mobility and lesion level, and moderately related to cognition, self-care and social function. Cognition and quality of life were moderately related to functional independence. Age correlated moderately with functional independence and quality of life. Hydrocephalus resulted in poorer motor/cognitive outcomes and lower functional independence.
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Arazpour M, Soleimani F, Sajedi F, Vameghi R, Bani MA, Gharib M, Samadian M. Effect of Orthotic Gait Training with Isocentric Reciprocating Gait Orthosis on Walking in Children with Myelomeningocele. Top Spinal Cord Inj Rehabil 2017; 23:147-154. [PMID: 29339891 PMCID: PMC5672882 DOI: 10.1310/sci2302-147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Mechanical orthoses are used to assist in standing and walking after neurological injury in children with myelomeningocele (MMC). Objectives: To evaluate the influence of orthotic gait training with an isocentric reciprocating gait orthosis (IRGO) on the kinematics and temporal-spatial parameters of walking in children with MMC. Methods: Five children with MMC were fitted with an IRGO. They walked at their own comfortable cadence using the orthosis. The hip joint angle, spatial temporal parameters, and compensatory motions were measured and analyzed. Results: Significant increases in walking speed and step length were demonstrated following orthotic gait training during walking with the IRGO. The sagittal plane hip range of motion was also significantly increased; however, the vertical and horizontal compensatory motions were significantly decreased. Conclusion: This study evaluated the influence of gait training with an IRGO on the kinematics and temporal spatial parameters in MMC children. The findings showed that orthotic gait training improved hip joint range of motion, increased walking speed and step length, and decreased lateral and vertical compensatory motions during level-ground walking trials.
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Affiliation(s)
- Mokhtar Arazpour
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Farin Soleimani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Firoozeh Sajedi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Roshanak Vameghi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Masoud Gharib
- Department of Occupational Therapy, Faculty of Para-medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Samadian
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Department of Neurosurgery, Tehran, Iran
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Bisaro DL, Bidonde J, Kane KJ, Bergsma S, Musselman KE. Past and current use of walking measures for children with spina bifida: a systematic review. Arch Phys Med Rehabil 2015; 96:1533-1543.e31. [PMID: 25944500 DOI: 10.1016/j.apmr.2015.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population. DATA SOURCES Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking. STUDY SELECTION Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review. DATA EXTRACTION Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used. DATA SYNTHESIS Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used. CONCLUSIONS Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.
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Affiliation(s)
- Derek L Bisaro
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julia Bidonde
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kyra J Kane
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shane Bergsma
- Department of Computer Science, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kristin E Musselman
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Stark C, Hoyer-Kuhn HK, Semler O, Hoebing L, Duran I, Cremer R, Schoenau E. Neuromuscular training based on whole body vibration in children with spina bifida: a retrospective analysis of a new physiotherapy treatment program. Childs Nerv Syst 2015; 31:301-9. [PMID: 25370032 DOI: 10.1007/s00381-014-2577-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Spina bifida is the most common congenital cause of spinal cord lesions resulting in paralysis and secondary conditions like osteoporosis due to immobilization. Physiotherapy is performed for optimizing muscle function and prevention of secondary conditions. Therefore, training of the musculoskeletal system is one of the major aims in the rehabilitation of children with spinal cord lesions. INTERVENTION AND METHODS The neuromuscular physiotherapy treatment program Auf die Beine combines 6 months of home-based whole body vibration (WBV) with interval blocks at the rehabilitation center: 13 days of intensive therapy at the beginning and 6 days after 3 months. Measurements are taken at the beginning (M0), after 6 months of training (M6), and after a 6-month follow-up period (M12). Gait parameters are assessed by ground reaction force and motor function by the Gross Motor Function Measurement (GMFM-66). Sixty children (mean age 8.71 ± 4.7 years) who participated in the program until February 2014 were retrospectively analyzed. RESULTS Walking velocity improved significantly by 0.11 m/s (p = 0.0026) and mobility (GMFM-66) by 2.54 points (p = 0.001) after the training. All changes at follow-up were not significant, but significant changes were observed after the training period. Decreased contractures were observed with increased muscle function. CONCLUSION Significant improvements in motor function were observed after the active training period of the new neuromuscular training concept. This first analysis of the new neuromuscular rehabilitation concept Auf die Beine showed encouraging results for a safe and efficient physiotherapy treatment program which increases motor function in children with spina bifida.
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Affiliation(s)
- C Stark
- Children's Hospital, University of Cologne, Cologne, Germany,
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Oliveira A, Jácome C, Marques A. Physical fitness and exercise training on individuals with spina bifida: a systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1119-1136. [PMID: 24612860 DOI: 10.1016/j.ridd.2014.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
Spina Bifida (SB) is characterized by several physical impairments; however, data on physical fitness and on the benefits of exercise training in individuals with SB are dispersed in the literature. Thus, this systematic review aimed to describe (i) physical fitness components (cardiorespiratory endurance, muscle strength, body composition, flexibility and neuromotor) and (ii) exercise training effects on the physical fitness of individuals with SB. CINAHL, MEDLINE and EMBASE were searched from January to March 2013 and updated in December 2013. Twenty-three studies were included. A summary of the results was performed using a best-evidence synthesis. Participants with SB had lower cardiorespiratory endurance (-32 to 54% in VO2 peak) and muscle strength (-58 to 90%) and higher body fat (159%) than their healthy peers. Mobility restrictions were present in 26.3-61% of participants. No data on neuromotor fitness were found. Aerobic and strength training improved participants' cardiorespiratory endurance (effect sizes 0.78-1.4) and muscle strength (effect sizes 0-0.59). Individuals with SB have impaired cardiorespiratory endurance, muscle strength, body composition and flexibility when compared to healthy peers. Exercise training seems to improve two of these fitness components (cardiorespiratory endurance and muscle strength). Nevertheless, the heterogeneity of the studies' designs, methods and instruments used limits the establishment of firm conclusions and highlights the need for further research.
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Affiliation(s)
- Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Cristina Jácome
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal.
| | - Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), 3810-193 Aveiro, Portugal; Unidade de Investigação e Formação sobre Adultos e Idosos (UniFAI), 4050-313 Porto, Portugal.
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Joyeux L, Chalouhi GE, Ville Y, Sapin E. [Maternal-fetal surgery for spina bifida: future perspectives]. ACTA ACUST UNITED AC 2014; 43:443-54. [PMID: 24582882 DOI: 10.1016/j.jgyn.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/14/2014] [Accepted: 01/21/2014] [Indexed: 12/29/2022]
Abstract
Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.
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Affiliation(s)
- L Joyeux
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
| | - G E Chalouhi
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - Y Ville
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - E Sapin
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France
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Pantall A, Teulier C, Ulrich BD. Changes in muscle activation patterns in response to enhanced sensory input during treadmill stepping in infants born with myelomeningocele. Hum Mov Sci 2012; 31:1670-87. [PMID: 23158017 DOI: 10.1016/j.humov.2012.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 04/20/2012] [Accepted: 04/21/2012] [Indexed: 10/27/2022]
Abstract
Infants with myelomeningocele (MMC) increase step frequency in response to modifications to the treadmill surface. The aim was to investigate how these modifications impacted the electromyographic (EMG) patterns. We analyzed EMG from 19 infants aged 2-10 months, with MMC at the lumbosacral level. We supported infants upright on the treadmill for 12 trials, each 30 seconds long. Modifications included visual flow, unloading, weights, Velcro and lcriction. Surface electrodes recorded EMG from tibialis anterior, lateral gastrocnemius, rectus femoris and biceps femoris. We determined muscle bursts for each stride cycle and from these calculated various parameters. Results indicated that each of the five sensory conditions generated different motor patterns. Visual flow and friction which we previously reported increased step frequency impacted lateral gastrocnemius most. Weights, which significantly decreased step frequency increased burst duration and co-activity of the proximal muscles. We also observed an age effect, with all conditions increasing muscle activity in younger infants whereas in older infants visual flow and unloading stimulated most activity. In conclusion, we have demonstrated that infants with myelomeningocele at levels which impact the myotomes of major locomotor muscles find ways to respond and adapt their motor output to changes in sensory input.
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Affiliation(s)
- Annette Pantall
- Center for Human Movement Studies, School of Applied Physiology, Georgia Institute of Technology, 555, 14th Street, Atlanta, GA 30332-0356, USA.
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Vinck A, Maassen BAM, Hulstijn W, Diender MG, Mullaart RA, Rotteveel JJ, Nijhuis-van der Sanden MWG. Motor sequence learning in children with spina bifida. Dev Neuropsychol 2012; 37:601-16. [PMID: 23066938 DOI: 10.1080/87565641.2012.697502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive and motor problems are common in children with spina bifida (SB), particularly in those children with cerebral malformations (SBM). Little is known about how these conditions affect motor learning. This study examines motor sequence learning in children with SB, SBM, and healthy controls. Assessment consisted of neuropsychological tests, a simple drawing task, and a spatial motor sequence learning task. Implicit motor learning was unaffected in children with SB(M), and their sequence learning ability was also similar to that of controls. However, both groups (SB and SBM) showed impaired motor performance. The role of cerebellar malformation with SB(M) is discussed.
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Affiliation(s)
- Anja Vinck
- Department of Medical Psychology/Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Danzer E, Gerdes M, Bebbington MW, Koh J, Adzick SN, Johnson MP. Fetal myelomeningocele surgery: preschool functional status using the Functional Independence Measure for children (WeeFIM). Childs Nerv Syst 2011; 27:1083-8. [PMID: 21327591 DOI: 10.1007/s00381-011-1388-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study preschool functional status in children following fetal myelomeningocele (fMMC) surgery. MATERIAL AND METHODS Prior to the NICHD-MOMS trial, 30 fMMC underwent standardized neurodevelopmental examination at 5 years of age. Functional status was determined with the Functional Independence Measure (WeeFIM), which assesses self-care, mobility, and cognitive independence. RESULTS Evaluations were completed in 26 (87%). Mean cognitive (93.0 ± 21.9), self-care (66.5 ± 23.9), mobility (82.3 ± 19.5), and total (77.9 ± 20.3) functional quotient of fMMC children were significantly lower than age-matched population norms (P < 0.01). Complete caregiver independence was achieved by 22 (84%), 10 (38%), 16 (62%), and 15 (58%) fMMC children for cognition, self-care, mobility, and total functional outcome, respectively. Cognitive, mobility, and total independence were higher in non-shunted than shunted fMMC children (P = 0.02, P = 0.02, and P < 0.01, respectively) and in fMMC children with average neurodevelopmental scores (P < 0.001, P = 0.01, and P < 0.01, respectively). Self-care independence tended to be higher in the non-shunted group and in fMMC children with normal neurodevelopmental outcome (P = 0.07 and P = 0.09, respectively). CONCLUSION The majority of fMMC children achieved cognitive and mobility independence, but continue to require significant assistance in self-care. Non-shunted and fMMC children with normal neurodevelopmental outcome were more likely to be independent in daily living activities. Better understanding of the extent of functional limitations following fMMC surgery will allow for more effective early interventions geared toward maximizing independence in everyday tasks in all environments.
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Affiliation(s)
- Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Fujisawa DS, Gois MLCDC, Dias JM, Alves EDONM, Tavares MDS, Cardoso JR. Intervening factors in the walking of children presenting myelomeningocele. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION: All children presenting myelomeningocele are capable of walking. Certain interventions can influence the walking prognosis of these children: physical therapy, medication, and nutritional orientation. OBJECTIVES: The aim of this study was to verify the association between ability to walk in children with myelomeningocele and clinical, socioeconomic and therapeutic factors. METHOD: This cross-sectional study was conducted at the University Hospital. The participants were children aged two years-old or more, diagnosed with myelomeningocele. Data collection was conducted by physical therapy assessment and medical records. The dependent variable was walking and the independent variables were clinical, socioeconomic and therapeutic factors. RESULTS: Forty-one children were evaluated, with a median age of 5 years-old (2-9). The clinical factors that revealed an association with walking were neurological area (p < 0,0001) and fractures (p = 0,022). Socioeconomic factors showed not to be significant in relation to ability to walk. Surgery (p = 0,017) and the use of assistive devices (p = 0,023) were also associated with the ability to walk. Conclusion: The determinant clinical factor for walking prognosis was the neurological area. The use of assistive devices and surgical intervention were shown to be necessary for promoting walking activity.
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Fägerskiöld A, Mattsson GG. Disabled children and adolescents may be outsiders in the community. Int Nurs Rev 2010; 57:470-7. [DOI: 10.1111/j.1466-7657.2010.00810.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Motor profile and cognitive functioning in children with spina bifida. Eur J Paediatr Neurol 2010; 14:86-92. [PMID: 19237302 DOI: 10.1016/j.ejpn.2009.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 01/17/2009] [Accepted: 01/19/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spina bifida is a complex neuroembryological disorder resulting from incomplete closure of the posterior neural tube. Morbidity in the different fields of motor and cognitive neurodevelopment is variable in nature and severity, and often hard to predict. AIMS The current study investigates the relationship between cognitive functioning, fine motor performance and motor quality in children with spina bifida myelomeningocele (SBM) and SB-only, taking into consideration the cerebral malformations. MATERIAL AND METHODS Forty-one children were included (22 girls and 19 boys aged between 6 and 14 years, mean age 10;0 years) in the study. A comprehensive assessment was conducted of cognitive functioning and motor profile, including fine motor and visual-motor functioning, and motor quality. The performance outcomes were analyzed for the total group of children and separately for the nonretarded children (FSIQ> or =70, N=30) to eliminate the influence of global intellectual impairment. RESULTS Although the children with spina bifida showed increased incidence of cognitive and fine motor impairment, and impaired motor quality, after exclusion of the overall retarded children no associations were found between cognitive functioning and motor profile. In the comparison of SBM to SB-only specific differences were found for performance IQ, visual-motor functioning and motor quality, but not fine motor functioning. CONCLUSION Our findings underscore the role of cerebral malformation in spina bifida and its consequences for neuropsychological functioning. The complicated developmental interactions found strengthen the need for an individualized management of children with SB.
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Peny-Dahlstrand M, Ahlander AC, Krumlinde-Sundholm L, Gosman-Hedström G. Quality of performance of everyday activities in children with spina bifida: a population-based study. Acta Paediatr 2009; 98:1674-9. [PMID: 19583706 DOI: 10.1111/j.1651-2227.2009.01410.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the quality of the performance of everyday activities in children with spina bifida. METHODS Fifty children with spina bifida (of 65 children in a geographic cohort), aged 6 to 14 years, were evaluated with Assessment of Motor and Process Skills. RESULTS Compared with age-normative values, 60% of the children with spina bifida were found to have motor ability measures below 2 SD and 48% process ability measures below 2 SD. Most of the children with spina bifida had difficulties performing well-known everyday activities in an effortless, efficient and independent way, relating to both motor and process skills. The motor skills hardest to accomplish involved motor planning and the process skills hardest to accomplish were adaptation of performance and initiations of new steps, thus actually getting the task done. CONCLUSION To reach autonomy in life, children with spina bifida may need particular guidance to learn not only how to do things but also how to get things done.
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Affiliation(s)
- M Peny-Dahlstrand
- Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Lindquist B, Uvebrant P, Rehn E, Carlsson G. Cognitive functions in children with myelomeningocele without hydrocephalus. Childs Nerv Syst 2009; 25:969-75. [PMID: 19263057 DOI: 10.1007/s00381-009-0843-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to explore the separate effects of myelomeningocele (MMC) and hydrocephalus on intelligence and neuropsychological functions in a population-based series of children. MATERIAL AND METHODS Of the 69 children with MMC born in 1992-1999 in western Sweden, nine did not develop hydrocephalus. Eight of them participated in this study and were compared with age- and gender-matched children with MMC in combination with hydrocephalus and with controls. RESULTS Children with only MMC had an IQ of 103 compared with 75 in those with hydrocephalus added to the MMC and they had significantly better immediate and long-term memory and executive functions. When compared with controls, they had difficulty with learning and executive functions, but when the two children with an IQ of <70 were excluded, those with only MMC performed just as well as the controls. CONCLUSION Hydrocephalus rather than MMC in itself appeared to cause the cognitive deficits found in children with MMC.
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Affiliation(s)
- Barbro Lindquist
- Department of Habilitation, Halmstad County Hospital, Halmstad, Sweden
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Coster WJ, Haley SM, Ni P, Dumas HM, Fragala-Pinkham MA. Assessing self-care and social function using a computer adaptive testing version of the pediatric evaluation of disability inventory. Arch Phys Med Rehabil 2008; 89:622-9. [PMID: 18373991 DOI: 10.1016/j.apmr.2007.09.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 09/15/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. DESIGN Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. SETTING Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children's homes. PARTICIPANTS Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden. RESULTS Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (r range, .94-.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales. CONCLUSIONS Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time.
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Affiliation(s)
- Wendy J Coster
- Department of Occupational Therapy and Rehabilitation Counseling, Boston University Sargent College, Boston, MA 02215, USA.
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Seitzberg A, Lind M, Biering-Sørensen F. Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life? Childs Nerv Syst 2008; 24:231-7. [PMID: 17710414 DOI: 10.1007/s00381-007-0450-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the prediction of ambulation in adults with myelomeningocele from muscle strength testing and ambulation in early life. MATERIALS AND METHODS Fifty-two myelomeningocele (MMC) individuals at the age 18-37 years at follow-up were studied. Information on muscle strength and ambulatory function in early life was retrieved from medical records. The motor levels determined by the muscle strength were used to predict ambulatory function later in life. At follow-up, a clinical examination was performed. RESULTS Of 20 MMC individuals assessed with muscle strength within the first year of life, 7 achieved the predicted ambulatory function, 6 had a better, and 7 a poorer function. Of 32 individuals with known muscle strength at the age of 5-8 years, 10 had function as predicted, 5 a better ambulatory function, and 17 had a poorer ambulation in adult life than predicted. Good strength in quadriceps muscles gave significant better prospect for adult walking. Of the 52 participants, 41 retained their ambulation status from 5-8 years of age. CONCLUSION For MMC individuals with motor levels L3-L5, adult ambulatory function cannot be determined from muscle strength in early life, while it to some extend can be predicted for motor levels at or above L2 and at or below S1. The majority of the participants who at the age 5-8 years were community walkers without walking aid kept that function.
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Affiliation(s)
- Aase Seitzberg
- Physiotherapy Department, Clinic for Orthopedics and Rehabilitation Rigshospitalet T4114, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Collange LA, Franco RC, Esteves RN, Zanon-Collange N. Desempenho funcional de crianças com mielomeningocele. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este trabalho visou analisar o impacto dos níveis de lesão, deambulação e alterações neurológicas associadas ao quadro clínico da mielomeningocele sobre o desempenho funcional de seus portadores. Neste estudo transversal prospectivo foram examinadas 40 crianças com mielomeningocele, avaliando-se nível de lesão, deambulação, malformação de Arnold-Chiari, hidrocefalia, hidromielia, medula ancorada e incontinência esfincteriana. O desempenho funcional foi avaliado pelo Pediatric Evaluation of Disability Inventory (PEDI), para um registro quantitativo da capacidade funcional e autonomia nas atividades cotidianas, nas áreas de autocuidado, mobilidade e função social. Os dados coletados foram analisados estatisticamente, estabelecendo-se o nível de significância em p<0,05. Os níveis de lesão e a deambulação influenciaram significativamente (p<0,01) os escores das três áreas do PEDI. Os graus de limitação foram diretamente proporcionais ao nível de lesão. O maior acometimento foi verificado no autocuidado e na mobilidade, tendo as crianças obtido melhor pontuação na área de função social. Nos pacientes com nível de lesão torácico, a hidromielia sintomática mostrou-se fator significativo na área de autocuidado (p<0,01). Conclui-se que os níveis de lesão e a deambulação influenciam, com impactos diferenciados, cada área do desempenho funcional. Em pacientes com lesão torácica, a hidromielia sintomática pode ser apontada como fator limitante do autocuidado.
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Doherty D, Shurtleff DB. Pediatric perspective on prenatal counseling for myelomeningocele. ACTA ACUST UNITED AC 2006; 76:645-53. [PMID: 17001678 DOI: 10.1002/bdra.20297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Over the past 35 years, advances in the prenatal diagnosis of spina bifida using ultrasound and laboratory testing have increased the number of patients seeking prenatal counseling. METHODS Traditionally, this counseling has been provided by practitioners with little direct experience in the care of individuals with spina bifida across their life span. RESULTS Physicians experienced in the care of children with spina bifida are able to provide information that is not available from other sources. CONCLUSIONS This review provides a broad overview of many of the issues encountered during prenatal counseling sessions and emphasizes the additional value of the pediatric perspective during the process of informed decision making or preparation for an the birth of an affected child.
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Affiliation(s)
- Daniel Doherty
- Department of Pediatrics, University of Washington, Seattle, Washington 98195, USA.
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Haley SM, Raczek AE, Coster WJ, Dumas HM, Fragala-Pinkham MA. Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory. Arch Phys Med Rehabil 2005; 86:932-9. [PMID: 15895339 DOI: 10.1016/j.apmr.2004.10.032] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). DESIGN Computer simulation analysis of cross-sectional and longitudinal retrospective data; and cross-sectional prospective study. SETTING Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics, community-based day care, preschool, and children's homes. PARTICIPANTS Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 41 children without disabilities and 39 with disabilities (cross-validation sample). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Summary scores from a prototype Mob-CAT application and versions using 15-, 10-, and 5-item stopping rules; scores from the Mob-59; and number of items and time (in seconds) to administer assessments. RESULTS Mob-CAT scores from both computer simulations (intraclass correlation coefficient [ICC] range, .94-.99) and field administrations (ICC=.98) were in high agreement with scores from the Mob-59. Using computer simulations of retrospective data, discriminant validity, and sensitivity to change of the Mob-CAT closely approximated that of the Mob-59, especially when using the 15- and 10-item stopping rule versions of the Mob-CAT. The Mob-CAT used no more than 15% of the items for any single administration, and required 20% of the time needed to administer the Mob-59. CONCLUSIONS Comparable score estimates for the PEDI mobility scale can be obtained from CAT administrations, with losses in validity and precision for shorter forms, but with a considerable reduction in administration time.
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Affiliation(s)
- Stephen M Haley
- Health and Disability Research Institute, Boston University, Boston, MA, USA.
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Kirby RL, Mifflen NJ, Thibault DL, Smith C, Best KL, Thompson KJ, MacLeod DA. The manual wheelchair-handling skills of caregivers and the effect of training. Arch Phys Med Rehabil 2005; 85:2011-9. [PMID: 15605341 DOI: 10.1016/j.apmr.2004.02.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To test the hypothesis that the Wheelchair Skills Training Program (WSTP) is effective in improving the wheelchair-handling skills of untrained caregivers. DESIGN Within-participant comparisons. SETTING Rehabilitation center and community. PARTICIPANTS Twenty-four caregivers of manual wheelchair users. INTERVENTIONS Caregiver participants underwent the WSTP, version 2.4, adapted for caregivers. Training was individualized on the basis of an integrated testing-and-training protocol that took place on a single occasion (total, approximately 50 min). MAIN OUTCOME MEASURES Total percentage scores on the objective Wheelchair Skills Test (WST), version 2.4, for the pretraining (N=24), posttraining (N=24), and retention (n=9) evaluations. For the skill-transfer evaluation (n=10), we used the questionnaire version (WST-Q), administered by telephone to participants after return to their communities. RESULTS There were no serious adverse incidents. The mean pretraining total WST score +/- standard deviation was 77.8%+/-12.0%. Posttraining, this increased to 94.7%+/-7.1% (P <.001), a 22% relative increase. At retention testing, a median latency of 7 days later, the mean value, 94.2%+/-7.1%, did not decrease significantly from the posttraining level (P =.38). At skill-transfer testing, a median latency of 179 days posttraining, the mean value, 92.5%+/-8.7%, did not decrease significantly from the posttraining level (P =.73). The greatest improvements were at the advanced skill level. CONCLUSIONS The WSTP is a safe, practical, and effective method of improving the wheelchair-handling skills of untrained caregivers. Skill improvements are generally well retained and transfer well to the community. Such training could play an important role in the rehabilitation process.
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Affiliation(s)
- R Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, NS, Canada.
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Haley SM, Fragala-Pinkham MA, Ni PS, Skrinar AM, Kaye EM. Pediatric physical functioning reference curves. Pediatr Neurol 2004; 31:333-41. [PMID: 15519114 DOI: 10.1016/j.pediatrneurol.2004.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 05/13/2004] [Indexed: 11/15/2022]
Abstract
We developed normative profiles of physical functioning (mobility and self-care) in infancy up through 14 years of age with an expanded version of the Pediatric Evaluation of Disability Inventory. Mobility and self-care reference curves were based on the original Pediatric Evaluation of Disability Inventory standardization data (n = 412) and data from an additional cross-sectional, convenience sample (n = 373) via web-based survey, telephone or in-person interviews of parents. This new sample, which included children up through 14 years-of-age, was stratified for race, age, and sex, but was primarily limited geographically to the Northeast region of the United States. Goodness of fit of male, female, and combined sex (male and female) reference curves was examined. The mobility and self-care reference curves produced efficient and well-fitting estimates of conventional percentiles (3rd, 10th, 25th, 50th, 75th, 97th). Differences between males' and females' reference curves were negligible. This study highlights the use of these reference curves for determining the functional impact of Pompe disease, a lysosomal storage disorder that affects skeletal and cardiac muscle, restricting normal expression of mobility and self-care activities. This physical functioning instrument could also be used to evaluate the impact of muscle weakness in other neuromuscular disorders.
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Affiliation(s)
- Stephen M Haley
- Health and Disability Research Institute, Boston University, Boston, MA 02215, USA
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Golomb MR, Garg BP, Williams LS. Measuring gross motor recovery in young children with early brain injury. Pediatr Neurol 2004; 31:311-7. [PMID: 15519111 DOI: 10.1016/j.pediatrneurol.2004.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 05/21/2004] [Indexed: 11/25/2022]
Abstract
Motor outcome measures may be used in both research and clinical practice. Although many motor outcome measures exist, only a small subset are suitable for use in children, and an even smaller subset is suitable for use in children under the age of 5 years who are undergoing rapid motor development. In this article, the issues involved in choosing an outcome measure are reviewed, and four of the most common gross motor outcomes measures used in young children are discussed.
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Affiliation(s)
- Meredith R Golomb
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
For families who are raising children with myelomeningocele, bowel and bladder incontinence presents unique challenges for everyday life. The Parenting and Childhood Chronicity model is used to describe the work of raising a child with a chronic condition in 6 areas, including medical care, adapted parenting, dealing with the systems, caring for siblings, maintaining relationships, and personal coping (keeping yourself going). This article provides an overview of the physiologic and developmental challenges inherent in this neural tube defect and illustrates the work that is involved in the child's care and the challenges of maintaining a balance in family life. Clinical implications are discussed, including the setting of appropriate expectations, providing parents with accurate information, ensuring that a focus on continence is not at the expense of other important aspects of the child's functioning, and supporting parents in their interaction with the school system. The medical team, consisting of nursing, urology, nephrology, and psychology working together, can be a strong support for families.
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Affiliation(s)
- David V Erickson
- Psychology Services, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.
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