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Johansen S, Andersen GL, Lydersen S, Kalleson R, Hollung SJ. Use of primary health care services among children and adolescents with cerebral palsy. Dev Med Child Neurol 2024; 66:1234-1243. [PMID: 38321621 DOI: 10.1111/dmcn.15879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
AIM To investigate the use of general practitioners and urgent care centres (UCC) among children and adolescents with cerebral palsy (CP) compared to a control group, and per gross motor function level. METHOD Data on children with CP born 1996 to 2014 were collected from the Norwegian Quality and Surveillance Registry for Cerebral Palsy. A control group was extracted from Statistics Norway. The date and diagnosis codes for general practitioner and UCC contacts from 2006 to 2015 were collected from the Norwegian Control and Payment of Health Reimbursement Database. Incidence rate ratios (IRR) for the number of contacts per person-year with 95% confidence intervals (CI) were calculated using Poisson regression. Risk differences with 95% CI were used to compare cumulative diagnosis incidences between children with CP and the control group. RESULTS The study included 2510 children (1457 males; 58.1%) with CP and 12 041 (7003 males; 58.2%) without CP (mean age in both groups 7 years 2 months, SD 4 years 8 months, range 0-19 years), with 336 250 contacts. Children with CP had more general practitioner (IRR 1.47; 95% CI 1.29-1.67) and UCC (IRR 1.30; 95% CI 1.13-1.50) contacts than children without CP, for all ages. IRRs remained unchanged when comparing children with CP in Gross Motor Function Classification System (GMFCS) levels I and II to children without CP. Among children with CP, contact increased as GMFCS levels increased, and they were in contact most often for respiratory and general and unspecified diagnoses. The risk for epilepsy was highest for those in contact with general practitioners. INTERPRETATION Children with CP, including those with less severe motor impairments, contacted general practitioners and UCCs more than children without CP. However, contact increased as gross motor impairment increased. They had contact for many diagnoses, mostly respiratory.
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Affiliation(s)
- Stine Johansen
- Habilitation Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Guro L Andersen
- Habilitation Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy, Vestfold Hospital Trust, Tønsberg, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Runa Kalleson
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Sandra Julsen Hollung
- Norwegian Quality and Surveillance Registry for Cerebral Palsy, Vestfold Hospital Trust, Tønsberg, Norway
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Xie Y, Wu J, Li Y, Liu H, Peng Y, Zhou P, Sun Y, Kang L, Jiang C, Wu H. Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review. Interact J Med Res 2024; 13:e50047. [PMID: 39110502 PMCID: PMC11339577 DOI: 10.2196/50047] [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: 06/18/2023] [Revised: 02/08/2024] [Accepted: 05/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. OBJECTIVE This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. METHODS A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. RESULTS The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. CONCLUSIONS Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.
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Affiliation(s)
- Yijun Xie
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yanyan Peng
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Ping Zhou
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Yizhou Sun
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Luyan Kang
- Office of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| | - Chenghua Jiang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Paget SP, Mcintyre S, Schneuer FJ, Martin T, Sellars L, Burnett H, Price S, Nassar N. Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy. Dev Med Child Neurol 2024; 66:733-743. [PMID: 37946594 DOI: 10.1111/dmcn.15800] [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] [Received: 04/23/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
AIM To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). METHOD In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). RESULTS Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). INTERPRETATION Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. WHAT THIS PAPER ADDS Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.
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Affiliation(s)
- Simon P Paget
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah Mcintyre
- Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
| | - Tanya Martin
- School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sellars
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Heather Burnett
- HNEkidsHealth, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Price
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Ostojic K, Karem I, Paget SP, Berg A, Dee-Price BJ, Lingam R, Dale RC, Eapen V, Woolfenden S. Social determinants of health for children with cerebral palsy and their families. Dev Med Child Neurol 2024; 66:32-40. [PMID: 37179527 DOI: 10.1111/dmcn.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Social determinants of health (SDH) influence health and social outcomes in positive and negative ways. Understanding the impact of SDH on children with cerebral palsy (CP) is essential to improve health equity, optimize health outcomes, and support children with CP and their families to thrive in society. In this narrative review, we summarize the landscape of SDH impacting children with CP and their families worldwide. In high-income countries, children from poorer neighbourhoods are more likely to have severe comorbidities, present with spastic bilateral CP, and report lower frequency of participation in community activities. In low- and middle-income countries, socioeconomic disadvantage is associated with increased risk of malnutrition, living in poorer housing conditions, not having access to proper sanitation, and living below the poverty line. Low maternal education is associated with increased likelihood of the child with CP experiencing increased severity of gross motor and bimanual functioning challenges, and poorer academic performance. Lower parental education is also associated with reduced child autonomy. On the other hand, higher parental income is a protective factor, associated with greater diversity of participation in day-to-day activities. A better physical environment and better social support are associated with higher participation in daily activities. Clinicians, researchers, and the community should be aware of these key challenges and opportunities. Then adopt a range of approaches that target adverse SDH/social needs and foster positive SDH in the clinical setting. WHAT THIS PAPER ADDS: Understanding how social determinants of health influence health and social outcomes is a critical step towards improving health equity and outcomes. Approaches are required that target the impact of adverse SDH on access to health care for children with cerebral palsy and that work towards ensuring equity of access for all.
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Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Isra Karem
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Alison Berg
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Betty-Jean Dee-Price
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Russell C Dale
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Neurology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Valsamma Eapen
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Lower Respiratory Tract Infections in Pediatric Patients with Severe Neurological Impairments: Clinical Observations and Perspectives in a Palliative Care Unit. CHILDREN 2022; 9:children9060852. [PMID: 35740789 PMCID: PMC9221664 DOI: 10.3390/children9060852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
Pediatric palliative care (PPC) patients with a severe neurologic impairment (SNI) suffer considerable morbidity and increased mortality from lower respiratory tract infections (LRTIs). The indication and choice of antibiotic therapy for bacterial LRTIs are often challenging given the lack of evidence-based treatment recommendations for this vulnerable patient population. We conducted an observational study before the SARS-CoV-2 pandemic in an eight-bed pediatric palliative care inpatient unit. During two years of surveillance, we diagnosed and treated 33 cases of a bacterial LRTI in patients with an SNI; 5 patients were hospitalized with an LRTI more than once. Two patients died from complications due to LRTIs during hospitalization. Three patients (15%) were colonized with multidrug-resistant organisms. An initial antibiotic treatment failed in one-third of the cases; a successful therapy of the LRTI was achieved with broad-spectrum and extended-spectrum penicillins (n = 13; in combination with β-lactamase inhibitors for n = 5 cases), cephalosporins (n = 13: n = 4 second-generation and n = 9 third-generation cephalosporins; in combination with other substances for n = 5 cases), ciprofloxacin (n = 3), and meropenem plus vancomycin (n = 2) or meropenem (n = 1). A respiratory specimen was obtained in 66.7% of cases with P. aeruginosa, E. coli, and K. pneumoniae accounting for the majority of the detected species. In most cases, there was no definite confirmation that the LRTI was caused by the species detected. The diagnostics and treatment of bacterial LRTIs in PPC patients with an SNI are challenging. The lack of controlled studies and the heterogeneity of this population often necessitate an individual approach. This lack of controlled studies may partly be compensated by a set of diagnostic and antibiotic stewardship criteria.
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Acceptability and feasibility of a vestibular nerve stimulation headset protocol in children with cerebral palsy. BMC Pediatr 2022; 22:34. [PMID: 35016677 PMCID: PMC8750849 DOI: 10.1186/s12887-021-03093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Research suggests electrical Vestibular Nerve Stimulation (VeNS) may improve balance for people with neurological impairments. This study aimed to assess the feasibility and acceptability of a VeNS headset protocol in children with cerebral palsy (CP). Methods Children aged 5–18 years with ambulant CP, their parents, and healthcare professionals were recruited via social media. Children completed a battery of balance tests and wore a sham VeNS headset one hour per day for four weeks. Perspectives on the balance tests and headset were ascertained from children, parents and healthcare professionals using semi-structured interviews. Interview data were analysed thematically. Results Two families and four healthcare professionals participated. Balance outcome measures were fully completed and deemed acceptable. Adherence with wearing the headset was 89–100% but discomfort with self-adhesive electrodes was reported. Four themes emerged from interview data: headset issues, perceptions about VeNS, the importance of balance, and modifications for future study. Conclusions Although the VeNS headset had high acceptability, the volunteer sample was small, potentially suggesting limited interest in VeNS as a treatment for children with CP, or reluctance to trial a ‘non-active’ headset. Recruitment via clinicians known to the family and use of an ‘active’ headset may increase participation in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03093-1.
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Schraeder K, Allemang B, Felske AN, Scott CM, McBrien KA, Dimitropoulos G, Samuel S. Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review. J Prim Care Community Health 2022; 13:21501319221084890. [PMID: 35323055 PMCID: PMC8961382 DOI: 10.1177/21501319221084890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Ongoing primary care during adolescence is recommended by best practice
guidelines for adolescents and young adults (AYAs; ages 12-25) with chronic
conditions. A synthesis of the evidence on the roles of Primary Care
Physicians (PCPs) and benefits of primary care is needed to support existing
guidelines. Methods: We used Arksey and O’Malley’s scoping review framework, and searched
databases (MEDLINE, EMBASE, PsychINFO, CINAHL) for studies that (i) were
published in English between 2004 and 2019, (ii) focused on AYAs with a
chronic condition(s) who had received specialist pediatric services, and
(iii) included relevant findings about PCPs. An extraction tool was
developed to organize data items across studies (eg, study design,
participant demographics, outcomes). Results: Findings from 58 studies were synthesized; 29 (50%) studies focused
exclusively on AYAs with chronic health conditions (eg, diabetes, cancer),
while 19 (33%) focused exclusively on AYAs with mental health conditions.
Roles of PCPs included managing medications, “non-complex” mental health
conditions, referrals, and care coordination, etc. Frequency of PCP
involvement varied by AYAs; however, female, non-Black, and older AYAs, and
those with severe/complex conditions appeared more likely to visit a PCP.
Positive outcomes were reported for shared-care models targeting various
conditions (eg, cancer, concussion, mental health). Conclusion: Our findings drew attention to the importance of effective collaboration
among multi-disciplinary specialists, PCPs, and AYAs for overcoming multiple
barriers to optimal transitional care. Highlighting the need for further
study of the implementation of shared care models to design strategies for
care delivery during transitions to adult care.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Ashley N Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cathie M Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Paget S, Ostojic K, Goldsmith S, Nassar N, McIntyre S. Determinants of hospital-based health service utilisation in cerebral palsy: a systematic review. Arch Phys Med Rehabil 2021; 103:1628-1637. [PMID: 34968439 DOI: 10.1016/j.apmr.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review and synthesize evidence of determinants associated with hospital-based health service utilisation among individuals with cerebral palsy (CP). DATA SOURCES Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020. STUDY SELECTION Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilisation (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilisation. DATA EXTRACTION After initial screen, two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle Ottawa scale. Determinants of health service utilisation were identified and categorised using the Andersen Behavioural Model. DATA SYNTHESIS Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across eight Andersen Model characteristics. Individual predisposing factors such as sex showed no difference in health service utilisation; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilisation was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants. CONCLUSIONS CP health service utilisation was associated with age, severity and comorbidities. Improved understanding of determinants of health service utilisation can support health service access for people with CP.
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Affiliation(s)
- Simon Paget
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Kids Rehab, the Children's Hospital at Westmead, Westmead NSW Australia.
| | - Katarina Ostojic
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Children's Health Ireland at Crumlin, Dublin, Ireland
- Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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McKinnon C, White J, Morgan P, Harvey A, Clancy C, Fahey M, Antolovich G. Clinician Perspectives of Chronic Pain Management in Children and Adolescents with Cerebral Palsy and Dyskinesia. Phys Occup Ther Pediatr 2021; 41:244-258. [PMID: 33251932 DOI: 10.1080/01942638.2020.1847236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To explore perspectives of clinicians from interdisciplinary teams on the barriers and facilitators to chronic pain management for children and adolescents with cerebral palsy and dyskinesia. METHODS Interdisciplinary focus groups (n = 2) were conducted at two Australian tertiary pediatric hospitals. Twenty-five experienced clinicians took part, including ten physiotherapists, six pediatricians, four rehabilitation physicians, four occupational therapists, and one speech and language therapist. An external moderator conducted the focus groups and data were analyzed using inductive thematic analysis. RESULTS Four key themes emerged: "balancing the intersection of pain and dyskinesia," "difficulty communicating between so many providers," "uncertainty surrounding chronic pain education," and "differing priorities." Key barriers were identified including a lack of access to some interdisciplinary team members and formalized guidance for health professionals regarding chronic pain education. CONCLUSION Key issues were reported to impact the delivery of coordinated inter-disciplinary chronic pain management at the tertiary level for children and adolescents with cerebral palsy and dyskinesia. In the absence of strong evidence, a strategy for implementing effective chronic pain management for children and adolescents with cerebral palsy and dyskinesia and gaining clinician consensus regarding the best practice management are recommended.
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Affiliation(s)
- Clare McKinnon
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer White
- Melbourne Ageing Research, National Aging Research Institute, Royal Melbourne Hospital, Victoria, Australia
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Adrienne Harvey
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neurodevelopment & Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Catherine Clancy
- Victorian Peadiatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Michael Fahey
- Victorian Peadiatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Giuliana Antolovich
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neurodevelopment & Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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11
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Pérez-Ardanaz B, Morales-Asencio JM, León-Campos Á, Kaknani-Uttumchandani S, López-Leiva I, Garcia-Piñero JM, Martí-García C, García-Mayor S. Quality of Life and Health Services Utilization for Spanish Children With Cerebral Palsy. J Pediatr Nurs 2020; 53:e121-e128. [PMID: 32201113 DOI: 10.1016/j.pedn.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the health-related quality of life of children with cerebral palsy and its relationship with their use of health resources, taking into account sociodemographic factors concerning the family context. DESIGN AND METHODS Cross-sectional study of children with cerebral palsy in Granada (Spain). Quality of life was evaluated with PedsQL questionnaire. RESULTS A total of 75 children were analysed (mean age 7.41 years; SD 4.37; 50.7% male). They made an average of 22.80 visits (SD 12.43) per year; greater use was made of resources by children who had been diagnosed with cerebral palsy for <45 months (36.00 vs. 26.93 visits per year, p < 0.0001). Older children suffered more fatigue and pain. Children aged 2-4 years who presented with fatigue had more hospitalizations (r = -0.35; p = 0.20), whereas those >4 years who had a higher quality of life for daily activities had made more visits to hospital A&E (r = 0.35, p = 0.043). Among the children studied, there was no significant association between HRQOL and the parents' education or occupation. CONCLUSION These findings highlight variables that may influence children's quality of life and their use of health resources, identifying certain profiles of children who might need individualized interventions. PRACTICE IMPLICATIONS These findings could inform services provided by paediatric nurses to children with cerebral palsy, to individualize interventions and improve patient centred care.
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Affiliation(s)
| | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain.
| | - Álvaro León-Campos
- Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Shakira Kaknani-Uttumchandani
- Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Inmaculada López-Leiva
- Universidad de Málaga, Faculty of Health Sciences, Spain; Hospital Materno-Infantil de Málaga, Spain
| | - José Miguel Garcia-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Spain; Hospital Materno-Infantil de Málaga, Spain
| | | | - Silvia García-Mayor
- Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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12
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Bartlett DJ, Gorter JW, Jeffries LM, Avery L, Hanna SE. Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy. Dev Med Child Neurol 2019; 61:469-476. [PMID: 30353544 DOI: 10.1111/dmcn.14080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
AIM First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels. METHOD A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression. RESULTS Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed. INTERPRETATION Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities. WHAT THIS PAPER ADDS For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.
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Affiliation(s)
- Doreen J Bartlett
- School of Physical Therapy, Western University, London, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Lynn M Jeffries
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lisa Avery
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Avery Information Services Ltd., Orillia, ON, Canada
| | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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13
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Do children with neurological disabilities use more inpatient resources: an observational study. Emerg Themes Epidemiol 2017; 14:5. [PMID: 28465710 PMCID: PMC5408490 DOI: 10.1186/s12982-017-0059-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 04/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background Advances in healthcare have improved the survival of children with neurological disabilities (ND). Studies in the US have shown that children with ND use a substantial proportion of resources in children’s hospitals, however, little research has been conducted in the UK. We aimed to test the hypothesis that children with neurological disabilities use more inpatient resources than children without neurological disabilities, and to quantify any significant differences in resource use. Methods
A retrospective observational study was conducted, looking at the number of hospital admissions, total inpatient days and the reason for admissions for paediatric inpatients from January 1st to March 31st 2015. Inpatients were assigned into one of three groups: children without ND, children with one ND, and children with more than one ND. Results The sample population included 942 inpatients (mean age 6y 6mo). Children with at least one ND accounted for 15.3% of the inpatients, 17.7% of total hospital inpatient admission episodes, and 27.8% of the total inpatients days. Neurological disability had a statistically significant effect on total hospital admissions (p < 0.001). Neurological disability also had a statistically significant effect on total inpatient days (p < 0.001). Neurological disability increased the length of inpatient stay across medicine, specialties, and surgery. Conclusions Children with ND had more frequent hospital admission episode and longer inpatient stays. We identified a smaller group within this population, with arguably more complex neurological disabilities, children with more than one ND. This group had the highest number of admissions and longest inpatient stays. More frequent hospital admissions and longer inpatient stays may place children with ND at greater risk of the adverse effects of hospitalisations. We recommend further investigations looking at each the effects of the different categories of ND on inpatient resource use, and repeat of this study at a national level and over a longer period of time.
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