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Brown A, Tornberg ÅB, Kristensson Hallström I. Parents' lived experience of early risk assessment for cerebral palsy in their young child using a mobile application after discharge from hospital in the newborn period. Ann Med 2024; 56:2309606. [PMID: 38300887 PMCID: PMC10836479 DOI: 10.1080/07853890.2024.2309606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore parents' lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period. METHODS An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans' lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents' lived experience. RESULTS The overall understanding of the parents' experience was 'Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future. CONCLUSIONS The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.
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Affiliation(s)
- Annemette Brown
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Pediatrics and Adolescence Medicine, Nordsjælland University Hospital, Capital Region of Denmark, Denmark
- Department of Neurology and Physiotherapy, Nordsjællands Hospital, Capital Region of Denmark, Denmark
| | - Åsa B. Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Williams SA, Nakarada-Kordic I, Mackey AH, Reay S, Stott NS. Prioritized strategies to improve diagnosis and early management of cerebral palsy for both Māori and non-Māori families. Dev Med Child Neurol 2024; 66:1074-1083. [PMID: 38236645 DOI: 10.1111/dmcn.15847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 07/05/2024]
Abstract
AIM To identify prioritized strategies to support improvements in early health service delivery around the diagnosis and management of cerebral palsy (CP) for both Māori and non-Māori individuals. METHOD Using a participatory approach, health care professionals and the parents of children with CP attended co-design workshops on the topic of early diagnosis and management of CP. Health design researchers facilitated two 'discovery' (sharing experiences and ideas) and two 'prototyping' (solution-focused) workshops in Aotearoa, New Zealand. A Māori health service worker co-facilitated workshops for Māori families. RESULTS Between 7 and 13 participants (14 health care professionals, 12 parents of children with CP across all functional levels) attended each workshop. The discovery workshops revealed powerful stories about early experiences and needs within clinician-family communication and service provision. The prototyping workshops revealed priorities around communication, and when, what, and how information is provided to families; recommendations were co-created around what should be prioritized within a resource to aid health care navigation. INTERPRETATION There is a critical need for improved communication, support, and guidance, as well as education, for families navigating their child with CP through the health care system. Further input from families and health care professionals partnering together will continue to guide strategies to improve health care service delivery using experiences as a mechanism for change.
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Affiliation(s)
- Sian A Williams
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Anna H Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Stephen Reay
- Good Health Design, Auckland University of Technology, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Adde L, Åberg KB, Fjørtoft T, Grunewaldt KH, Lade R, Osland S, Piegsa F, Sandstrøm PG, Støen R, Størvold GV, Eriksen BH. Implementation of remote general movement assessment using the in-motion instructions in a high-risk norwegian cohort. BMC Pediatr 2024; 24:442. [PMID: 38987721 PMCID: PMC11234780 DOI: 10.1186/s12887-024-04927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND General Movement Assessment (GMA) is recommended for early detection of risk for cerebral palsy but requires trained clinical experts. We aimed to implement home- and hospital-based filming for remote GMA in a Norwegian high-risk infant cohort, as well as evaluating parents' experiences in filming their infant at home. METHODS This knowledge translational study used a prospective cohort design including participants referred to neurodevelopmental follow-up across three sites in the Central Norway Regional Health Authority. Two home films of the fidgety type of general movements were collected between 12+1-14+6 and 15+1-17+6 weeks after term by parents. An additional film was collected at the hospital between 12+1 and 17+6 weeks after term. The instructional guide for all filming was the In-Motion App standards. Videos were transferred to a remote GMA team and classified as either "GMA scorable" or "GMA not scorable" based on Prechtl's GMA standards. Parents responded to an online survey using a 5-point Likert scale to collect information about their perspectives, experiences, and possible worries by filming their infant at home. RESULTS One-hundred-and-two infants from 95 families participated. Ninety-two (96.8%) families transferred 177 home-based videos. Eighty-four (92%) of these had 95 videos taken in their local hospital. All 177 home-videos were "GMA scorable" and three (3,1%) out of 95 hospital-based videos were classified as "GMA not scorable". Eight families did not respond to the survey and two families did not receive the survey due to a technical error. Seventy-eight (91.7%) respondents agreed or strongly agreed that it was easy to perform home filming and five (5.9%) agreed that they were more worried about their child`s development after filming at home. Almost 80% of respondents agreed that a video for GMA can be taken at home instead of in hospital. CONCLUSIONS This study strengthens the clinical implementation of home filming by parents and remote GMA for early detection of CP in high-risk follow-up programs. The implementation of remote GMA has the potential to facilitate early intervention to improve function in children with CP in line with international recommendations. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04287166 Date of registration: 27/02/2020.
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Affiliation(s)
- Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | | | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristine Hermansen Grunewaldt
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Lade
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Siril Osland
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Frank Piegsa
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | | | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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McNAMARA LM, Scott KM, Boyd RN, Webb AE, Taifalos CJ, Novak IE. Effectiveness of early diagnosis of cerebral palsy guideline implementation: a systematic review. Minerva Pediatr (Torino) 2024; 76:414-424. [PMID: 37021615 DOI: 10.23736/s2724-5276.22.07112-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Tailored implementation interventions are required to overcome the diagnostic research-practice gap for cerebral palsy (CP). Evaluating the impact of interventions on patient outcomes is a priority. This review aimed to summarize the established evidence for the effectiveness of guideline implementations in lowering the age of CP diagnosis. EVIDENCE ACQUISITION A systematic review was conducted according to PRISMA. CINAHL, Embase, PubMed and MEDLINE were searched (2017-October 2022). Inclusion criteria were studies that evaluated effect of CP guideline interventions on health professional behaviour or patient outcomes. GRADE was used to determine quality. Studies were coded for use of theory (Theory Coding Scheme). Meta-analysis was performed and a standardized metric used to summarize statistics of intervention effect estimates. EVIDENCE SYNTHESIS Of (N.=249) records screened, (N.=7) studies met inclusion, comprising interventions following infants less than 2 years of age with CP risk factors (N.=6280). Guideline feasibility in clinical practice was established through health professional adherence and patient satisfaction. Efficacy of patient outcome of CP diagnosis by 12 months of age was established in all studies. Weighted averages were: (1) high-risk of CP (N.=2) 4.2 months and (2) CP diagnosis (N.=5) at 11.6 months. Meta-analysis of (N.=2) studies found a large, pooled effect size Z = 3.00 (P=0.003) favoring implementation interventions lowering age of diagnosis by 7.50 months, however study heterogeneity was high. A paucity of theoretical frameworks were identified in this review. CONCLUSIONS Multifaceted interventions to implement the early diagnosis of CP guideline are effective in improving patient outcomes by lowering the age of CP diagnosis in high-risk infant follow-up clinics. Further targeted health professional interventions including low-risk infant populations are warranted.
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Affiliation(s)
- Lynda M McNAMARA
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia -
| | - Karen M Scott
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Annabel E Webb
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chloe J Taifalos
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Iona E Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Rawnsley KL, Doyle LW, Anderson PJ, Olsen JE, Kwong AKL, Mainzer RM, Josev EK, Roberts G, Spittle AJ, Cheong JLY. Parent screening questionnaires to detect cognitive and language delay at 2 years in high-risk infants: an analysis from the Victorian Infant Collaborative Study 2016-2017 cohort. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326618. [PMID: 38604647 DOI: 10.1136/archdischild-2023-326618] [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: 11/13/2023] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To determine the accuracy of two developmental screening questionnaires to detect cognitive or language delay, defined using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), in children born extremely preterm (EP: <28 weeks' gestation) or extremely low birth weight (ELBW: <1000 g). DESIGN Prospective cohort study. SETTING State of Victoria, Australia. PATIENTS 211 infants born EP/ELBW assessed at 2 years' corrected age (mean 2.2, SD 0.2). MAIN OUTCOME MEASURES Cognitive and language delay (<-1 SD) on the Bayley-III. The screening questionnaires were the Parent Report of Children's Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3). RESULTS The PARCA-R performed better than the ASQ-3, but neither questionnaire had substantial agreement with the Bayley-III to detect cognitive delay; kappa (95% CI): PARCA-R 0.43 (0.23, 0.63); ASQ-3 0.15 (-0.05, 0.35); sensitivity (95% CI): PARCA-R 70% (53%, 84%) ASQ-3 62% (47%, 76%); specificity (95% CI): PARCA-R 73% (60%, 84%) ASQ-3 53% (38%, 68%). When both tools were used in combination (below cut-off on at least one assessment), sensitivity increased to 78% (60%, 91%) but specificity fell to 45% (29%, 62%). Similar trends were noted for language delay on the Bayley-III, although kappa values were better than for cognitive delay. CONCLUSIONS Neither screening questionnaire identified cognitive delay well, but both were better at identifying language delay. The PARCA-R detects delay on the Bayley-III more accurately than the ASQ-3. Sensitivity for detecting delay is greatest when the PARCA-R and ASQ-3 were used in combination, but resulted in lower specificity.
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Affiliation(s)
- Kate L Rawnsley
- Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Joy E Olsen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Amanda K L Kwong
- Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rheanna M Mainzer
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elisha K Josev
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gehan Roberts
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Badawi N, Novak I, Morgan C, Crowle C. Early detection of cerebral palsy using general movements assessment and MRIs - a sensible way forward. Pediatr Res 2024; 95:1191-1192. [PMID: 38167645 DOI: 10.1038/s41390-023-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Nadia Badawi
- The Children's Hospital Westmead, Hawkesbury Rd, Westmead, NSW, 2145, Australia
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, PO Box 171, Allambie Heights, NSW, 2100, Australia
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia
| | - Cathryn Crowle
- The Children's Hospital Westmead, Hawkesbury Rd, Westmead, NSW, 2145, Australia.
- University of Sydney, Faculty of Medicine and Health, Campderdown, NSW, 2006, Australia.
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Fortune A, Perkins E, Paize F, Palanisami B, Gladstone M. Managing mothers' and fathers' uncertainty during their journey through early neurodevelopmental follow-up for their high-risk infants-A qualitative account. Child Care Health Dev 2024; 50:e13168. [PMID: 37737651 DOI: 10.1111/cch.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early diagnosis of cerebral palsy is possible by 5 months corrected age for 'at-risk' infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of appropriate information and support is essential. AIM To explore parents' views and experiences in relation to the new early neurodevelopmental follow-up of 'at-risk' infants. METHODS Thirteen in-depth one-to-one qualitative interviews were conducted by the primary researcher, with eight parents (six mothers and two fathers) of 'at-risk' infants eligible for a follow-up clinic where the GMA and HINE were performed at 12-week corrected age. Interviews used a pre-piloted topic guide and took place before and after the clinic. Interviews were audio-recorded, transcribed verbatim and analysed using inductive coding and thematic analysis using the framework approach. FINDINGS Seven themes were identified: (1) attempting to manage uncertainty, (2) taking priority, (3) trusting professionals, (4) independence in the parent role, (5) feeling understood, (6) patterns of care and (7) individuality. Parents reported experiencing uncertainty about their current situation and future. Adequate preparation for and timing of information are vital. When uncertainty is poorly managed, parents' wellbeing suffers. Individual parents' perspectives and infants' developmental trajectories differ, and information should be tailored specifically for this. CONCLUSION A parent's understanding of the journey through neurodevelopmental care for their high risk infants is initially very limited. Implementing a counselling service for parents to access psychological support and digital reminder system for clinic appointments, as well as providing more tailored information through trusted professionals, could all improve future parents' experiences.
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Affiliation(s)
- Alice Fortune
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, Institute of Population Health, Liverpool, UK
| | - Fauzia Paize
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - Melissa Gladstone
- Department Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Kim F, Maitre N. A Call for Early Detection of Cerebral Palsy. Neoreviews 2024; 25:e1-e11. [PMID: 38161182 DOI: 10.1542/neo.25-1-e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Cerebral palsy (CP) is the most common physical disability across the lifespan, but historically, CP has not been diagnosed before the age of 2 years. Barriers to early diagnosis ranged from lack of available biomarkers, absence of curative treatments, perceived stigma associated with a lifelong diagnosis, and a desire to rule out other diagnoses first. Most importantly, the fundamental question that remained was whether children would benefit from earlier detection and intervention given the paucity of research. However, evidence-based guidelines published in 2017 demonstrated that the General Movements Assessment, the Hammersmith Infant Neurological Examination, and neuroimaging can be combined with other elements such as a clinical history and standardized motor assessments to provide the highest predictive value for diagnosing CP as early as age 3 months in high-risk newborns. Implementation of these guidelines has been successful in decreasing the age at CP diagnosis, particularly in high-risk infant follow-up clinics with expertise in performing these assessments. Early detection of CP allows for clinical and research opportunities investigating earlier interventions during a critical period of neuroplasticity, with the goal of improving developmental trajectories for children and their families. New guidelines and research are now being developed with a focus on early, targeted interventions that continue to be studied, along with global detection initiatives.
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Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Children's Hospital of New York, New York, NY
| | - Nathalie Maitre
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Pettinger KJ, Copper C, Boyle E, Blower S, Hewitt C, Fraser L. Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis. Pediatrics 2023; 152:e2023061878. [PMID: 37946609 PMCID: PMC10657778 DOI: 10.1542/peds.2023-061878] [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] [Accepted: 08/23/2023] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.
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Affiliation(s)
| | | | - Elaine Boyle
- University of Leicester, Leicester, United Kingdom
| | | | | | - Lorna Fraser
- University of York, York, United Kingdom
- King’s College London, London, United Kingdom
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Wege M, von Blanckenburg P, Maier RF, Knoeppel C, Grunske A, Seifart C. Do parents get what they want during bad news delivery in NICU? J Perinat Med 2023; 51:1104-1111. [PMID: 37336635 DOI: 10.1515/jpm-2023-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Little is known about parents' preferences in breaking bad news (BBN) in neonatology. The study was aimed at comparing parents' experiences with their first BBN discussion with a neonatologist/pediatric surgeon to their personal preferences. METHODS We conducted a quantitative survey amongst 54 parents of hospitalized preterm or term infants with severe diseases in two medium-size and one small German neonatal units. Parents answered self-rated questions on how they perceived BBN during their infant's hospital stay, asking for procedure and perception of BBN, their preferences and satisfaction with BBN. RESULTS Overall satisfaction with BBN was moderate to high (median (min-max): 8 (1-10) on a 1-10-Likert scale). A compassionate way of disclosure correlated highest with overall satisfaction with BBN. Thorough transmission of information in an easy to understand manner emerged as another crucial point and correlated significantly to satisfaction with BBN, too. The study revealed that it was highly important for parents, that physicians had good knowledge of the infant and the course of his/her disease, which was only met in a minority of cases. Moreover, there was a major discrepancy between expected and observed professional competence of the delivering physicians. Additionally, physicians did not set aside sufficient time for BBN and parents reported a lack of transporting assurance and hope. CONCLUSIONS In BBN physicians should draw greatest attention to ensure understanding in parents, with good knowledge of child and disease and sufficient time in a trustworthy manner. Physicians should focus on transporting competence, trust and gentleness.
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Affiliation(s)
- Mirjam Wege
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Carmen Knoeppel
- Children's Hospital, Hospital Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | | | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, Marburg, Germany
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Wege M, von Blanckenburg P, Maier RF, Seifart C. Does Educational Status Influence Parents' Response to Bad News in the NICU? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1729. [PMID: 38002820 PMCID: PMC10670369 DOI: 10.3390/children10111729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Communication in neonatal intensive care units and the relationship between families and staff have been reported to influence parental mental well-being. Research has also shown an impact of parental educational level on their well-being. However, whether different educational levels result in different reactions to breaking bad news (BBN) by physicians remains unanswered so far. We therefore examined the impact of parental level of education on their mental state after a BBN conversation and their relation to physicians. A prospective quantitative survey was conducted amongst 54 parents whose preterm or term infants were hospitalized in three German neonatal units. Parental education was classified as low (lower secondary/less (1), n: 23) or high (higher secondary/more (2), n: 31). Parents answered questions about certain aspects of and their mental state after BBN and their trust in physicians. The two groups did not differ significantly in their mental condition after BBN, with both reporting high levels of exhaustion and worries, each (median (min;max): (1): 16 (6;20) vs. (2): 14 (5;20), (scaling: 5-20)). However, lower-educated parents reported a lower trust in physicians (median (min;max): (1): 2 (0;9) vs. (2): 1 (0;6), p < 0.05 (scaling: 0-10)) and felt less safe during BBN (median (min;max): (1): 15 (9;35) vs. (2): 13 (9;33), p < 0.05). Only among higher-educated parents was trust in physicians significantly correlated with the safety and orientation provided during BBN (r: 0.583, p < 0.05, r: 0.584, p < 0.01). Concurrently, only among less-educated parents was safety correlated with the hope conveyed during BBN (r: 0.763, p < 0.01). Therefore, in BBN discussions with less-educated parents, physicians should focus more on giving them hope to promote safety.
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Affiliation(s)
- Mirjam Wege
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany;
| | - Rolf Felix Maier
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, 35033 Marburg, Germany;
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12
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Magoulas PL. Supporting Parents Throughout the Genetic Testing Process and New Diagnosis. Pediatr Clin North Am 2023; 70:917-928. [PMID: 37704350 DOI: 10.1016/j.pcl.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Receiving a genetic diagnosis can be challenging for parents as they learn to cope and adapt to this news. They often experience a myriad of emotions ranging from shock to relief. Yet overwhelmingly, parents report a negative experience with this process. Factors that improve parental satisfaction include being provided written information, emotional and psychosocial support, and connections with other parents. Genetics care providers are particularly equipped to solicit parental needs and provide support before, during, and after receiving a diagnosis. This review will provide suggestions and recommendations for supporting parents throughout the diagnostic testing experience and receiving a genetic diagnosis.
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Affiliation(s)
- Pilar L Magoulas
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
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13
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Jawed A, Mowry M. Strengthening Equitable Access to Care and Support for Children with Cerebral Palsy and Their Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:994. [PMID: 37371227 DOI: 10.3390/children10060994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cerebral palsy is one of the most prevalent groups of motor disorders affecting children and adults across the world. As increasingly more children with cerebral palsy are living longer into adulthood, it is ever more crucial to ensure access to timely and needed early intervention from the onset of diagnosis, on a continuum, to optimize medical, developmental, socio-emotional, and academic outcomes for these children over time. The American Academy of Pediatrics (AAP), in collaboration with the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM), substantially revised the clinical practice guidelines for cerebral palsy in 2022, after their prior publication of the guidelines in 2006. The revised guidelines account for a range of considerations that are in line with the biopsychosocial, risk and resilience, and family-centered care models as well as promote a more strengths-based approach to care. Furthermore, there is increased emphasis in the guidelines on promoting equitable access to care as part of contributing towards health equity for all children with cerebral palsy. In addition, the 2022 guidelines clearly present recommendations for earlier diagnosis of cerebral palsy, potentially as early as infancy, as the basis for activating access to early intervention services for children that can bolster their neuroplasticity and global development from an earlier age onward. We consolidate the existing literature on caregiver perceptions, beliefs and concerns surrounding earlier diagnosis of cerebral palsy and connect them to the recommendations in the revised guidelines. We also delineate several considerations surrounding education for healthcare providers and caregivers of children in navigating the chronicity of cerebral palsy in both community and healthcare contexts. There is a scant amount of literature on cerebral palsy across traditional and nontraditional sources of media in published studies, which we also review. Lastly, we present a wealth of recommendations for further research and practice that account for the revised 2022 guidelines, caregiver preferences and acceptability of care, and health equity as the bases for strengthening equitable access to care for children with cerebral palsy on a continuum as they transition into adulthood.
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Affiliation(s)
- Aysha Jawed
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Social Work, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
| | - Michelle Mowry
- Johns Hopkins Children's Center, Baltimore, MD 21287, USA
- Department of Pediatric Nursing, Johns Hopkins Children's Center, Baltimore, MD 21287, USA
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14
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Mendoza-Sengco P, Lee Chicoine C, Vargus-Adams J. Early Cerebral Palsy Detection and Intervention. Pediatr Clin North Am 2023; 70:385-398. [PMID: 37121632 DOI: 10.1016/j.pcl.2023.01.014] [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: 05/02/2023]
Abstract
Early identification of cerebral palsy (CP) facilitates optimal care, support, and outcomes for children and their families. Ideally, infants with risk factors or developmental deviations should be evaluated early using standardized assessments of neurodevelopment and brain imaging. If a diagnosis of CP or high risk for CP (HRCP) is established, specialized, evidence-informed therapy and family support should be initiated. With task-specific motor skill training and an enriched environment, infants with CP show greater gross motor and cognitive gains. These enhanced outcomes are only achievable with early diagnosis and subsequent intervention.
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Affiliation(s)
- Paola Mendoza-Sengco
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA.
| | - Caitlin Lee Chicoine
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
| | - Jilda Vargus-Adams
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
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15
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Mayo Pais ME, Real Deus JE, Iglesias-Souto PM, Taboada-Ares EM. Flashbulb Memories in the Communication of the Diagnosis of Visual Impairment: The Effect of Context and Content. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050881. [PMID: 37238429 DOI: 10.3390/children10050881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
The diagnosis of a child's visual impairment is remembered vividly and intensely by their parents. However, the way in which the diagnosis is communicated may affect the development and persistence of this memory. The aim of this study is to analyze the circumstances in which the first news of the diagnosis of visual impairment in children is given and whether the memory of this event persists over time leading to a flashbulb memory. A longitudinal study was carried out with the participation of 38 mothers. Data were collected on sociodemographics, clinical variables, circumstances surrounding the communication of the diagnosis, and the degree of agreement of the information in the two phases of the research. The diagnosis was, on the whole, given to both parents at the same time, in medical language and with little tact, generally in the office of an ophthalmologist. The mothers would have preferred to have received the news in a different way, and the existence of a flashbulb memory is confirmed, more dependent on the context in which the diagnosis was given and its content than on sociodemographic and clinical factors. The way in which the first news of such a diagnosis is given plays a significant role in how it is remembered. Therefore, an improvement in medical practice regarding the communication of such diagnoses is recommended.
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Affiliation(s)
- Mª Emma Mayo Pais
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago, Spain
| | - José Eulogio Real Deus
- Department of Social, Basic and Methodological Psychology, University of Santiago de Compostela, 15782 Santiago, Spain
| | - Patricia Mª Iglesias-Souto
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago, Spain
| | - Eva Mª Taboada-Ares
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago, Spain
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16
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Implementation of Early Detection and Intervention for Cerebral Palsy in High-Risk Infant Follow-Up Programs: U.S. and Global Considerations. Clin Perinatol 2023; 50:269-279. [PMID: 36868710 DOI: 10.1016/j.clp.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Early detection and intervention for cerebral palsy is best practice for all high-risk infants according to international guidelines, consensus statements and research-supported evidence. It allows support for families and optimization of developmental trajectories into adulthood. All phases of implementation of CP early detection can be found across the world in high-risk infant follow-up programs, demonstrating feasibility and acceptability through standardized implementation science. The largest clinical network for CP early detection and intervention in the world has now sustained an average age at detection less than 12 months corrected age for more than 5 years. Targeted referrals and interventions for CP can now be offered to patients in optimal periods of neuroplasticity, and new therapies researched as the age of detection decreases. Implementation of guidelines and incorporation of rigorous CP research studies both allow high-risk infant follow-up programs to fulfill their mission of improving outcomes of those with the most vulnerable developmental trajectories from birth.
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17
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Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [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: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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18
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Officer E, Johnson M, Blickwedel J, Reynolds A, Pearse R, Pearse J, Basu AP. Evaluation of the Training in Early Detection for Early Intervention (TEDEI) e-learning course using Kirkpatrick's method. BMC MEDICAL EDUCATION 2023; 23:129. [PMID: 36842995 PMCID: PMC9968638 DOI: 10.1186/s12909-023-04113-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Early intervention in cerebral palsy could improve motor outcome but is only possible following early identification of those affected. There is a need for training of healthcare professionals (HCPs) in early detection of atypical motor development. We developed a video-based e-learning course - Training in Early Detection for Early Intervention (TEDEI) - to address this need. We evaluated whether participation in the course improved knowledge and changed behaviour of HCPs. METHODS Participants were 332 HCPs (38% physiotherapists, 35.8% occupational therapists), predominantly UK-based (83.7%). Analysis of training effects used mixed methods and followed Kirkpatrick's model, first assessing "Reaction" through a feedback questionnaire involving Likert scale and free text responses (n = 141). "Learning" was assessed through multiple choice questions (MCQs): all 332 HCPs completed a pre-course quiz of 6 MCQs followed by the course, then a 16 item post-course quiz including the 6 pre-course questions. "Behaviour" was assessed through in-depth qualitative interviewing of 23 participants. RESULTS "Reaction": TEDEI was found to be effective, engaging and well structured. "Learning": Scores improved significantly between the pre-course and post-course quiz, median improvement 1/6 (z = 5.30, p < 0.001). HCPs also reported a perceived improvement in their knowledge, confidence and ability. "Behaviour": HCPs could see how TEDEI would improve their clinical practice through having an assessment framework, ways of working better with parents, and developing observational skills useful for tele-health assessments. CONCLUSION Our brief e-learning course on early detection for early intervention was viewed positively, improved knowledge and showed potential for positive changes in practice. Kirkpatrick's model provided a useful framework for undertaking this evaluation.
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Affiliation(s)
- Eleanor Officer
- School of Psychology, Newcastle University, Newcastle upon Tyne, England, UK
| | - Maisie Johnson
- School of Psychology, Newcastle University, Newcastle upon Tyne, England, UK
| | | | - Ashley Reynolds
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, UK
| | - Rachel Pearse
- North East and North Cumbria GP Training Programme, Newcastle upon Tyne, England, UK
| | - Janice Pearse
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK
- Therapy Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK
| | - Anna Purna Basu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK.
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK.
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19
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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20
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McNamara L, Scott K, Boyd RN, Farmer E, Webb A, Bosanquet M, Nguyen K, Novak I. Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost-consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes. BMJ Open 2022; 12:e063558. [PMID: 36410832 PMCID: PMC9680174 DOI: 10.1136/bmjopen-2022-063558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12-24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research-practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control. METHODS AND ANALYSIS This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost-consequence analysis from funders' and societal perspectives. ETHICS AND DISSEMINATION Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.
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Affiliation(s)
- Lynda McNamara
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Karen Scott
- Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Elizabeth Farmer
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Annabel Webb
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Paediatric Department, Townsville Hospital and Health Service District (THHS), Townsville, Queensland, Australia
| | - Kim Nguyen
- Faculty of Medicine, Centre for Health Service Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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21
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Chen D, Wu Y, Li H, Pan X, Zhou J. Treatment on patients with spastic cerebral palsy in the past 30 years: A systematic review and bibliometric analysis. Medicine (Baltimore) 2022; 101:e30535. [PMID: 36397367 PMCID: PMC9666139 DOI: 10.1097/md.0000000000030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past 30 years, treatments from different disciplines have been applied to spastic cerebral palsy (SCP). However, few bibliometric studies have been conducted to date. This study explored the knowledge base, emerging hotspots, and future trends related to SCP treatment research using bibliometric analysis. METHODS Publications on SCP treatment included in the Web of Science Core Collection database between 1990 and 2020 were retrieved, and Medical Subject Headings terms were extracted from PubMed. Online bibliometric analysis website (http://bibliometric.com/), 2 pieces of software called "CiteSpace" and "VOSViewer" were used for quantitative analysis and knowledge map establishment. RESULTS A total of 1668 papers were retrieved from 1990 to 2020. The number of publications has increased annually. Developmental Medicine and Child Neurology is the most productive and the highest co-cited journal. The United States has been the largest contributor. Vrije Universiteit Amsterdam ranked first in the number of papers published among institutions that have conducted correlational research. Becher JG and Graham HK should be considered scholars who have made outstanding contributions. The knowledge base of the SCP treatment research field is thoughtfully constructed to promote understanding of the field. CONCLUSION This bibliometric study identified global achievements, research hotspots, and trends of SCP treatment. They provide insights into the research field and valuable information for future scientific research and clinical treatment.
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Affiliation(s)
- Dingfang Chen
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Yuefeng Wu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - HaiYing Li
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Xue Pan
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Jin Zhou
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Jin Zhou, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
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22
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Groos D, Adde L, Aubert S, Boswell L, de Regnier RA, Fjørtoft T, Gaebler-Spira D, Haukeland A, Loennecken M, Msall M, Möinichen UI, Pascal A, Peyton C, Ramampiaro H, Schreiber MD, Silberg IE, Songstad NT, Thomas N, Van den Broeck C, Øberg GK, Ihlen EA, Støen R. Development and Validation of a Deep Learning Method to Predict Cerebral Palsy From Spontaneous Movements in Infants at High Risk. JAMA Netw Open 2022; 5:e2221325. [PMID: 35816301 PMCID: PMC9274325 DOI: 10.1001/jamanetworkopen.2022.21325] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Early identification of cerebral palsy (CP) is important for early intervention, yet expert-based assessments do not permit widespread use, and conventional machine learning alternatives lack validity. OBJECTIVE To develop and assess the external validity of a novel deep learning-based method to predict CP based on videos of infants' spontaneous movements at 9 to 18 weeks' corrected age. DESIGN, SETTING, AND PARTICIPANTS This prognostic study of a deep learning-based method to predict CP at a corrected age of 12 to 89 months involved 557 infants with a high risk of perinatal brain injury who were enrolled in previous studies conducted at 13 hospitals in Belgium, India, Norway, and the US between September 10, 2001, and October 25, 2018. Analysis was performed between February 11, 2020, and September 23, 2021. Included infants had available video recorded during the fidgety movement period from 9 to 18 weeks' corrected age, available classifications of fidgety movements ascertained by the general movement assessment (GMA) tool, and available data on CP status at 12 months' corrected age or older. A total of 418 infants (75.0%) were randomly assigned to the model development (training and internal validation) sample, and 139 (25.0%) were randomly assigned to the external validation sample (1 test set). EXPOSURE Video recording of spontaneous movements. MAIN OUTCOMES AND MEASURES The primary outcome was prediction of CP. Deep learning-based prediction of CP was performed automatically from a single video. Secondary outcomes included prediction of associated functional level and CP subtype. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed. RESULTS Among 557 infants (310 [55.7%] male), the median (IQR) corrected age was 12 (11-13) weeks at assessment, and 84 infants (15.1%) were diagnosed with CP at a mean (SD) age of 3.4 (1.7) years. Data on race and ethnicity were not reported because previous studies (from which the infant samples were derived) used different study protocols with inconsistent collection of these data. On external validation, the deep learning-based CP prediction method had sensitivity of 71.4% (95% CI, 47.8%-88.7%), specificity of 94.1% (95% CI, 88.2%-97.6%), positive predictive value of 68.2% (95% CI, 45.1%-86.1%), and negative predictive value of 94.9% (95% CI, 89.2%-98.1%). In comparison, the GMA tool had sensitivity of 70.0% (95% CI, 45.7%-88.1%), specificity of 88.7% (95% CI, 81.5%-93.8%), positive predictive value of 51.9% (95% CI, 32.0%-71.3%), and negative predictive value of 94.4% (95% CI, 88.3%-97.9%). The deep learning method achieved higher accuracy than the conventional machine learning method (90.6% [95% CI, 84.5%-94.9%] vs 72.7% [95% CI, 64.5%-79.9%]; P < .001), but no significant improvement in accuracy was observed compared with the GMA tool (85.9%; 95% CI, 78.9%-91.3%; P = .11). The deep learning prediction model had higher sensitivity among infants with nonambulatory CP (100%; 95% CI, 63.1%-100%) vs ambulatory CP (58.3%; 95% CI, 27.7%-84.8%; P = .02) and spastic bilateral CP (92.3%; 95% CI, 64.0%-99.8%) vs spastic unilateral CP (42.9%; 95% CI, 9.9%-81.6%; P < .001). CONCLUSIONS AND RELEVANCE In this prognostic study, a deep learning-based method for predicting CP at 9 to 18 weeks' corrected age had predictive accuracy on external validation, which suggests possible avenues for using deep learning-based software to provide objective early detection of CP in clinical settings.
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Affiliation(s)
- Daniel Groos
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sindre Aubert
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lynn Boswell
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Raye-Ann de Regnier
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Deborah Gaebler-Spira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Shirley Ryan AbilityLab, Chicago, Illinois
| | - Andreas Haukeland
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Loennecken
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Msall
- Section of Developmental and Behavioral Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
- Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Unn Inger Möinichen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Colleen Peyton
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Heri Ramampiaro
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michael D. Schreiber
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | | | - Nils Thomas Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Gunn Kristin Øberg
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Espen A.F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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23
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Haffner DN, Sankovic A. A Neurologist's Guide to Neonatal Neurodevelopmental Assessments and Preterm Brain Injury. Semin Pediatr Neurol 2022; 42:100974. [PMID: 35868724 DOI: 10.1016/j.spen.2022.100974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
Despite advances in medical care and improved survival of extremely preterm infants, rates of neurodevelopmental impairment remain high. Outcomes are significantly improved with early intervention, but infants must be appropriately identified to facilitate services. Neuroimaging provides important information regarding neurodevelopmental outcomes but prognosticating and communicating risk remains challenging. Standardized neonatal neurodevelopmental assessments provide supplemental information to aid in the identification of high-risk infants and counseling for their families.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States.
| | - Alexandra Sankovic
- Division of Pediatric Neurology, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr Columbus, 43205 OH, United States
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24
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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25
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Bayer ND, Hall M, Li Y, Feinstein JA, Thomson J, Berry JG. Trends in Health Care Use and Spending for Young Children With Neurologic Impairment. Pediatrics 2022; 149:183773. [PMID: 34854922 PMCID: PMC8762668 DOI: 10.1542/peds.2021-050905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.
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Affiliation(s)
- Nathaniel D. Bayer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Rochester and Golisano Children’s Hospital, Rochester, New York,Address correspondence to Nathaniel D. Bayer, MD, Division of Pediatric Hospital Medicine, Golisano Children’s Hospital and Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 667, Rochester, NY 14642. E-mail:
| | | | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, College of Medicine University of Cincinnati, Cincinnati, Ohio
| | - Jay G. Berry
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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26
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Na JY, Lee WH, Lim YH, Cho SH, Cho SH, Park HK. Early screening tool for developmental delay in infancy: Quantified assessment of movement asymmetry using IR-UWB radar. Front Pediatr 2022; 10:731534. [PMID: 36313883 PMCID: PMC9614076 DOI: 10.3389/fped.2022.731534] [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: 06/27/2021] [Accepted: 09/26/2022] [Indexed: 12/01/2022] Open
Abstract
In the untact COVID-19 era, the feasibility of a noncontact, impulse-radio ultrawideband (IR-UWB) radar sensor has important medical implications. Premature birth is a major risk factor for brain injury and developmental delay; therefore, early intervention is crucial for potentially achieving better developmental outcomes. Early detection and screening tests in infancy are limited to the quantification of differences between normal and spastic movements. This study investigated the quantified asymmetry in the general movements of an infant with hydrocephalus and proposes IR-UWB radar as a novel, early screening tool for developmental delay. To support this state-of-the-art technology, data from actigraphy and video camcorder recordings were adopted simultaneously to compare relevant time series as the infant grew. The data from the three different methods were highly concordant; specifically, the ρz values comparing radar and actigraphy, which served as the reference for measuring movements, showed excellent agreement, with values of 0.66 on the left and 0.56 on the right. The total amount of movement measured by radar over time increased overall; movements were almost dominant on the left at first (75.2% of total movements), but following shunt surgery, the frequency of movement on both sides was similar (54.8% of total movements). As the hydrocephalus improved, the lateralization of movement on radar began to coincide with the clinical features. These results support the important complementary role of this radar system in predicting motor disorders very early in life.
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Affiliation(s)
- Jae Yoon Na
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Won Hyuk Lee
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seok Hyun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, Hanyang University, Seoul, South Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
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27
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Grumi S, Borgatti R, Provenzi L. Supporting Parenting at Home-Empowering Rehabilitation through Engagement (SPHERE): study protocol for a randomised control trial. BMJ Open 2021; 11:e051817. [PMID: 34907057 PMCID: PMC8672000 DOI: 10.1136/bmjopen-2021-051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infants with neurodevelopmental disabilities (NDs) show emotional, cognitive and sociointeractive dysregulation dramatically impacting on caregiving behaviour. Early video-feedback interventions (VFIs) are effective in promoting sensitive parenting, which in turn supports infants' development, even in case of ND. In the light of limited resources of the healthcare systems, technological advances in telemedicine may facilitate the delivery of VFI to a greater number of families of infants with ND. To date, no study has implemented a telemedicine VFI (TVFI) for families of infants diagnosed with ND. METHODS AND ANALYSIS The Supporting Parenting at Home-Empowering Rehabilitation through Engagement project is a randomised controlled trial aimed at assessing the effectiveness of an early family-centred TVFI parenting support on dyads with infants diagnosed with ND. It includes two arms (TVFI vs Booklet Psychoeducational Intervention) and three assessment phases: T0, baseline; T1, immediate postintervention; T2, 6-month follow-up. ETHICS AND DISSEMINATION This study is funded by the Italian Ministry of Health and was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER The study protocol has been also registered on NIH Clinical Trials (protocol code NCT04656483; Pre-results).
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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28
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Chérif L, Yaich K, Sahnoun C, Khemekhem K, Boudabbous J, HadjKacem I, Ayadi H, Moalla Y. Autisme : annonce du diagnostic et vécu des parents. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Mailleux L, De Beukelaer N, Carbone MB, Ortibus E. Early interventions in infants with unilateral cerebral palsy: A systematic review and narrative synthesis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104058. [PMID: 34412011 DOI: 10.1016/j.ridd.2021.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Recent systematic reviews have already provided an overview of the impact of early interventions on developmental outcomes in infants at risk for cerebral palsy. However, none has thus far focused specifically on how early interventions might improve motor outcome in infants diagnosed with unilateral cerebral palsy (uCP). Hence, the aim of this systematic review was to provide an overview of early intervention programs used in infants with uCP to improve motor outcome. METHODS A systematic literature search was performed in PubMed, Embase, Cochrane Central Register of Controlled trials, CINAHL and Web of Science following the PRISMA-statement guidelines. Risk of bias was assessed using the Cochrane risk-of-bias 2 tool. RESULTS Three single-blinded randomized controlled trials (RCTs) were identified, including 88 infants with uCP. These RCTs suggest that modified constraint-induced movement therapy (mCIMT) is effective and safe for improving upper limb function in infants with uCP. Bimanual training compared to mCIMT was found to be equally effective in one study. No clinical or neurological predictors of treatment response could be identified yet. CONCLUSION Although more high-quality RCTs are urgently needed, early interventions seem effective, safe and feasible to apply in infants with uCP for improving upper limb motor function. This underlines the importance of prompt referral to diagnostic-specific centres to start up such early interventions.
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Affiliation(s)
- Lisa Mailleux
- Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Nathalie De Beukelaer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | | | - Els Ortibus
- Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Leuven, Belgium
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30
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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31
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Age of Diagnosis, Fidelity and Acceptability of an Early Diagnosis Clinic for Cerebral Palsy: A Single Site Implementation Study. Brain Sci 2021; 11:brainsci11081074. [PMID: 34439692 PMCID: PMC8391606 DOI: 10.3390/brainsci11081074] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Cerebral palsy (CP) diagnosis is historically late, at between 12 and 24 months. We aimed to determine diagnosis age, fidelity to recommended tests and acceptability to parents and referrers of an early diagnosis clinic to implement a recent evidence-based clinical guideline for the early diagnosis of CP. A prospective observational case series of infants <12 months with detectable risks for CP attending our clinic was completed with data analysed cross-sectionally. Infants had a high risk of CP diagnosis at a mean age of 4.4 (standard deviation [SD] 2.3) months and CP diagnosis at 8.5 [4.1] months. Of the 109 infants seen, 57% had a diagnosis of CP or high risk of CP, showing high specificity to our inclusion criteria. Parent and referrer acceptability of the clinic was high. Paediatricians had the highest rate of referral (39%) followed by allied health (31%), primary carer (14%) and other health workers (16%). Fidelity to the guideline was also high. All infants referred <5 mths had the General Movements Assessment (GMA) and all except one had the Hammersmith Infant Neurological Examination (HINE) administered. N = 92 (84%) of infants seen had neuroimaging, including n = 53 (49%) who had magnetic resonance imaging (MRI), showing recommended tests are feasible. Referral to CP-specific interventions was at 4.7 [3.0] months, sometimes before referral to clinic. Clinicians can be confident CP can be diagnosed well under 12 months using recommended tools. This clinic model is acceptable to parents and referrers and supports access to CP-specific early interventions when they are likely to be most effective.
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32
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Mohanty M, Beaulieu F, Sampath S, Tambunan D, Kataria S, Rosman NP. "Your Child Has Cerebral Palsy": Parental Understanding and Misconceptions. J Child Neurol 2021; 36:648-654. [PMID: 33620264 DOI: 10.1177/0883073821991300] [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: 11/16/2022]
Abstract
IMPORTANCE Caregivers of children with cerebral palsy can best help their child if they understand the disorder and the correct terminology. OBJECTIVE To assess caregiver understanding of cerebral palsy. DESIGN This was a cross-sectional study from a large tertiary medical center in Boston, to assess understanding of the term cerebral palsy by primary caregivers of children and adolescents with cerebral palsy. All cases were obtained from hospital electronic medical records. Telephone surveys were conducted. Caregiver understanding of cerebral palsy was assessed by open-ended responses (50%) and success in answering true/false questions about cerebral palsy (50%). PARTICIPANTS Primary caregivers of children 18 years and younger with cerebral palsy. RESULTS Thirty-three percent of caregivers denied ever being told that their child had cerebral palsy. Most caregivers identified cerebral palsy as a brain problem (79%), lifelong condition (73%), often caused by a perinatal (60%) or gestational (40%) insult. Fifty-two percent knew that cerebral palsy was nonprogressive. Sixty-two percent of caregivers believed they had a good, very good, or excellent understanding of cerebral palsy, whereas the investigators found 69% of caregivers had a good, very good, or excellent understanding of cerebral palsy (P = .006). Most caregivers rated very good or excellent the setting where cerebral palsy was discussed (58%), the explanations provided (55%), and the amount of time spent (45%), yet using a Pearson correlation coefficient, most important was the time spent (r = 0.53). CONCLUSIONS Following discussion with their child's physician, most primary caregivers of children with cerebral palsy have a good, very good, or excellent understanding of cerebral palsy. Most critical to a good understanding of cerebral palsy was the time spent in explaining the diagnosis.
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Affiliation(s)
- Mugdha Mohanty
- Division of Pediatric Neurology, Department of Pediatrics, 3354UMass Memorial Medical Center, MA, USA
| | | | | | | | - Shivangi Kataria
- School of Public Health, Boston University, Boston, MA, USA.,Division of Pediatric Neurology, Department of Pediatrics and Neurology, 1836Boston University School of Medicine, Boston, MA, USA
| | - N Paul Rosman
- Division of Pediatric Neurology, 1836Boston University School of Medicine, Boston, MA, USA
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33
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Sivaratnam C, Devenish B, Howells K, Chellew T, Reynolds K, Rinehart N. Risk factors for mental health difficulties in parents of children with cerebral palsy: a systematic review and meta-analysis. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2020.1829945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Sivaratnam
- Deakin Child Study Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - B. Devenish
- Deakin Child Study Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - K. Howells
- Deakin Child Study Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - T. Chellew
- Deakin Child Study Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - K. Reynolds
- Kids Plus Foundation, Highton, Victoria, Australia
| | - N. Rinehart
- Deakin Child Study Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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34
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Williams SA, Alzaher W, Mackey A, Hogan A, Battin M, Sorhage A, Stott NS. "It Should Have Been Given Sooner, and We Should Not Have to Fight for It": A Mixed-Methods Study of the Experience of Diagnosis and Early Management of Cerebral Palsy. J Clin Med 2021; 10:jcm10071398. [PMID: 33807393 PMCID: PMC8036895 DOI: 10.3390/jcm10071398] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 01/31/2023] Open
Abstract
Listening to the family experience is integral to identifying areas of strength and for improvement in health service delivery around diagnosis and early management of cerebral palsy (CP). Families of children with a diagnosis of CP were invited to complete a purpose-developed electronic survey that included items around the timing of diagnosis, their experiences and satisfaction. It also allowed families to expand on their experiences through free text. Of the 57 families responding, 49% of children functioned at Gross Motor Function Classification System (GMFCS) levels I or II, 8% at GMFCS level III and 23% at GMFCS levels IV or V. 51% of participants were satisfied or very satisfied with the diagnosis experience, 18% were neutral about the experience and 31% were dissatisfied or very dissatisfied. Though the findings of this study may be subject to selection bias, perceived delays in the receipt of diagnosis of CP appeared common with 60% of participants indicating concerns about their child by <6 months of age but only 21% provided with a diagnosis of CP <6 months of age. Approximately 18% of families experienced a delay of more than 12 months. Thirty-four (61%) participants noted a delay between referrals to a service and receipt of service management/therapy. Common themes impacting on families' experience in the diagnosis and health service delivery journey related to provision of information, and the style of communication, with both direct and ongoing communication styles common for greater family satisfaction. Overall, families desired the diagnosis experience to be informative and timely, with early follow up support and assistance with health sector navigation.
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Affiliation(s)
- Sîan A Williams
- Curtin School of Allied Health, Curtin University, Perth 6845, Australia
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
- Correspondence:
| | - Woroud Alzaher
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - Amy Hogan
- The Cerebral Palsy Society of New Zealand, Auckland 1023, New Zealand;
| | - Malcolm Battin
- Newborn Services, Starship Child Health, Auckland District Health Board, Auckland 1023, New Zealand;
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland 1023, New Zealand; (W.A.); (A.M.); (A.S.)
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
- Department of Paediatric Orthopaedics, Starship Child Health, Auckland District Health Board, Auckland 1023, New Zealand
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35
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Grumi S, Provenzi L, Gardani A, Aramini V, Dargenio E, Naboni C, Vacchini V, Borgatti R. Rehabilitation services lockdown during the COVID-19 emergency: the mental health response of caregivers of children with neurodevelopmental disabilities. Disabil Rehabil 2020; 43:27-32. [PMID: 33167738 DOI: 10.1080/09638288.2020.1842520] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The present study investigated the impact of the COVID-19-related rehabilitation services lockdown on the mental health of caregivers of children with neurodevelopmental disabilities. METHODS Between 26 March and 11 May 2020, 84 caregivers filled out ad-hoc and standardized questionnaires through an online survey in order to measure their psychological response to the emergency and lockdown as well as their levels of parenting stress, anxiety and depression. RESULTS Worries about COVID-19 contagion and concerns for the child left without rehabilitation programs were the greatest sources of mental health burden for caregivers. Nonetheless, only the concerns for the child were significantly associated with caregivers' reports of stress, depressive and anxious symptoms. DISCUSSION These findings highlight the burden faced by caregivers of children with neurodevelopmental disabilities during the COVID-19 emergency in Italy. These families should be considered as a high-risk population that requires dedicated healthcare attention, such as promoting continuity of care by investing in tele-rehabilitation programs. Implications for rehabilitation Caregivers of children with disability reported symptoms of anxiety and depression during COVID-19 emergency. Major concerns regarded COVID-19 contagion risk and child development during rehabilitation lockdown. Caregivers' psychological symptoms were associated with concerns for child development during the lockdown. Parents of children with disability may face relevant stress during and after COVID-19 psychological burden. During COVID-19 recovery, policy-makers and clinicians should dedicate specific care actions for families of children with disability.
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alice Gardani
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Aramini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Erika Dargenio
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valeria Vacchini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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36
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Montirosso R, Rosa E, Giorda R, Fazzi E, Orcesi S, Cavallini A, Provenzi L. Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial. BMJ Open 2020; 10:e035249. [PMID: 32699128 PMCID: PMC7375429 DOI: 10.1136/bmjopen-2019-035249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disability (ND) represents an adverse condition for infants' socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens' development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation. METHODS AND ANALYSIS Dyads will be randomly assigned to the video-feedback Intervention Group or Control Group ('dummy' intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T0, baseline; T1, post-intervention; T2, short-term follow-up (3 month); T3, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups. ETHICS AND DISSEMINATION Ethics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences. TRIAL REGISTRATION NUMBER NCT03853564; Pre-results.
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Affiliation(s)
- Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Elisa Rosa
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Roberto Giorda
- Biology Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child and Adolescence Neuropsychiatry, ASST Spedali Civili, Brescia, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anna Cavallini
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Byrd CT, Werle D, St Louis KO. Speech-Language Pathologists' Comfort Level With Use of Term "Stuttering" During Evaluations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:841-850. [PMID: 32233922 DOI: 10.1044/2020_ajslp-19-00081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Speech-language pathologists (SLPs) anecdotally report concern that their interactions with a child who stutters, including even the use of the term "stuttering," might contribute to negative affective, behavioral, and cognitive consequences. This study investigated SLPs' comfort in providing a diagnosis of "stuttering" to children's parents/caregivers, as compared to other commonly diagnosed developmental communication disorders. Method One hundred forty-one school-based SLPs participated in this study. Participants were randomly assigned to one of two vignettes detailing an evaluation feedback session. Then, participants rated their level of comfort disclosing diagnostic terms to parents/caregivers. Participants provided rationale for their ratings and answered various questions regarding academic and clinical experiences to identify factors that may have influenced ratings. Results SLPs were significantly less likely to feel comfortable using the term "stuttering" compared to other communication disorders. Thematic responses revealed increased experience with a specific speech-language population was related to higher comfort levels with using its diagnostic term. Additionally, knowing a person who stutters predicted greater comfort levels as compared to other clinical and academic experiences. Conclusions SLPs were significantly less comfortable relaying the diagnosis "stuttering" to families compared to other speech-language diagnoses. Given the potential deleterious effects of avoidance of this term for both parents and children who stutter, future research should explore whether increased exposure to persons who stutter of all ages systematically improves comfort level with the use of this term.
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Affiliation(s)
- Courtney T Byrd
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Danielle Werle
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Kenneth O St Louis
- Department of Communication Sciences and Disorders, West Virginia University, Morgantown
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Maitre NL, Burton VJ, Duncan AF, Iyer S, Ostrander B, Winter S, Ayala L, Burkhardt S, Gerner G, Getachew R, Jiang K, Lesher L, Perez CM, Moore-Clingenpeel M, Lam R, Lewandowski DJ, Byrne R. Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis. Pediatrics 2020; 145:e20192126. [PMID: 32269135 PMCID: PMC7193973 DOI: 10.1542/peds.2019-2126] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3- to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with P < .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability. CONCLUSIONS Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
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Affiliation(s)
- Nathalie L Maitre
- Center for Perinatal Research and
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Vera J Burton
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Andrea F Duncan
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sai Iyer
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Betsy Ostrander
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Sarah Winter
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Lauren Ayala
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | | | - Gwendolyn Gerner
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ruth Getachew
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
| | - Kelsey Jiang
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Laurie Lesher
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Carrie M Perez
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Rebecca Lam
- Cerebral Palsy Foundation, New York, New York
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DORNER REBECCAA, BOSS RENEED, BURTON VERAJOANNA, RAJA KATHERINE, LEMMON MONICAE. Parent preferences for neurodevelopmental screening in the neonatal intensive care unit. Dev Med Child Neurol 2020; 62:500-505. [PMID: 31909496 PMCID: PMC7056590 DOI: 10.1111/dmcn.14457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine whether, and how, neonatal intensive care unit (NICU) parents want to receive early neurodevelopmental screening information about their child's future risk of cerebral palsy and other disabilities. METHOD This was a qualitative interview study. Parents of hospitalized infants born preterm completed semi-structured interviews. Data were analysed using a directed content analysis approach. RESULTS Thematic saturation was achieved after 19 interviews. Four themes characterized parent perceptions of early neurodevelopmental screening: (1) acceptability: most parents were in favour of neurodevelopmental screening if parents could refuse; (2) disclosure of results: parents want emotional preparation for results, especially false positives; (3) emotional burden of uncertainty: parents of children in the NICU balance taking their infant's illness 'day by day' and preparing for an uncertain future. Parents expressed distress with screening that increased uncertainty about the future; and (4) disability: prior experience with disability informs parent concerns. INTERPRETATION Parents interpret the risks and benefits of NICU developmental screening through the lens of prior experiences with disability. Most expressed interest in screening and emphasized a desire for autonomy, pretest counselling, and emotional preparation. WHAT THIS PAPER ADDS Most parents with infants in the neonatal intensive care unit expressed interest in early screening for developmental disability. Prior experience with disability informed concerns about specific deficits. Parents emphasized a desire for autonomy, pretest counselling, and emotional preparation.
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Affiliation(s)
- REBECCA A DORNER
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - RENEE D BOSS
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD;,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - VERA JOANNA BURTON
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD;,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - MONICA E LEMMON
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD;,Department of Pediatrics, Division of Pediatric Neurology, Duke University School of Medicine, Durham, NC;,Duke-Margolis Center for Health Policy, Durham, NC, USA
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Boychuck Z, Andersen J, Fehlings D, Kirton A, Oskoui M, Shevell M, Majnemer A, Burko B, Dagenais E, Dagenais L, Darsaklis VB, Leduc D, Li P, Shiller M, Snider L, Thibault J, Ahmed S, Bussières A, Rodriguez R, Shikako Thomas K. Current Referral Practices for Diagnosis and Intervention for Children with Cerebral Palsy: A National Environmental Scan. J Pediatr 2020; 216:173-180.e1. [PMID: 31843111 DOI: 10.1016/j.jpeds.2019.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To describe current physician referral practices with respect to age at referral to medical specialists for initial diagnosis of cerebral palsy (CP) and rehabilitation specialists for intervention and to identify factors associated with delayed referral. STUDY DESIGN National environmental scan of 455 children diagnosed with CP who were born in Canada between 2008 and 2011, selected from 4 sites within the Canadian CP Registry (Edmonton, Calgary, Toronto, and Montreal). Two sources of information were used-children's medical charts and the population-based registry, which provided corresponding data for each child. Primary outcomes extracted from the charts were age at referral for diagnostic assessment, age at diagnosis, age at referral for rehabilitation services, and age at initial rehabilitation intervention. Twelve variables were explored as potential predictors. Descriptive statistics, bivariate analyses, and multiple linear regressions were conducted. RESULTS Median age (in months) at referral for diagnostic assessment was 8 (mean: 12.7 ± 14.3), diagnosis 16 (mean: 18.9 ± 12.8), referral for rehabilitation services 10 (mean: 13.4 ± 13.5), and rehabilitation initiation 12 (mean: 15.9 ± 12.9). Lower maternal education, mild severity of motor dysfunction, type of CP, early discharge after birth, and region of residence explained between 20% and 32% of the variance in age at referral for assessment, diagnosis, referral for rehabilitation, and rehabilitation initiation. CONCLUSIONS Findings suggest wide variability exists in the age at which young children with CP are referred to specialists for diagnosis and intervention. User-friendly tools are therefore needed to enhance early detection and referral strategies by primary care practitioners, to ensure early interventions to optimize developmental outcomes and enhance opportunities for neural repair at a younger age.
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Affiliation(s)
- Zachary Boychuck
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Andersen
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Maryam Oskoui
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michael Shevell
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Ihlen EAF, Støen R, Boswell L, de Regnier RA, Fjørtoft T, Gaebler-Spira D, Labori C, Loennecken MC, Msall ME, Möinichen UI, Peyton C, Schreiber MD, Silberg IE, Songstad NT, Vågen RT, Øberg GK, Adde L. Machine Learning of Infant Spontaneous Movements for the Early Prediction of Cerebral Palsy: A Multi-Site Cohort Study. J Clin Med 2019; 9:E5. [PMID: 31861380 PMCID: PMC7019773 DOI: 10.3390/jcm9010005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early identification of cerebral palsy (CP) during infancy will provide opportunities for early therapies and treatments. The aim of the present study was to present a novel machine-learning model, the Computer-based Infant Movement Assessment (CIMA) model, for clinically feasible early CP prediction based on infant video recordings. METHODS The CIMA model was designed to assess the proportion (%) of CP risk-related movements using a time-frequency decomposition of the movement trajectories of the infant's body parts. The CIMA model was developed and tested on video recordings from a cohort of 377 high-risk infants at 9-15 weeks corrected age to predict CP status and motor function (ambulatory vs. non-ambulatory) at mean 3.7 years age. The performance of the model was compared with results of the general movement assessment (GMA) and neonatal imaging. RESULTS The CIMA model had sensitivity (92.7%) and specificity (81.6%), which was comparable to observational GMA or neonatal cerebral imaging for the prediction of CP. Infants later found to have non-ambulatory CP had significantly more CP risk-related movements (median: 92.8%, p = 0.02) compared with those with ambulatory CP (median: 72.7%). CONCLUSION The CIMA model may be a clinically feasible alternative to observational GMA.
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Affiliation(s)
- Espen A. F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Ragnhild Støen
- Department of Neonatology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Lynn Boswell
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (L.B.); (R.-A.d.R.)
| | - Raye-Ann de Regnier
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (L.B.); (R.-A.d.R.)
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Deborah Gaebler-Spira
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Cathrine Labori
- Department of Clinical Therapeutic Services, University Hospital of North Norway, 9038 Tromsø, Norway; (C.L.); (G.K.Ø.)
| | - Marianne C. Loennecken
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Michael E. Msall
- University of Chicago Medicine, Comer Children’s Hospital, Section of Developmental and Behavioral Pediatrics, Chicago, IL 60637, USA; (M.E.M.); (M.D.S.)
- University of Chicago, Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL 60637, USA
| | - Unn I. Möinichen
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Colleen Peyton
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (D.G.-S.); (C.P.)
- Department of Pediatrics, Comer Children’s Hospital, Department of Physical Therapy and Human Movement Science, Chicago, IL 60637, USA
| | - Michael D. Schreiber
- University of Chicago Medicine, Comer Children’s Hospital, Section of Developmental and Behavioral Pediatrics, Chicago, IL 60637, USA; (M.E.M.); (M.D.S.)
| | - Inger E. Silberg
- Department of Pediatrics, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, 0372 Oslo, Norway; (M.C.L.); (U.I.M.); (I.E.S.)
| | - Nils T. Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, 9038 Tromsø, Norway;
| | - Randi T. Vågen
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Gunn K. Øberg
- Department of Clinical Therapeutic Services, University Hospital of North Norway, 9038 Tromsø, Norway; (C.L.); (G.K.Ø.)
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT- The Arctic University of Norway, 9019 Tromsø, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
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Novak I, Morgan C, McNamara L, Te Velde A. Best practice guidelines for communicating to parents the diagnosis of disability. Early Hum Dev 2019; 139:104841. [PMID: 31607402 DOI: 10.1016/j.earlhumdev.2019.104841] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conveying a diagnosis of a disability to the parents of young children is difficult both for the parent and the clinician, however there is an ethical and medical imperative to do so. However, the process and manner of disclosure needs to be done well. When communication between parent and clinicians fails, parental mental health can be adversely affected. This paper adapts and explains how to use the SPIKES protocol to deliver "bad news" about a developmental disability diagnosis with families of infants <12-months old, using cerebral palsy as an example. Next, the range of responses parents experience to the delivery of bad news from "watchful waiting" to "acceptance" are outlined and explained. The knowledge needs of parents range from causes and prognosis to treatments and outcomes. Using clinical scenarios of recently diagnosed infants, commonly asked questions and suggested answers are tabled.
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Affiliation(s)
- I Novak
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, PO, Box 6427, Frenchs Forest NSW, 2086, Australia.
| | - C Morgan
- Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, PO, Box 6427, Frenchs Forest NSW, 2086, Australia.
| | - L McNamara
- Queensland Health, Child Development Service, PO Box 1055, Cairns 4870, Australia.
| | - A Te Velde
- Cerebral Palsy Alliance, PO Box 6427, Frenchs Forest, NSW 2086, Australia.
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Byrne R, Duncan A, Pickar T, Burkhardt S, Boyd RN, Neel ML, Maitre NL. Comparing parent and provider priorities in discussions of early detection and intervention for infants with and at risk of cerebral palsy. Child Care Health Dev 2019; 45:799-807. [PMID: 31323144 DOI: 10.1111/cch.12707] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/11/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although literature suggests that parents need support when their child is diagnosed with cerebral palsy (CP), it is unclear to what extent providers implement these supports in practice and what parental perspectives surround provider early diagnosis and management of CP. Therefore, we aimed to characterize and compare experiences of providers and parents of children with CP with regards to early detection and intervention. METHOD Seventeen parents participated in day-long world-café style workshops focused on categories extracted from the International Classification of Function framework and recent systematic reviews of early detection for CP. Thirty regional providers (generalists, specialists, and therapists) caring for infants with CP completed surveys with scaled score and open-ended questions. Quantitative and qualitative data were independently assessed by two reviewers to identify prominent themes. RESULTS All parents (100%) stated early diagnosis or high risk for CP classification was beneficial compared with only 50% of providers who often gave early CP diagnoses before 12 months. Top parent priorities were honesty and positively phrased messages. Providers most often addressed cognition, primary care need, motor, and feeding issues (80%, 62%, 54%, 54% frequently/sometimes). Matching priorities for discussion were neuroimaging timing/risk/benefit, cognition, primary care, motor, and feeding/nutrition. Discordance occurred for participation, parent well-being, pain and vision, with parents wanting more education and resources. CONCLUSIONS Receiving early diagnoses or high-risk for CP classification is a parent priority. Alignment between parents and providers exists for International Classification of Function domains of body functions/structures and activity, but less for those of environment, personal, and participation.
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Affiliation(s)
| | - Andrea Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Stephanie Burkhardt
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation and Research Center, Queensland, Australia
| | - Mary Lauren Neel
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
| | - Nathalie L Maitre
- Department of Pediatrics & Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH
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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of High-Risk Infants in a Clinical Follow-Up Setting. J Clin Med 2019; 8:jcm8111790. [PMID: 31717717 PMCID: PMC6912231 DOI: 10.3390/jcm8111790] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP). METHODS Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009-2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results. RESULTS Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18-24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging. CONCLUSION In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.
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te Velde A, Morgan C, Novak I, Tantsis E, Badawi N. Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. J Clin Med 2019; 8:E1599. [PMID: 31623303 PMCID: PMC6832653 DOI: 10.3390/jcm8101599] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Since the 1800s, there have been calls in the literature for the early diagnosis of cerebral palsy (CP). However, diagnosis still often occurs late, from 12 to 24 months in high income countries and as late as 5 years in low resource settings. This is after the optimal timeframe for applying interventions which could harness neuroplastic potential in the developing brain. Multiple barriers exist which affect clinicians' confidence in diagnosing CP early. These range from the lack of definitive biomarkers to a lack of curative treatments for CP. Further barriers to diagnosis are proposed including; (a) difficulty finding a congruent fit with the definition of CP in an infant, where expected activity limitations might not yet be apparent; and (b) differences in the presentation of motor type and topography classifications between infants and children. These barriers may affect a clinicians' confidence using "pattern recognition" in the differential diagnosis process. One of the central tenets of this paper is that diagnosis and classification are different, involving different instruments, and are more accurately conducted separately in infants, whereas they are fundamentally interconnected in older children and inform therapeutic decisions. Furthermore, we need to be careful not to delay early diagnosis because of the low reliability of early classification, but instead uncouple these two processes. Ongoing implementation of best practice for early detection requires creative solutions which might include universal screening for CP. Implementation and accompanying knowledge translation studies are underway to decrease the average age of diagnosis in CP.
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Affiliation(s)
- Anna te Velde
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Esther Tantsis
- TJ Nelson Department of Neurology & Neurosurgery, The Children's Hospital at Westmead, New South Wales 2145, Australia.
| | - Nadia Badawi
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
- The Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead NSW 2145, Australia.
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Boychuck Z, Bussières A, Goldschleger J, Majnemer A. Age at referral for diagnosis and rehabilitation services for cerebral palsy: a scoping review. Dev Med Child Neurol 2019; 61:908-914. [PMID: 30273970 DOI: 10.1111/dmcn.14034] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 01/02/2023]
Abstract
AIM This study sought to: (1) determine what is known about age at referral for diagnosis and rehabilitation services for children suspected of having cerebral palsy (CP); and (2) identify factors associated with earlier referral. METHOD A scoping review was conducted to summarize existing literature. We systematically searched Allied and Complementary Medicine, CINAHL, Cochrane Library, Embase, and PsycINFO for evidence published between 1979 and 2017 on age at referral for diagnosis or age at referral to rehabilitation services for children suspected of having CP. Quantitative and thematic analyses of the literature were performed. RESULTS Our search yielded 777 articles, of which 15 met the inclusion criteria. Only one study focused on age at referral for diagnosis of CP (mean 16.6mo±19.2mo), with two on age at referral to rehabilitation services (means 13.9mo±15.8mo and 12.4mo). Potential predictors of earlier referral identified include referral source, type of CP, and a complicated birth history. INTERPRETATION Evidence is sparse; however, available studies suggest high variation in the age at which children are being referred for diagnosis, typically ranging from 10 months to 21 months. Evidence indicates that subgroups of children with CP might be experiencing prolonged delays. Findings highlight the need to better understand what contributes to delays in referral for diagnosis and rehabilitation. WHAT THIS PAPER ADDS Evidence on age at referral for diagnosis of cerebral palsy is sparse. Potential predictors of delayed referral represent targets to minimize delays in diagnosis. A subset of children may be experiencing unnecessary delays in referral.
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Affiliation(s)
- Zachary Boychuck
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Jessica Goldschleger
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Choe EK, Duarte ME, Suh H, Pratt W, Kientz JA. Communicating Bad News: Insights for the Design of Consumer Health Technologies. JMIR Hum Factors 2019; 6:e8885. [PMID: 31102374 PMCID: PMC6543800 DOI: 10.2196/humanfactors.8885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/05/2018] [Accepted: 02/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.
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Affiliation(s)
- Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States
| | - Marisa E Duarte
- School of Social Transformation, Arizona State University, Tempe, AZ, United States
| | - Hyewon Suh
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
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Boychuck Z, Andersen J, Bussières A, Fehlings D, Kirton A, Li P, Oskoui M, Rodriguez C, Shevell M, Snider L, Majnemer A. Use of consensus methods to determine the early clinical signs of cerebral palsy. Paediatr Child Health 2019; 25:300-307. [PMID: 32765166 DOI: 10.1093/pch/pxz061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop expert-informed content regarding the early motor attributes of cerebral palsy (CP) that should prompt physician referral for diagnostic assessment of CP, as well as concurrent referral recommendations. This content will be used in the creation of knowledge translation (KT) tools for primary care practitioners and parents. Methods Two nominal group processes were conducted with relevant stakeholders, representing Canadian 'content experts' and 'knowledge-users', using an integrated KT approach. Results Six attributes were identified that should prompt referral for diagnosis. If the child demonstrates: Early handedness <12 months; stiffness or tightness in the legs between 6 and 12 months; persistent fisting of the hands >4 months; persistent head-lag >4 months; inability to sit without support >9 months; any asymmetry in posture or movement. Five referral recommendations were agreed upon: Motor intervention specialist (physical therapy and/or occupational therapy) for ALL; speech-language pathology IF there is a communication delay; audiology IF there is parental or healthcare professional concern regarding a communication delay; functional vision specialist (e.g., optometrist or occupational therapist) IF there is a vision concern (e.g., not fixating, following, or tracking); feeding specialist (e.g., occupational therapist, speech-language pathologist) IF there are feeding difficulties (e.g., poor sucking, poor swallowing, choking, and/or not gaining weight). Conclusion Rigorous consensus methods provided the initial evidence necessary to inform the content of tools to assist primary care providers in the early detection of CP. Results will be validated through a Delphi process with international experts, and user-friendly formats of this KT tool will be developed collaboratively with stakeholders.
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Affiliation(s)
- Zachary Boychuck
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec.,Research Institute-McGill University Health Centre and Montreal Children's Hospital, Montreal, Quebec
| | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario
| | - Adam Kirton
- Alberta Children's Hospital, Calgary, Alberta
| | - Patricia Li
- Research Institute-McGill University Health Centre and Montreal Children's Hospital, Montreal, Quebec.,Department of Pediatrics, McGill University, Montreal, Quebec.,Department of Family Medicine, McGill University, Montreal, Quebec
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology & Neurosurgery, McGill University, Montreal, Quebec
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, Montreal, Quebec
| | - Michael Shevell
- Departments of Pediatrics and Neurology & Neurosurgery, McGill University, Montreal, Quebec
| | - Laurie Snider
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec.,Research Institute-McGill University Health Centre and Montreal Children's Hospital, Montreal, Quebec
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec.,Research Institute-McGill University Health Centre and Montreal Children's Hospital, Montreal, Quebec
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Marcroft C, Tsutsumi A, Pearse J, Dulson P, Embleton ND, Basu AP. Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists. Phys Occup Ther Pediatr 2019; 39:151-167. [PMID: 30211625 DOI: 10.1080/01942638.2018.1503212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. DESIGN Web-based cross-sectional survey. METHODS Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. RESULTS 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. CONCLUSIONS Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.
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Affiliation(s)
- Claire Marcroft
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | | | - Janice Pearse
- c Newcastle upon Tyne Hospitals NHS Foundation Trust , Paediatric Occupational Therapy Services , Newcastle upon Tyne , UK
| | - Pat Dulson
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | - Nicholas D Embleton
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK.,d Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Anna P Basu
- e Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK.,f Department of Paediatric Neurology , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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